1
|
Zhao D, Zhou Z. Values of three-dimensional speckle tracking imaging for the diagnosis of coronary artery disease. SCAND CARDIOVASC J 2024; 58:2373091. [PMID: 38980113 DOI: 10.1080/14017431.2024.2373091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/22/2024] [Indexed: 07/10/2024]
Abstract
Background: Coronary artery disease (CAD) is a top life-threatening disease and early and sensitive detection of CAD remains a challenge. This study aimed to assess the value of three-dimensional speckle tracking imaging (3D-STI) in diagnosing CAD patients and investigate the parameters of 3D-STI associated with disease severity. Methods: A total of 260 suspected CAD patients who met the study criteria underwent coronary angiography within one week after the ultrasound examination. Based on the examination results, 142 patients were confirmed to have CAD (CAD group), while 118 patients were classified as non-CAD (NCAD group). Age, gender, family history, smoking status, diabetes, hypertension, dyslipidemia, electrocardiogram, BMI, heart rate, and left ventricular ejection fraction were compared between the two groups. Additionally, 3D-STI parameters including left ventricular global radial strain (GRS), left ventricular global longitudinal strain (GLS), left ventricular global area strain (GAS), and left ventricular global circumferential strain (GCS) were analyzed. Results: No significant differences were found between the CAD and NCAD groups in terms of demographics, smoking history, physiological measurements, and common comorbidities such as diabetes mellitus and dyslipidemia. However, when comparing the 3D-STI parameters, all four parameters, including GLS, GRS, GCS, and GAS, were significantly different in the CAD group compared to the NCAD group. The results suggest that 3D-STI parameters have diagnostic value for CAD, and their changes are associated with CAD severity. Conclusions: Combined detection of these parameters enhances diagnostic accuracy compared to individual detection.
Collapse
Affiliation(s)
- Dexia Zhao
- Department of Ultrasonic Medicine, Daqing Oilfield General Hospital, Heilongjiang, China
| | - Zhenfang Zhou
- Department of Ultrasonic Medicine, Daqing Oilfield General Hospital, Heilongjiang, China
| |
Collapse
|
2
|
Yang Q, Zhang Y, Zhao Y, Liu X, Sun L, Gu X, Yang X, Han J, He Y. Prenatal diagnosis of criss-cross heart - case series and review of the literature. J Matern Fetal Neonatal Med 2024; 37:2362333. [PMID: 38897818 DOI: 10.1080/14767058.2024.2362333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE This study aimed to improve the accuracy of prenatal diagnosis by analyzing fetal echocardiographic features of criss-cross heart (CCH), to provide an effective basis for the development of management strategies and improve the prognosis of patients. METHODS A retrospective analysis was performed on CCH cases diagnosed prenatally at our center between July 2016 and June 2022. Clinical data and prenatal fetal echocardiographic images were reviewed. Literature on prenatal diagnosis of CCH was searched from January 2000 to December 2023 in the PubMed database. RESULTS Fourteen (0.03%) CCH cases were diagnosed from a database of fetal echocardiograms of 41354 cases at our center. The prenatal genetic testing results were normal in 10 cases and 4 cases didn't check. All cases underwent termination of pregnancy. All cases showed crossed ventricular inflow tracts and combined with other cardiac structural abnormalities. A total of eight articles containing 25 cases were found in the literature review and all cases were associated with other cardiac structural abnormalities. CONCLUSION Prenatal echocardiography is the primary tool for fetal diagnosis of CCH. Continuous scanning helps avoid missing data and misdiagnosis.
Collapse
Affiliation(s)
- Qi Yang
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ye Zhang
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Ying Zhao
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaowei Liu
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Lin Sun
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaoyan Gu
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xu Yang
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jiancheng Han
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yihua He
- Maternal-Fetal Medicine Center in Fetal Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
3
|
Subbotina A, Skjølsvik E, Solbu MD, Miroslawska A, Steigen T. Echocardiographic findings following renal sympathetic denervation for treatment resistant hypertension, the ReShape CV-risk study. Blood Press 2024; 33:2326298. [PMID: 38469724 DOI: 10.1080/08037051.2024.2326298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 02/28/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE The aim of this study was to describe and compare echocardiographic findings before renal sympathetic denervation (RDN) and 6 and 24 months after the procedure. MATERIALS AND METHODS Patients with treatment resistant hypertension (TRH) were included in this non-randomised intervention study. RDN was performed by a single experienced operator using the Symplicity Catheter System. Echocardiographic measurements were performed at baseline, and after 6 and 24 months. RESULTS The cohort consisted of 21 patients with TRH, with a mean systolic office blood pressure (BP) of 163 mmHg and mean diastolic BP 109 mmHg. Mixed model analysis showed no significant change in left ventricular (LV) mass index (LVMI) or left atrium volume index (LAVI) after the RDN procedure. Higher LVMI at baseline was significantly associated with greater reduction in LVMI (p < 0.001). Relative wall thickness (RWT) increased over time (0.48 mm after two years) regardless of change in BP. There was a small but significant reduction in LV end-diastolic (LVIDd) and end-systolic (LVIDs) diameters after RDN, with a mean reduction of 2.6 and 2.4 mm, respectively, after two years. Progression to concentric hypertrophy was observed only in in patients who did not achieve normal BP values, despite BP reduction after RDN. CONCLUSION There was no reduction of LV mass after RDN. We found a small statistically significant reduction in LVIDd and LVIDs, which together with increase in RWT can indicate progression towards concentric hypertrophy. BP reduction after RDN on its own does not reverse concentric remodelling if target BP is not achieved.
Collapse
Affiliation(s)
- Anna Subbotina
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Eystein Skjølsvik
- Department of Cardiology, ProCardio Center for Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Dahl Solbu
- Section of Nephrology, University Hospital of North Norway, Tromsø, Norway
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Atena Miroslawska
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
| | - Terje Steigen
- Department of Cardiology, University Hospital of North Norway, Tromsø, Norway
- Clinical Cardiovascular Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| |
Collapse
|
4
|
Kowalczyk M, Kordybach-Prokopiuk M, Marczak M, Hoffman P, Kowalski M. The utility of novel STE parameters in echocardiographic assessment of single ventricle after Fontan palliation. Int J Cardiol 2024; 412:132286. [PMID: 38908552 DOI: 10.1016/j.ijcard.2024.132286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/31/2024] [Accepted: 06/19/2024] [Indexed: 06/24/2024]
Abstract
Background and aims of the study A functionally single ventricle (FSV) refers to a group of congenital heart defects that are not amenable for biventricular correction. The Fontan operation is utilized as surgical treatment for most of FSV patients. The evaluation of FSV function is extremely difficult due to its unique pathophysiology. This study aimed to explore the efficacy of speckle tracking echocardiography (STE) parameters measured at rest and during exercise for comprehensive assessment of univentricular heart. METHODS We enrolled 37 patients with a functionally single ventricle after the Fontan operation, hospitalized in the Department of Congenital Heart Defects between years 2019 and 2021.The echocardiographic stress tests were performed in the Echocardiography Laboratory of the Congenital Heart Defects Department. The study was conducted on a bicycle ergometer in a semi-recumbent position. The parameters obtained by speckle tracking echocardiography (STE): the longitudinal strain of the FSV free wall (Ɛ) and the longitudinal strain of myocardial layers: subendocardial, medial and subepicardial were analyzed. A transmural longitudinal strain gradient (TG) was calculated as the difference between longitudinal deformation of the subendocardial and subepicardial layers. Current results of cardiac magnetic resonance imaging (CMR) and cardio-pulmonary test (CPET) were also incorporated. Demographic data, past interventions, pharmacological treatment and comorbidities were extracted from medical records. RESULTS Ɛ at rest and during exercise were not related to the parameters of physical capacity obtained on CPET nor to the CMR results. The transmural strain gradient was dependent on physical performance parameter- peak oxygen uptake- and related to the FSV ejection fraction calculated by magnetic resonance imaging. CONCLUSIONS The transmural strain gradient and FSV free wall strain are readily measurable and suitable for evaluating single ventricle function. The TG is positively correlated with peak oxygen uptake during the cardiopulmonary test and with the ejection fraction derived from cardiac magnetic resonance imaging. The applicability of these findings in patients undergoing the Fontan procedure warrants further exploration.
Collapse
Affiliation(s)
- Małgorzata Kowalczyk
- Department of Adult Congenital Heart Defects, National Institute of Cardiology in Warsaw, Poland.
| | - Maria Kordybach-Prokopiuk
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology in Warsaw, Poland
| | - Magdalena Marczak
- Department of Radiology, Magnetic Resonance Unit, National Institute of Cardiology in Warsaw, Poland
| | - Piotr Hoffman
- Department of Adult Congenital Heart Defects, National Institute of Cardiology in Warsaw, Poland
| | - Mirosław Kowalski
- Department of Adult Congenital Heart Defects, National Institute of Cardiology in Warsaw, Poland
| |
Collapse
|
5
|
Pastore MC, Cavigli L, Olivoni G, Morrone F, Amati F, Imbalzano E, Rinaldi A, Liga R, Mattioli AV, Scicchitano P, Curcio A, Barillà F, Ciccarelli M, Maestrini V, Perrone Filardi P, D'Ascenzi F, Cameli M. Physical exercise in hypertensive heart disease: From the differential diagnosis to the complementary role of exercise. Int J Cardiol 2024; 410:132232. [PMID: 38844090 DOI: 10.1016/j.ijcard.2024.132232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/10/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Arterial hypertension (AH) is one of the most common pathologic conditions and uncontrolled AH is a leading risk factor for cardiovascular disease and mortality. AH chronically causes myocardial and arterial remodelling with hemodynamic changes affecting the heart and other organs, with potentially irreversible consequences leading to poor outcomes. Therefore, a proper and early treatment of AH is crucial after the diagnosis. Beyond medical treatment, physical exercise also plays a therapeutic role in reducing blood pressure, given its potential effects on sympathetic tone, renin-angiotensin-aldosterone system, and endothelial function. International scientific societies recommend physical exercise among lifestyle modifications to treat AH in the first stages of the disease. Moreover, some studies have also shown its usefulness in addition to drugs to reduce blood pressure further. Therefore, an accurate, personalized exercise prescription is recommended to optimize the prevention and treatment of hypertension. On the other hand, uncontrolled AH in athletes requires proper risk stratification and careful evaluation to practice competitive sports safely. Moreover, the differential diagnosis between hypertensive heart disease and athlete's heart is sometimes challenging and requires a careful and comprehensive interpretation in order not to misinterpret the clinical findings. The present review aims to discuss the relationship between hypertensive heart disease and physical exercise, from diagnostic tools to prevention and treatment strategies.
Collapse
Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Gabriele Olivoni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Francesco Morrone
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Egidio Imbalzano
- Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Andrea Rinaldi
- Unit of Cardiology, Department of Experimental, Diagnostic and Specialty Medicine-DIMES, University of Bologna, Sant'Orsola-Malpighi Hospital, IRCCS, Bologna, Italy
| | - Riccardo Liga
- Department of Surgical, Medical, Molecular Pathology and Critical Area, University of Pisa, Pisa, Italy
| | | | | | - Antonio Curcio
- Division of Cardiology, Department of Pharmacy, Health and Nutritional Sciences, University of Calabria, Rende, Italy
| | - Francesco Barillà
- Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Michele Ciccarelli
- Cardiovascular Research Unit, Department of Medicine and Surgery, University of Salerno, Salerno, Italy
| | | | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Italian Society of Cardiology, Federico II University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| |
Collapse
|
6
|
Cau R, Palmisano A, Suri JS, Pisu F, Esposito A, Saba L. Prognostic role of cardiovascular magnetic resonance in Takotsubo syndrome: A systematic review. Eur J Radiol 2024; 177:111576. [PMID: 38897052 DOI: 10.1016/j.ejrad.2024.111576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 06/08/2024] [Accepted: 06/14/2024] [Indexed: 06/21/2024]
Abstract
BACKGROUND Takotsubo syndrome (TS) is characterized by transient myocardial dysfunction with outcomes ranging from favorable to life-threatening. Cardiovascular magnetic resonance (CMR) has emerged as an essential tool in its diagnosis and management and is consistently recommended by current guidelines in the diagnostic work-up. However, the prognostic value of CMR in patients with TS remains undetermined. The aim of this study was to assess the prognostic value of CMR in managing patients with TS. METHOD PubMed, MEDLINE via Ovid, Scopus, and the Cochrane Library were searched to identify studies reporting the prognostic role of multiparameteric CMR in patients with TS with a follow-up ≥ 12 months. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE), defined as all-cause mortality, cardiac death, heart failure, sudden cardiac death, recurrence of TS, and cerebrovascular events. RESULTS Five studies with 564 patients were included for reporting correlation of CMR parameters with MACCE. Primary endpoint occurred in 69 (12%) patients. Among the CMR parameters assessed, myocardial strain parameters (including measurements of the left atrium, left and right ventricle), right ventricle involvement, and a CMR-based radiomics model demonstrated correlations with MACCE. Additionally, one study showed the predictive ability of a CMR score. CONCLUSION The current systematic review suggests that CMR may offer prognostic insights in TS patients, underscoring its potential clinical utility for integration into clinical practice. However, scarce data are currently available; hence, further research is needed.
Collapse
Affiliation(s)
- Riccardo Cau
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, Cagliari 09045, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60 20132, Milan, Italy
| | - Jasjit S Suri
- Stroke Diagnostic and Monitoring Division, Atheropoint, Roseville, CA, USA
| | - Francesco Pisu
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, Cagliari 09045, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; School of Medicine, Vita-Salute San Raffaele University, Via Olgettina 58-60 20132, Milan, Italy
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), di Cagliari - Polo di Monserrato s.s. 554 Monserrato, Cagliari 09045, Italy.
| |
Collapse
|
7
|
Madias JE. Left ventricular outflow tract obstruction/hypertrophic cardiomyopathy/takotsubo syndrome: A new hypothesis of takotsubo syndrome pathophysiology. Curr Probl Cardiol 2024; 49:102668. [PMID: 38797507 DOI: 10.1016/j.cpcardiol.2024.102668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 05/20/2024] [Indexed: 05/29/2024]
Abstract
The pathophysiology of TTS is still elusive. This viewpoint proposes that TTS is an acute coronary syndrome, engendered by an ASNS/catecholamine-induced LVOTO, which results in an enhanced wall stress and afterload-based supply/demand mismatch, culminating in a segmental myocardial ischemic injury state, in susceptible individuals. Such individuals are felt to be particularly women with chronic hypertension, known or latent HCM, or non-HCM segmental myocardial hypertrophy, and certain structural abnormalities involving the LV and the MV apparatus. Recommendations are provided to explore further this hypothesis, while maintaining our focus on all other advanced TTS pathophysiology hypotheses for all patients, or those who do not experience LVOTO, men, the young, and patients with reverse, mid-ventricular, or right ventricular TTS, in whom more prolonged hyperadrenergic stimulation and/or larger amounts of blood-ridden catecholamines, segmental particularities of cardiac innervation and/or density of α-, and β-adrenergic receptors, pheochromocytoma, neurological chronic or acute comorbidities/catastrophies, coronary epicardial/microvascular vasospasm, and CMD.
Collapse
Affiliation(s)
- John E Madias
- From the Icahn School of Medicine at Mount Sinai, New York, NY, United States; Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, United States.
| |
Collapse
|
8
|
Lima FVP, Andrade DDM, Filho JE, Souza PL, Azevedo LF, Coelho MM, de Lima JRP, Trevizan PF, Laterza MC, Martinez DG. Acute effect of ultramarathon on systolic and diastolic cardiac function: Systematic review and meta-analysis. Int J Cardiol 2024; 408:132106. [PMID: 38705202 DOI: 10.1016/j.ijcard.2024.132106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 04/09/2024] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
BACKGROUND Ultramarathon running poses physiological challenges, impacting cardiac function. This systematic review and meta-analysis explore the acute effects of single-stage ultramarathon running on cardiac function. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses recommendations were followed. Searches covered Medline, Embase, CINAHL, SPORTDiscus, Web of Science, Central Cochrane, and Scopus. Random effects meta-analyses assessed left ventricular (LV) and right ventricular (RV) variables, expressed as mean differences (MD) with 95% confidence intervals (CI). RESULTS Among 6972 studies, 17 were included. Post-ultramarathon reductions were found in LV end-diastolic diameter (LVEDD) (-1.24; 95% CI = -1.77, -0.71 mm), LV end-diastolic volume (LVEDV) (-9.92; 95% CI = -15.25, -4.60 ml), LV stroke volume (LVSV) (-8.96 ml, 95% CI -13.20, -4.72 ml), LV ejection fraction (LVEF) (-3.71; 95% CI = -5.21, -2.22%), LV global longitudinal strain (LVGLS) (-1.48; 95% CI = -2.21, -0.76%), E/A (-0.30; 95% CI = -0.38, -0.22 cm/s), .E' (-1.35 cm/s, 95% CI -1.91, -0.79 cm/s), RV fractional area change (RVFAC) (-3.34, 95% CI = -5.84, -0.84%), tricuspid annular plane systolic excursion (TAPSE) (-0.12, 95% CI = -0.22, -0.02 cm), RV global longitudinal strain (RVGLS) (-1.73, 95% CI = -2.87, -0.59%), with increases in RV end-diastolic area (RVEDA) (1.89, 95% CI = 0.63, 3.14 cm2), RV Peak A' (1.32 cm/s, 95% CI 0.20, 2.44), and heart rate (18.24, 95% CI = 15.16, 21.32). No significant differences were observed in LV end-systolic diameter (LVESD), LV end-systolic volume (LVESV), RV end-diastolic diameter (RVEDD), RV Peak E', and RV Peak S'. CONCLUSIONS Evidence suggests immediate impairment of systolic and diastolic cardiac function post-ultramarathon running.
Collapse
Affiliation(s)
- Francisco Veríssimo Perrout Lima
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil.
| | - Diana de Medeiros Andrade
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - José Elias Filho
- Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Pedro Lima Souza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Luciene Ferreira Azevedo
- Echocardiography Unit, University of São Paulo. Av. Dr. Enéas de Carvalho Aguiar, São Paulo, SP 44 - 05403-900, Brazil
| | - Marcelo Martins Coelho
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Jorge Roberto Perrout de Lima
- Faculty of Physical Education and Sports, Federal University of Juiz de Fora. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Patrícia Fernandes Trevizan
- Department of Physical Therapy, Federal University of Minas Gerais. Av. Presidente Carlos Luz, 6627 - Pampulha, Belo Horizonte, MG 31310-25, Brazil
| | - Mateus Camaroti Laterza
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| | - Daniel Godoy Martinez
- Cardiovascular Research Unit and Exercise Physiology, Federal University of Juiz de Fora, Brazil. José Lourenço Kelmer, s/n, Martelos, Juiz de Fora 36036-900, Brazil
| |
Collapse
|
9
|
Kintsu M, Odajima S, Takeuchi K, Ichikawa Y, Todo S, Ota E, Yamauchi Y, Shiraki H, Yamashita K, Fukuda T, Hisamatsu E, Minami H, Hirata KI, Tanaka H. Effect of increase in heart rate after anthracycline chemotherapy on subsequent left ventricular dysfunction. J Cardiol 2024; 84:119-125. [PMID: 37949314 DOI: 10.1016/j.jjcc.2023.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 11/01/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Anthracycline chemotherapy-related cardiac dysfunction is believed to be refractory to conventional pharmacological therapy and is associated with a poor prognosis. Increased heart rate (HR) is a known marker of cardiovascular outcomes for various categories of heart failure (HF). However, little interest has been expressed regarding increased HR after anthracycline chemotherapy. Aim of this study was to investigate the effect of increased HR soon after completion of anthracycline chemotherapy on subsequent left ventricular (LV) ejection fraction (LVEF) in cancer patients. METHODS We studied 172 patients with breast cancer and malignant lymphoma with preserved LVEF (≥ 50 %) and sinus rhythm treated with anthracyclines. Electrocardiography was performed before and soon after completion of anthracycline chemotherapy (2.3 months), and echocardiography before and late after completion of anthracycline chemotherapy (10.5 months). RESULTS HR significantly increased from 74.2 ± 14.2 bpm to 75.9 ± 13.2 bpm (P = 0.05) soon after completion of anthracycline chemotherapy, while LVEF subsequently significantly decreased from 65.3 ± 5.5 % to 62.4 ± 6.1 % (P < 0.01) late after completion of anthracycline chemotherapy. Patients whose HR increased ≥10 bpm subsequently showed a significantly greater decrease in LVEF than those whose HR increased <10 bpm [-4.9 % (-32.7 % - 10.8 %) vs. -2.2 % (-21.2 % - 12.9 %), p = 0.04]. Multivariable logistic regression analysis showed that an increase in HR soon after completion of anthracycline chemotherapy was independently associated with a subsequent decrease in LVEF (odds ratio: 1.022, 95 % confidential interval; 1.008-1.037, P = 0.002). CONCLUSIONS Our findings may have a novel effect on the management of cancer patients scheduled for anthracycline chemotherapy.
Collapse
Affiliation(s)
- Masayuki Kintsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Susumu Odajima
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimikazu Takeuchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yasushi Ichikawa
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Saki Todo
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eri Ota
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yuki Yamauchi
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroaki Shiraki
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kentaro Yamashita
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Terunobu Fukuda
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Eriko Hisamatsu
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hironobu Minami
- Division of Medical Oncology/Hematology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan.
| |
Collapse
|
10
|
Perera Molligoda Arachchige AS. Translating musculoskeletal radiology reports into patient-friendly summaries using ChatGPT-4: additional considerations. Skeletal Radiol 2024; 53:1625. [PMID: 38421402 DOI: 10.1007/s00256-024-04633-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 02/07/2024] [Accepted: 02/21/2024] [Indexed: 03/02/2024]
|
11
|
Tetterton-Kellner J, Jensen BC, Nguyen J. Navigating cancer therapy induced cardiotoxicity: From pathophysiology to treatment innovations. Adv Drug Deliv Rev 2024; 211:115361. [PMID: 38901637 DOI: 10.1016/j.addr.2024.115361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 06/09/2024] [Accepted: 06/16/2024] [Indexed: 06/22/2024]
Abstract
Every year, more than a million people in the United States undergo chemotherapy or radiation therapy for cancer, as estimated by the CDC. While chemotherapy has been an instrumental tool for treating cancer, it also causes severe adverse effects. The more commonly acknowledged adverse effects include hair loss, fatigue, and nausea, but a more severe and longer lasting side effect is cardiotoxicity. Cardiotoxicity, or heart damage, is a common complication of cancer treatments. It can range from mild to severe, and it can affect some patients temporarily or others permanently, even after they are cured of cancer. Dexrazoxane is the only FDA-approved drug for treating anthracycline induced cardiotoxicity, but it also has drawbacks and adverse effects. There is no other type of chemotherapy induced cardiotoxicity that has an approved treatment option. In this review, we discuss the pathophysiology of chemotherapeutic-induced cardiotoxicity, methods and guidelines of diagnosis, methods of treatment and mitigation, and current drug delivery approaches in therapeutic development.
Collapse
Affiliation(s)
- Jessica Tetterton-Kellner
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Brian C Jensen
- McAllister Heart Institute, University of North Carolina, Chapel Hill, NC 27599, USA; Department of Medicine, Division of Cardiology, University of North Carolina, Chapel Hill, NC 27599, USA.
| | - Juliane Nguyen
- Division of Pharmacoengineering and Molecular Pharmaceutics, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; McAllister Heart Institute, University of North Carolina, Chapel Hill, NC 27599, USA.
| |
Collapse
|
12
|
Rizzoni D. Commentary on: 'Cuspidi C., et al. Left ventricular systolic dysfunction in obesity: a meta-analysis of speckle tracking echocardiographic studies'. J Hypertens 2024; 42:1309-1310. [PMID: 38934188 DOI: 10.1097/hjh.0000000000003766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Affiliation(s)
- Damiano Rizzoni
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| |
Collapse
|
13
|
Critser PJ, Buchmiller TL, Gauvreau K, Zalieckas JM, Sheils CA, Visner GA, Shafer KM, Chen MH, Mullen MP. Exercise-Induced Pulmonary Hypertension in Long-Term Survivors of Congenital Diaphragmatic Hernia. J Pediatr 2024; 271:114034. [PMID: 38552948 DOI: 10.1016/j.jpeds.2024.114034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 03/17/2024] [Accepted: 03/26/2024] [Indexed: 05/16/2024]
Abstract
OBJECTIVE To determine the prevalence of exercise-induced pulmonary hypertension (PH) among long-survivors of congenital diaphragmatic hernia repair. STUDY DESIGN This is a single-center, retrospective cohort study of CDH survivors who underwent exercise stress echocardiography (ESE) at Boston Children's Hospital from January 2006 to June 2020. PH severity was assessed by echocardiogram at baseline and after exercise. Patients were categorized by right ventricular systolic pressure (RVSP) after exercise: Group 1 - no or mild PH; and Group 2 - moderate or severe PH (RVSP ≥ 60 mmHg or ≥ ½ systemic blood pressure). RESULTS Eighty-four patients with CDH underwent 173 ESE with median age 8.1 (4.8 - 19.1) years at first ESE. Sixty-four patients were classified as Group 1, 11 as Group 2, and 9 had indeterminate RVSP with ESE. Moderate to severe PH after exercise was found in 8 (10%) patients with no or mild PH at rest. Exercise-induced PH was associated with larger CDH defect size, patch repair, use of ECMO, supplemental oxygen at discharge, and higher WHO functional class. Higher VE/VCO2 slope, lower peak oxygen saturation, and lower percent predicted FEV1, and FEV1/FVC ratio were associated with Group 2 classification. ESE changed management in 9/11 Group 2 patients. PH was confirmed in all 5 Group 2 patients undergoing cardiac catheterization after ESE. CONCLUSIONS Among long-term CDH survivors, 10% had moderate-severe exercise-induced PH on ESE, indicating ongoing pulmonary vascular abnormalities. Further studies are needed to optimally define PH screening and treatment for patients with repaired CDH.
Collapse
Affiliation(s)
- Paul J Critser
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - Terry L Buchmiller
- Department of Surgery, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Jill M Zalieckas
- Department of Surgery, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA
| | - Catherine A Sheils
- Harvard Medical School, Boston, MA; Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA
| | - Gary A Visner
- Harvard Medical School, Boston, MA; Division of Pulmonary Medicine, Boston Children's Hospital, Boston, MA
| | - Keri M Shafer
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA
| | - Ming Hui Chen
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Division of Genetics and Genomics, Boston Children's Hospital, Boston, MA
| | - Mary P Mullen
- Department of Cardiology, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
| |
Collapse
|
14
|
Ladányi Z, Eltayeb A, Fábián A, Ujvári A, Tolvaj M, Tokodi M, Choudhary KA, Kovács A, Merkely B, Vriz O, Lakatos BK. The effects of mitral stenosis on right ventricular mechanics assessed by three-dimensional echocardiography. Sci Rep 2024; 14:17112. [PMID: 39048660 DOI: 10.1038/s41598-024-68126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024] Open
Abstract
Mitral stenosis (MS) is a complex valvular pathology with significant clinical burden even today. Its effect on the right heart is often overlooked, despite it playing a considerable part in the symptomatic status. We enrolled 39 mitral valve stenosis patients and 39 age- and gender-matched healthy controls. They underwent conventional, speckle-tracking and 3D echocardiographic examinations. The 3D data was analyzed using the ReVISION software to calculate RV functional parameters. In the MS group, 3D RV ejection fraction (EF) (49 ± 7% vs. 61 ± 4%; p < 0.001), global circumferential (GCS) (- 21.08 ± 5.64% vs. - 25.07 ± 4.72%; p = 0.001) and longitudinal strain (GLS) (- 16.60% ± 4.07% vs. - 23.32 ± 2.82%; p < 0.001) were reduced. When comparing RV contraction patterns between controls, MS patients in sinus rhythm and those with atrial fibrillation, radial (REF) (32.06 ± 5.33% vs. 23.62 ± 7.95% vs. 20.89 ± 6.92%; p < 0.001) and longitudinal ejection fraction (LEF) (24.85 ± 4.06%; 17.82 ± 6.16% vs. 15.91 ± 4.09%; p < 0.001) were decreased in both MS groups compared to controls; however, they were comparable between the two MS subgroups. Anteroposterior ejection fraction (AEF) (29.16 ± 4.60% vs. 30.87 ± 7.71% vs. 21.48 ± 6.15%; p < 0.001) showed no difference between controls and MS patients in sinus rhythm, while it was lower in the MS group with atrial fibrillation. Therefore, utilizing 3D echocardiography, we found distinct morphological and functional alterations of the RV in MS patients.
Collapse
Affiliation(s)
- Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary.
| | - Abdalla Eltayeb
- King Faisal Specialist Hospital and Research Center Hospital, Riyadh, Saudi Arabia
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Máté Tolvaj
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Olga Vriz
- King Faisal Specialist Hospital and Research Center Hospital, Riyadh, Saudi Arabia
- Ospedale Sant'Antonio, San Daniele del Friuli, Italy
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| |
Collapse
|
15
|
Karigyo CJT, Pessoa BMS, Nicacio SP, Terwilliger E, Costa P, dos Santos PR, Ernani V, Seetharam M, Murakami AN, Batalini F. Cardiac Tumors: Review. Braz J Cardiovasc Surg 2024; 39:e20230405. [PMID: 39038269 PMCID: PMC11262154 DOI: 10.21470/1678-9741-2023-0405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 02/12/2024] [Indexed: 07/24/2024] Open
Abstract
Cardiac tumors are rare and encompass a variety of presentations. Clinica symptoms are usually nonspecific, but they can present as obstructive, embolic, or constitutional symptoms. Treatment options and prognosis vary highly depending on the subtype, tumor size, and location. Surgical resection is usually the first-line therapy, except for cardiac lymphomas, and provides favorable long-term prognosis in most benign tumors. Cardiac sarcomas, however, are usually diagnosed in advanced stages, and the treatment relies on a multimodal approach with chemotherapy and radiotherapy. Metastatic cardiac tumors are usually related to advanced disease and carry an overall poor prognosis.
Collapse
Affiliation(s)
- Carlos J. T. Karigyo
- Engineering Center for Circulatory Assistance, Instituto Dante
Pazzanese de Cardiologia, São Paulo, São Paulo, Brazil
- Postgraduate Program in Medicine/Technology and Intervention in
Cardiology, Universidade de São Paulo, São Paulo, São Paulo,
Brazil
| | | | | | - Emma Terwilliger
- Mayo Clinic College of Medicine and Science, Rochester, Minnesota,
United States of America
| | - Philippos Costa
- Division of Hematology and Oncology, Yale University Yale Cancer
Center, New Haven, Connecticut, United States of America
| | - Pedro Reck dos Santos
- Division of Cardiothoracic Surgery, Mayo Clinic Arizona, Phoenix,
Arizona, United States of America
| | - Vinicius Ernani
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | - Mahesh Seetharam
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| | | | - Felipe Batalini
- Division of Oncology, Mayo Clinic Arizona, Phoenix, Arizona, United
States of America
| |
Collapse
|
16
|
Skoog J, Svensson C, Eriksson P, Sjöwall C, Zachrisson H. High-frequency ultrasound with superb microvascular imaging: a potential tool for ultrasound assessment in patients with giant cell arteritis. Front Med (Lausanne) 2024; 11:1431385. [PMID: 39050531 PMCID: PMC11266178 DOI: 10.3389/fmed.2024.1431385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024] Open
Abstract
Objective The objective of this study was 2-fold: first, to evaluate whether superb microvascular imaging (SMI) could be used to visualize neovascularization in temporal arteries, and, second, to evaluate the diagnostic performance of high frequency ultrasound with SMI using an extended protocol in patients with suspected giant cell arteritis (GCA). Methods This retrospective study comprised 120 patients consecutively examined with an extended CDU protocol (temporal, facial, axillary, subclavian, brachiocephalic, and carotid arteries) between 2020 and 2022. Of all patients, 107 had no previous GCA diagnosis and 13 had a previous GCA diagnosis. SMI was used to evaluate neovascularization in the temporal arteries. Arteritis were characterized as low- or medium-echogenic, homogeneous wall thickening, with or without a positive compression sign in the temporal arteries. The Halo count, i.e., the number of temporal and axillary artery segments with signs of arteritis, was evaluated. The reference was clinically diagnosed GCA confirmed after ≥6-month follow-up. Results Of the eligible 107 patients with new suspected GCA, 33 (31%) received a clinical GCA diagnosis. Neovascularization was detected in 14 patients (43%). Patients with neovascularization displayed a higher halo count [median 6 (25th-75th percentile 4.75-7) vs. 3 (2-4-4), p = 0.005]. CDU of only the temporal arteries showed sensitivity and specificity (95% confidence intervals) of 94% (80-100%) and 100% (95-100%), respectively. The addition of extra-cranial arteries increased the sensitivity to 100%. Of the 13 patients investigated for suspected relapse, three had a clinically confirmed relapse. One of them displayed neovascularization together with other signs of inflammation. Conclusions We show for the first time that inflammatory neovascularization of the temporal arteries can be detected by SMI. Neovascularization is associated with a more-widespread cranial disease. The value of neovascularization should be further investigated, especially for the detection of GCA relapse.
Collapse
Affiliation(s)
- Johan Skoog
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Christina Svensson
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Per Eriksson
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Christopher Sjöwall
- Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection/Rheumatology, Linköping University, Linköping, Sweden
| | - Helene Zachrisson
- Department of Clinical Physiology and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
17
|
Song K, Jang WS, Kim YS, Yoo J. Outcomes of maze procedure and mitral valve surgery in atrial functional mitral regurgitation: a retrospective study. J Cardiothorac Surg 2024; 19:433. [PMID: 38987787 PMCID: PMC11234554 DOI: 10.1186/s13019-024-02858-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Accepted: 06/14/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Atrial functional mitral regurgitation (AFMR) is a newly discovered condition associated with longstanding atrial fibrillation. This retrospective study aimed to analyze the outcomes of the maze procedure and mitral regurgitation (MR) surgery in AFMR and atrial fibrillation in comparison with those in degenerative MR (DMR). METHODS Patients who underwent mitral valve repair/replacement with a maze procedure at a hospital (July 2012-August 2021) were included. We excluded patients aged below 18 years undergoing concomitant coronary artery bypass grafting or atrial septal defect repair and those with MR etiology other than ARMR or DMR. RESULTS We included 35 patients with AFMR and 50 patients with DMR. Patient characteristics and postoperative outcomes were not significantly different between the two groups. Long-term outcomes revealed no significant differences in the ratio of cardiac mortality, stroke, or hospital readmission. However, after the maze procedure, the sinus rhythm restoration rate was significantly lower (62% vs. 28.5%, p < 0.001), a junctional rhythm state (p < 0.001) and permanent pacemaker insertion for sick sinus syndrome (SSS) (p = 0.03) were significantly more common in AFMR than DMR. On postoperative transthoracic echocardiography (TTE), the pulmonary artery systolic pressure was significantly less decreased in the AFMR group than in the DMR group compared with that on preoperative TTE (p = 0.04). CONCLUSIONS AFMR showed excellent mitral valve surgery outcomes, similar to DMR, but had a significantly higher risk of pacemaker insertion for SSS after the maze procedure.
Collapse
Affiliation(s)
- Kyungsub Song
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea.
| | - Woo Sung Jang
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Yun Seok Kim
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| | - Jonghoon Yoo
- Department of Emergency Medicine, Keimyung University Dongsan Medical Center, Keimyung University College of Medicine, 1035, Dalgubeol-daero, Dalseo-gu, Daegu, 42601, Republic of Korea
| |
Collapse
|
18
|
Custódio P, de Campos D, Moura AR, Shiwani H, Savvatis K, Joy G, Lambiase PD, Moon JC, Khanji MY, Augusto JB, Lopes LR. Mitral Annulus Disjunction: A Comprehensive Cardiovascular Magnetic Resonance Phenotype and Clinical Outcomes Study. J Magn Reson Imaging 2024. [PMID: 38982805 DOI: 10.1002/jmri.29524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Revised: 06/16/2024] [Accepted: 06/20/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND Clinical importance of mitral annulus disjunction (MAD) is not well established. PURPOSE Characterize a population of MAD all-comers diagnosed by cardiac magnetic resonance imaging (MRI). STUDY TYPE Retrospective. POPULATION MAD confirmed in 222 patients, age of 49.2 ± 19.3 years, 126 (56.8%) males. FIELD STRENGTH/SEQUENCE 1.5 T and 3 T/steady-state free precession and inversion recovery. ASSESSMENT Clinical history, outcomes, imaging, and arrhythmia data. MAD defined as a separation ≥2 mm between left ventricular myocardium and mitral annulus. Presence and pattern of late gadolinium enhancement (LGE) were analyzed. LGE in the papillary muscles and adjacent to MAD were identified as MAD related. Ventricular arrhythmias (VA) were grouped into non-sustained ventricular arrhythmias (NSVA) or sustained. Cardiovascular death assessed. STATISTICAL TESTS Differences between baseline characteristics were compared. Univariate regression was used to investigate possible associations between ventricular arrhythmia and cardiovascular death with characteristics associated with the severity of MAD. A multivariable logistic regression included significant variables from the univariate analysis and was performed for MAD-related and global LGE. RESULTS MAD extent 5.0 ± 2.6 mm. MV annulus expanded during systole for MAD ≥6 mm. Systolic expansion associated with prolapse, billowing, and curling. LGE present in 82 patients (36.9%). Twenty-three patients (10.4%) showed MAD-related LGE by three different observers. No association of LGE with MAD extent (P = 0.545) noted. Follow-up 4.1 ± 2.4 years. No sustained VA observed. In univariable analysis, NSVA was more prevalent in patients with MAD ≥6 mm (33.3% vs. 9.9%), but this was attenuated on multivariate analysis (P = 0.054). The presence of NSVA was associated with global LGE but not MAD-related LGE in isolation (P = 0.750). Three patients died of cardiovascular causes (1.4%) and none had MAD-related LGE. None died of sudden cardiac arrest. CONCLUSION In patients referred for cardiac MRI, mitral valve dysfunction was associated with MAD severity. Scar was not related to the extent of MAD, but associated with NSVA. The risk of sustained arrhythmias and cardiovascular death was low in this population. EVIDENCE LEVEL 4 TECHNICAL EFFICACY: Stage 2.
Collapse
Affiliation(s)
- Pedro Custódio
- St Bartholomew's Hospital, London, UK
- Hospital Vila Franca de Xira, Vila Franca de Xira, Portugal
| | - Diana de Campos
- St Bartholomew's Hospital, London, UK
- Centro Hospitalar Universitário de Coimbra, Coimbra, Portugal
| | - Ana Rita Moura
- St Bartholomew's Hospital, London, UK
- Hospital Distrital de Santarém, Santarém, Portugal
| | - Hunain Shiwani
- St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Konstantinos Savvatis
- St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
- Queen Mary University of London, London, UK
- NIHR University College London Hospitals Biomedical Research Centre, London, UK
| | - George Joy
- St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Pier D Lambiase
- St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - James C Moon
- St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Mohammed Y Khanji
- St Bartholomew's Hospital, London, UK
- Queen Mary University of London, London, UK
| | - João B Augusto
- Institute of Cardiovascular Science, University College London, London, UK
- Cardiology Department, Hospital Fernando da Fonseca, Amadora, Portugal
| | - Luís R Lopes
- St Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| |
Collapse
|
19
|
Lan X, Ye Z, Du J, Liu L, Tian C, Huang L, Mo X. Cross-sectional study on the impact of cardiac and hepatic iron overload, as measured by MRI T2*, on the quality of life in children with severe beta-thalassemia major. Medicine (Baltimore) 2024; 103:e38817. [PMID: 38968493 PMCID: PMC11224881 DOI: 10.1097/md.0000000000038817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/13/2024] [Indexed: 07/07/2024] Open
Abstract
A cross-sectional study to explore the correlation between cardiac and hepatic iron overload and its impact on the quality of life in children diagnosed with severe beta-thalassemia major (β-TM). A cohort of 55 pediatric patients with β-TM, diagnosed via genetic testing at the Affiliated Hospital of Guangdong Medical University from January 2015 to January 2022, was included in this study. The assessment of cardiac and hepatic iron overload was conducted using the magnetic resonance imaging T2* technique. The Chinese version of the Pediatric Quality of Life Inventory (PedsQL) 4.0. Pearson correlation analysis was utilized to assess the relationships between the cardiac and hepatic T2* values and between these T2* values and the total scores of PedsQL 4.0. Analysis showed no significant correlation between cardiac and hepatic T2* values. However, a significant relationship was observed between cardiac T2* values and PedsQL 4.0 total scores (r = 0.313, P < .05), indicating that cardiac, but not hepatic, iron overload is associated with the quality of life. This study highlights the absence of correlation between cardiac and hepatic iron overload levels and demonstrates a significant impact of cardiac iron overload on the quality of life in children with β-TM. These findings suggest the need for a focused approach to cardiac health in managing β-TM.
Collapse
Affiliation(s)
- Xiang Lan
- Department of Paediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Zhonglv Ye
- Department of Paediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Jiayi Du
- Department of Paediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Lili Liu
- Department of Paediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Chuan Tian
- Department of Paediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Linming Huang
- Department of Paediatrics, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaohuan Mo
- Department of Laboratory, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| |
Collapse
|
20
|
Watanabe R, Hori K, Ishihara K, Tsujikawa S, Hino H, Matsuura T, Takahashi Y, Shibata T, Mori T. Possible role of QRS duration in the right ventricle as a perioperative monitoring parameter for right ventricular function: a prospective cohort analysis in robotic mitral valve surgery. Front Cardiovasc Med 2024; 11:1418251. [PMID: 39027000 PMCID: PMC11254697 DOI: 10.3389/fcvm.2024.1418251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background The clinical importance of the right ventricle (RV) has recently been recognized; however, assessing its function during cardiac surgery remains challenging owing to its complex anatomy. A temporary transvenous pacing catheter is a useful tool in the small surgical field of minimally invasive cardiac surgery, and an electrocardiogram recorded through the catheter is composed of the direct electrophysiological activity of the RV. Therefore, we hypothesized that QRS duration in the RV (QRSRV) could be a useful monitoring parameter for perioperative RV function. Methods We conducted a prospective cohort analysis involving adult patients undergoing robotic mitral valve repair. A bipolar pacing catheter was inserted using x-ray fluoroscopy, and the QRSRV duration was assessed at four time points: preoperative baseline, during one-lung ventilation, after weaning from cardiopulmonary bypass, and before the end of surgery. At the same time points, right ventricular fractional area change (RVFAC) measured by transesophageal echocardiography and QRS duration at V5 lead of the body surface electrocardiogram (QRSV5) were also evaluated. Results In the 94 patients analyzed, QRSRV duration was significantly prolonged during robotic mitral valve repair (p = 0.0009), whereas no significant intraoperative changes in RVFAC were observed (p = 0.2). By contrast, QRSV5 duration was significantly shortened during surgery (p < 0.00001). Multilinear regression showed a significant correlation of QRSRV duration with RVFAC (p = 0.00006), but not with central venous pressure (p = 0.9), or left ventricular ejection fraction (p = 0.3). When patients were divided into two groups by postoperative QRSRV > 100 or ≤100 ms, 25 patients (26.6%) exhibited the prolonged QRSRV duration, and the mean increase in the postoperative QRSRV from preoperative baseline was 12 ms (p = 0.001), which was only 0.6 ms in patients with QRSRV ≤ 100 ms (p = 0.6). Cox regression analysis showed that prolonged postoperative QRSRV duration was the only significant parameter associated with a longer ICU stay after surgery (p = 0.02; hazard ratio, 0.55). Conclusion Our data suggest that QRSRV duration is a useful parameter for monitoring the RV during cardiac surgery, possibly better than a commonly used echocardiographic parameter, RVFAC. An electrophysiological assessment by QRSRV duration could be a practical tool for the complex anatomy of the RV, especially with limited modalities in perioperative settings.
Collapse
Affiliation(s)
- Ryota Watanabe
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kotaro Hori
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Ishihara
- Department of Anesthesiology, Osaka City General Hospital, Osaka, Japan
| | - Shogo Tsujikawa
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hideki Hino
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Matsuura
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mori
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
21
|
Campora A, Lisi M, Pastore MC, Mandoli GE, Ferrari Chen YF, Pasquini A, Rubboli A, Henein MY, Cameli M. Atrial Fibrillation, Atrial Myopathy, and Thromboembolism: The Additive Value of Echocardiography and Possible New Horizons for Risk Stratification. J Clin Med 2024; 13:3921. [PMID: 38999487 PMCID: PMC11242512 DOI: 10.3390/jcm13133921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Revised: 06/22/2024] [Accepted: 07/01/2024] [Indexed: 07/14/2024] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac sustained arrhythmia, and it is associated with increased stroke and dementia risk. While the established paradigm attributes these complications to blood stasis within the atria and subsequent thrombus formation with cerebral embolization, recent evidence suggests that atrial myopathy (AM) may play a key role. AM is characterized by structural and functional abnormalities of the atria, and can occur with or without AF. Moving beyond classifications based solely on episode duration, the 4S-AF characterization has offered a more comprehensive approach, incorporating patient's stroke risk, symptom severity, AF burden, and substrate assessment (including AM) for tailored treatment decisions. The "ABC" pathway emphasizes anticoagulation, symptom control, and cardiovascular risk modification and emerging evidence suggests broader benefits of early rhythm control strategies, potentially reducing stroke and dementia risk and improving clinical outcomes. However, a better integration of AM assessment into the current framework holds promise for further personalizing AF management and optimizing patient outcomes. This review explores the emerging concept of AM and its potential role as a risk factor for stroke and dementia and in AF patients' management strategies, highlighting the limitations of current risk stratification methods, like the CHA2DS2-VASc score. Echocardiography, particularly left atrial (LA) strain analysis, has shown to be a promising non-invasive tool for AM evaluation and recent studies suggest that LA strain analysis may be a more sensitive risk stratifier for thromboembolic events than AF itself, with some studies showing a stronger association between LA strain and thromboembolic events compared to traditional risk factors. Integrating it into routine clinical practice could improve patient management and targeted therapies for AF and potentially other thromboembolic events. Future studies are needed to explore the efficacy and safety of anticoagulation in AM patients with and without AF and to refine the diagnostic criteria for AM.
Collapse
Affiliation(s)
- Alessandro Campora
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Matteo Lisi
- Department of Emergency, Internal Medicine and Cardiology-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Yu Fu Ferrari Chen
- Cardiovascular Division, Pisa University Hospital and University of Pisa, Via Paradisa 2, 56124 Pisa, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Andrea Rubboli
- Department of Emergency, Internal Medicine and Cardiology-AUSL Romagna, Division of Cardiology, Ospedale S. Maria delle Croci, Viale Randi 5, 48121 Ravenna, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| |
Collapse
|
22
|
Kagiyama N, Abe Y, Kusunose K, Kato N, Kaneko T, Murata A, Ota M, Shibayama K, Izumo M, Watanabe H. Multicenter validation study for automated left ventricular ejection fraction assessment using a handheld ultrasound with artificial intelligence. Sci Rep 2024; 14:15359. [PMID: 38965290 PMCID: PMC11224326 DOI: 10.1038/s41598-024-65557-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 06/20/2024] [Indexed: 07/06/2024] Open
Abstract
We sought to validate the ability of a novel handheld ultrasound device with an artificial intelligence program (AI-POCUS) that automatically assesses left ventricular ejection fraction (LVEF). AI-POCUS was used to prospectively scan 200 patients in two Japanese hospitals. Automatic LVEF by AI-POCUS was compared to the standard biplane disk method using high-end ultrasound machines. After excluding 18 patients due to infeasible images for AI-POCUS, 182 patients (63 ± 15 years old, 21% female) were analyzed. The intraclass correlation coefficient (ICC) between the LVEF by AI-POCUS and the standard methods was good (0.81, p < 0.001) without clinically meaningful systematic bias (mean bias -1.5%, p = 0.008, limits of agreement ± 15.0%). Reduced LVEF < 50% was detected with a sensitivity of 85% (95% confidence interval 76%-91%) and specificity of 81% (71%-89%). Although the correlations between LV volumes by standard-echo and those by AI-POCUS were good (ICC > 0.80), AI-POCUS tended to underestimate LV volumes for larger LV (overall bias 42.1 mL for end-diastolic volume). These trends were mitigated with a newer version of the software tuned using increased data involving larger LVs, showing similar correlations (ICC > 0.85). In this real-world multicenter study, AI-POCUS showed accurate LVEF assessment, but careful attention might be necessary for volume assessment. The newer version, trained with larger and more heterogeneous data, demonstrated improved performance, underscoring the importance of big data accumulation in the field.
Collapse
Affiliation(s)
- Nobuyuki Kagiyama
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0021, Japan.
- Department of Digital Health and Telemedicine R&D, Juntendo University, Tokyo, Japan.
| | - Yukio Abe
- Department of Cardiology, Osaka City General Hospital, Osaka, Japan
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Nephrology, and Neurology, University of the Ryukyus, Okinawa, Japan
| | - Nahoko Kato
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | - Tomohiro Kaneko
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0021, Japan
| | - Azusa Murata
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, 2-1-1 Hongo, Tokyo, 113-0021, Japan
| | - Mitsuhiko Ota
- Department of Cardiovascular Center, Toranomon Hospital, Tokyo, Japan
| | - Kentaro Shibayama
- Department of Cardiovascular Medicine, Tokyo Cardiovascular and Internal Medicine Clinic, Tokyo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Hiroyuki Watanabe
- Department of Cardiology, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| |
Collapse
|
23
|
Kahnert K, Soattin L, Mills RW, Wilson C, Maurya S, Sorrentino A, Al-Othman S, Tikhomirov R, van de Vegte YJ, Hansen FB, Achter J, Hu W, Zi M, Smith M, van der Harst P, Olesen MS, Boisen Olsen K, Banner J, Jensen THL, Zhang H, Boyett MR, D’Souza A, Lundby A. Proteomics couples electrical remodelling to inflammation in a murine model of heart failure with sinus node dysfunction. Cardiovasc Res 2024; 120:927-942. [PMID: 38661182 PMCID: PMC11218694 DOI: 10.1093/cvr/cvae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/22/2023] [Accepted: 01/08/2024] [Indexed: 04/26/2024] Open
Abstract
AIMS In patients with heart failure (HF), concomitant sinus node dysfunction (SND) is an important predictor of mortality, yet its molecular underpinnings are poorly understood. Using proteomics, this study aimed to dissect the protein and phosphorylation remodelling within the sinus node in an animal model of HF with concurrent SND. METHODS AND RESULTS We acquired deep sinus node proteomes and phosphoproteomes in mice with heart failure and SND and report extensive remodelling. Intersecting the measured (phospho)proteome changes with human genomics pharmacovigilance data, highlighted downregulated proteins involved in electrical activity such as the pacemaker ion channel, Hcn4. We confirmed the importance of ion channel downregulation for sinus node physiology using computer modelling. Guided by the proteomics data, we hypothesized that an inflammatory response may drive the electrophysiological remodeling underlying SND in heart failure. In support of this, experimentally induced inflammation downregulated Hcn4 and slowed pacemaking in the isolated sinus node. From the proteomics data we identified proinflammatory cytokine-like protein galectin-3 as a potential target to mitigate the effect. Indeed, in vivo suppression of galectin-3 in the animal model of heart failure prevented SND. CONCLUSION Collectively, we outline the protein and phosphorylation remodeling of SND in heart failure, we highlight a role for inflammation in electrophysiological remodelling of the sinus node, and we present galectin-3 signalling as a target to ameliorate SND in heart failure.
Collapse
Affiliation(s)
- Konstantin Kahnert
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Luca Soattin
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Robert W Mills
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Claire Wilson
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- Institute of Systems, Molecular & Integrative Biology, University of Liverpool, Liverpool, UK
| | - Svetlana Maurya
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Andrea Sorrentino
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Sami Al-Othman
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Roman Tikhomirov
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Yordi J van de Vegte
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Finn B Hansen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Jonathan Achter
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Wei Hu
- Department of Physics & Astronomy, Biological Physics Group, University of Manchester, Manchester, UK
| | - Min Zi
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
| | - Matthew Smith
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Genetics, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Durrer Center for Cardiogenetic Research, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Morten S Olesen
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| | - Kristine Boisen Olsen
- Department of Forensic Medicine, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | - Jytte Banner
- Department of Forensic Medicine, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark
| | | | - Henggui Zhang
- Department of Physics & Astronomy, Biological Physics Group, University of Manchester, Manchester, UK
| | - Mark R Boyett
- Faculty of Life Sciences, University of Bradford, Bradford, UK
| | - Alicia D’Souza
- Division of Cardiovascular Sciences, University of Manchester, Core Technology Facility, 46 Grafton Street, Manchester, M13 9NT, UK
- National Heart and Lung Institute, Imperial College London, Imperial Centre for Translational and Experimental Medicine (ICTEM), 72 Du Cane Road, London W12 0NN, UK
| | - Alicia Lundby
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
| |
Collapse
|
24
|
Ficial B, Dolce P, Petoello E, Flore AI, Nogara S, Ciarcià M, Brancolini G, Alfarano A, Marzollo R, Bosio I, Raimondi F, Risso FM, Beghini R, Dani C, Benfari G, Ribichini FL, Corsini I. Left atrial strain assessment unveils left ventricular diastolic dysfunction in neonates with transient tachypnea of the newborn: A prospective observational study. Pediatr Pulmonol 2024. [PMID: 38953730 DOI: 10.1002/ppul.27156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 06/02/2024] [Accepted: 06/20/2024] [Indexed: 07/04/2024]
Abstract
INTRODUCTION An inadequate clearance of lung fluid plays a key role in the pathogenesis of transient tachypnea of the newborn (TTN). OBJECTIVES To evaluate if left ventricular diastolic dysfunction contributes to reduced clearance of lung fluid in TTN. MATERIALS AND METHODS This was a prospective, observational study. Echocardiography and lung ultrasound were performed at 2, 24 and 48 h of life (HoL) to assess biventricular function and calculate lung ultrasound score (LUS). Left atrial strain reservoir (LASr) provided surrogate measurement of left ventricular diastolic function. RESULTS Twenty-seven neonates with TTN were compared with 27 controls with no difference in gestation (36.1 ± 2 vs. 36.9 ± 2 weeks) or birthweight (2508 ± 667 vs. 2718 ± 590 g). Biventricular systolic function was normal in both groups. LASr was significantly lower in cases at 2 (21.0 ± 2.7 vs. 38.1 ± 4.4; p < 0.01), 24 (25.2 ± 4.5 vs. 40.6 ± 4.0; p < 0.01) and 48 HoL (36.5 ± 5.8 and 41.6 ± 5.2; p < 0.01), resulting in a significant group by time interaction (p < 0.001), after adjusting for LUS and gestational diabetes. A logistic regression model including LUS, birth weight and gestational diabetes as covariates, showed that LASr at 2 HoL was a predictor of respiratory support at 24 HoL, with an adjusted odds ratio of 0.60 (CI 0.36-0.99). CONCLUSIONS LASr was reduced in neonates with TTN, suggesting diastolic dysfunction, that may contribute to the delay in lung fluid clearance.
Collapse
Affiliation(s)
- Benjamim Ficial
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Pasquale Dolce
- Department of Translational Medical Science, University of Naples Federico II, Naples, Italy
| | - Enrico Petoello
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Alice Iride Flore
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Silvia Nogara
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Martina Ciarcià
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Giovanna Brancolini
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Angela Alfarano
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Roberto Marzollo
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Ilaria Bosio
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Francesco Raimondi
- Division of Neonatology and Department of Translational Medical Sciences, Università "Federico II" di Napoli, Naples, Italy
| | - Francesco Maria Risso
- Neonatal Intensive Care Unit, Children's Hospital, ASST Spedali Civili di Brescia, Brescia, Italy
| | - Renzo Beghini
- Neonatal Intensive Care Unit, Azienda Ospedaliera Universitaria Integrata Verona, Verona, Italy
| | - Carlo Dani
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | | | - Iuri Corsini
- Division of Neonatology, Careggi University Hospital of Florence, Florence, Italy
| |
Collapse
|
25
|
Wada N, Keisuke S, Nomura T, Keira N, Tatsumi T. LEOPARD syndrome with accelerated idioventricular rhythm and systolic anterior motion of the posterior mitral leaflet: a case report. Eur Heart J Case Rep 2024; 8:ytae309. [PMID: 39006213 PMCID: PMC11245702 DOI: 10.1093/ehjcr/ytae309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 04/23/2024] [Accepted: 06/24/2024] [Indexed: 07/16/2024]
Abstract
Background PTPN11 is ubiquitously expressed and has a variety of phenotypes even in a single heart. We examined LEOPARD syndrome (LS) in a patient with PTPN11 variants through pathological, electrophysiological, and anatomical studies. Case summary A 49-year-old man with no previous medical history was brought to our emergency department because of syncope. An electrocardiogram (ECG) revealed alternating bundle branch block, and echocardiography revealed hypertrophic cardiomyopathy-like morphology with systolic anterior motion of the posterior mitral valve. Atrioventricular block, left ventricular outflow tract (LVOT) obstruction, and ventricular tachycardia were considered the differential diagnoses; however, the treatment plan was difficult to determine. An electrophysiological study revealed the cause of the ECG abnormality to be accelerated idioventricular rhythm, and the programmed ventricular stimulation was negative. Genetic testing revealed LS with PTPN11 variant, which was speculated to be the cause of these various unique cardiac features. The cause of syncope was considered to be exacerbation of LVOT obstruction due to dehydration, and the patient was treated with oral beta-blockers. Implantable loop recorder observation for 1 year revealed no arrhythmia causing syncope, and an implantable cardioverter-defibrillator and pacemaker were deemed unnecessary for primary prevention of syncope. During 2.5 years of follow-up, the LVOT peak velocity fluctuated between 2.5 and 3.5 m/s, but the patient remained stable with no recurrent syncope. Conclusion We confirmed that LS is distinct from other cardiomyopathies using characterization, physiological, electrophysiological, and pathological examinations. Evidence supporting a specific treatment strategy for LS is limited, and understanding the pathogenesis may help establish effective treatment strategies.
Collapse
Affiliation(s)
- Naotoshi Wada
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, Yagi-cho, Nantan City, Kyoto 629-0197, Japan
| | - Shoji Keisuke
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, Yagi-cho, Nantan City, Kyoto 629-0197, Japan
| | - Tetsuya Nomura
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, Yagi-cho, Nantan City, Kyoto 629-0197, Japan
| | - Natsuya Keira
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, Yagi-cho, Nantan City, Kyoto 629-0197, Japan
| | - Tetsuya Tatsumi
- Department of Cardiovascular Medicine, Kyoto Chubu Medical Center, 25, Yagi-Ueno, Yagi-cho, Nantan City, Kyoto 629-0197, Japan
| |
Collapse
|
26
|
Mansour MJ, De Marco C, Haddad K, Potter BJ, Argentin S, Bérubé L, Honos G, Le VV, Legault S, Nguyen TP, Salem R, Santagata P, Tournoux F, Cyr V, Romanelli G. Prognostic value of exercise longitudinal right ventricular free wall strain in patients with sickle cell disease. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1413-1421. [PMID: 38689030 DOI: 10.1007/s10554-024-03116-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/10/2024] [Indexed: 05/02/2024]
Abstract
Longitudinal right ventricular free wall strain (RVFWS) has been identified as an independent prognostic marker in patients with pulmonary hypertension. Little is known however about the prognostic value of RVFWS in patients with sickle cell (SC) disease, particularly during exercise. We therefore examined the prognostic significance of RVFWS both at rest and with exercise in patients with SC disease and normal resting systolic pulmonary artery pressure (SPAP). Consecutive patients with SC disease referred for bicycle ergometer stress echocardiography (SE) were enrolled ftom July 2019 to January 2021. All patients had measurable tricuspid regurgitation velocity (TRV). Conventional echocardiography parameters, left ventricular global longitudinal strain (LVGLS), RVFWS, and ventriculoarterial coupling indices (TAPSE/SPAP and RVFWS/SPAP) were assessed at rest and peak exercise. Repeat SE was performed at a median follow-up of 2 years. The cohort consisted of 87 patients (mean age was 31 ± 11 years, 66% females). All patients had normal resting TRV < 2.8 m/s, RVFWS and LVGLS at baseline. There were 23 (26%) patients who had peak stress RVFWS < 20%. They had higher resting and peak stress TRV and SPAP, but lower resting and peak stress TAPSE/SPAP, RVFWS/SPAP, and LVGLS as well as lower peak stress cardiac output when compared to patients with peak stress RVFWS ≥ 20% (p < 0.05). Patients with baseline peak stress RVFWS < 20% had a significant decrease in exercise performance at follow-up (7.5 ± 2.7 min at baseline vs. 5.5 ± 2.8 min at follow-up, p < 0.001). In the multivariate analysis, baseline peak stress RVFWS was the only independent predictor of poorer exercise performance at follow-up [odds ratio 8.2 (1.2, 56.0), p = 0.033]. Among patients with SC disease who underwent bicycle ergometer SE, a decreased baseline value of RVFWS at peak stress predicted poorer exercise time at follow-up.
Collapse
Affiliation(s)
- Mohamad Jihad Mansour
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1.
- Université de Montréal, Montréal, QC, Canada.
| | - Corrado De Marco
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Kevin Haddad
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Brian James Potter
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Stefania Argentin
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Lyne Bérubé
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - George Honos
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Vy-Van Le
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Sylvie Legault
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Tuong-Phong Nguyen
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Reda Salem
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Patrizia Santagata
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - François Tournoux
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Véronique Cyr
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| | - Giovanni Romanelli
- Department of Cardiology, Centre hospitalier de l'Université de Montréal, 1000 Saint-Denis Street, Montréal, QC, Canada, H2X0C1
- Université de Montréal, Montréal, QC, Canada
| |
Collapse
|
27
|
Canton L, Suma N, Amicone S, Impellizzeri A, Bodega F, Marinelli V, Ciarlantini M, Casuso M, Bavuso L, Belà R, Salerno J, Armillotta M, Angeli F, Sansonetti A, Attinà D, Russo V, Lovato L, Tuttolomondo D, Gaibazzi N, Bergamaschi L, Pizzi C. Clinical impact of multimodality assessment of myocardial viability. Echocardiography 2024; 41:e15854. [PMID: 38940225 DOI: 10.1111/echo.15854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 05/20/2024] [Indexed: 06/29/2024] Open
Abstract
Coronary artery disease (CAD) is a prevalent cause of left ventricular dysfunction. Nevertheless, effective elective revascularization, particularly surgical revascularization, can enhance long-term outcomes and, in selected cases, global left ventricular contractility. The assessment of myocardial viability and scars is still relevant in guiding treatment decisions and selecting patients who are likely to benefit most from blood flow restoration. Although the most recent randomized studies challenge the notion of "hibernating myocardium" and the clinical usefulness of assessing myocardial viability, the advancement of imaging techniques still renders this assessment valuable in specific situations. According to the guidelines of the European Society of Cardiology, non-invasive stress imaging may be employed to define myocardial ischemia and viability in patients with CAD and heart failure before revascularization. Currently, several non-invasive imaging techniques are available to evaluate the presence and extent of viable myocardium. The selection of the most suitable technique should be based on the patient, clinical context, and resource availability. This narrative review evaluates the characteristics of available imaging modalities for assessing myocardial viability to determine the most appropriate therapeutic strategy.
Collapse
Affiliation(s)
- Lisa Canton
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Nicole Suma
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Sara Amicone
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Andrea Impellizzeri
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesca Bodega
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Virginia Marinelli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Mariachiara Ciarlantini
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Marcello Casuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Leonardo Bavuso
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Rebecca Belà
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Jessica Salerno
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Angelo Sansonetti
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Domenico Attinà
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Russo
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Luigi Lovato
- Department of Radiology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | | | - Nicola Gaibazzi
- Department of Cardiology, Parma University Hospital, Parma, Italy
| | - Luca Bergamaschi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Carmine Pizzi
- Cardiology Unit, Cardiac Thoracic and Vascular Department, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences-DIMEC-Alma Mater Studiorum, University of Bologna, Bologna, Italy
| |
Collapse
|
28
|
Payne DL, Purohit K, Borrero WM, Chung K, Hao M, Mpoy M, Jin M, Prasanna P, Hill V. Performance of GPT-4 on the American College of Radiology In-training Examination: Evaluating Accuracy, Model Drift, and Fine-tuning. Acad Radiol 2024; 31:3046-3054. [PMID: 38653599 DOI: 10.1016/j.acra.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/01/2024] [Accepted: 04/06/2024] [Indexed: 04/25/2024]
Abstract
RATIONALE AND OBJECTIVES In our study, we evaluate GPT-4's performance on the American College of Radiology (ACR) 2022 Diagnostic Radiology In-Training Examination (DXIT). We perform multiple experiments across time points to assess for model drift, as well as after fine-tuning to assess for differences in accuracy. MATERIALS AND METHODS Questions were sequentially input into GPT-4 with a standardized prompt. Each answer was recorded and overall accuracy was calculated, as was logic-adjusted accuracy, and accuracy on image-based questions. This experiment was repeated several months later to assess for model drift, then again after the performance of fine-tuning to assess for changes in GPT's performance. RESULTS GPT-4 achieved 58.5% overall accuracy, lower than the PGY-3 average (61.9%) but higher than the PGY-2 average (52.8%). Adjusted accuracy was 52.8%. GPT-4 showed significantly higher (p = 0.012) confidence for correct answers (87.1%) compared to incorrect (84.0%). Performance on image-based questions was significantly poorer (p < 0.001) at 45.4% compared to text-only questions (80.0%), with adjusted accuracy for image-based questions of 36.4%. When the questions were repeated, GPT-4 chose a different answer 25.5% of the time and there was no change in accuracy. Fine-tuning did not improve accuracy. CONCLUSION GPT-4 performed between PGY-2 and PGY-3 levels on the 2022 DXIT, significantly poorer on image-based questions, and with large variability in answer choices across time points. Exploratory experiments in fine-tuning did not improve performance. This study underscores the potential and risks of using minimally-prompted general AI models in interpreting radiologic images as a diagnostic tool. Implementers of general AI radiology systems should exercise caution given the possibility of spurious yet confident responses.
Collapse
Affiliation(s)
- David L Payne
- Stony Brook University Hospital Department of Radiology, 101 Nicolls Road, Stony Brook, New York 11794, USA (D.L.P., K.P., W.M.B., K.C., M.H., M.M., M.J.); Stony Brook University Department of Biomedical Informatics, 1 Lauterbur Drive, Stony Brook, New York 11794, USA (D.L.P., P.P.).
| | - Kush Purohit
- Stony Brook University Hospital Department of Radiology, 101 Nicolls Road, Stony Brook, New York 11794, USA (D.L.P., K.P., W.M.B., K.C., M.H., M.M., M.J.)
| | - Walter Morales Borrero
- Stony Brook University Hospital Department of Radiology, 101 Nicolls Road, Stony Brook, New York 11794, USA (D.L.P., K.P., W.M.B., K.C., M.H., M.M., M.J.)
| | - Katherine Chung
- Stony Brook University Hospital Department of Radiology, 101 Nicolls Road, Stony Brook, New York 11794, USA (D.L.P., K.P., W.M.B., K.C., M.H., M.M., M.J.)
| | - Max Hao
- Stony Brook University Hospital Department of Radiology, 101 Nicolls Road, Stony Brook, New York 11794, USA (D.L.P., K.P., W.M.B., K.C., M.H., M.M., M.J.)
| | - Mutshipay Mpoy
- Stony Brook University Hospital Department of Radiology, 101 Nicolls Road, Stony Brook, New York 11794, USA (D.L.P., K.P., W.M.B., K.C., M.H., M.M., M.J.)
| | - Michael Jin
- Stony Brook University Hospital Department of Radiology, 101 Nicolls Road, Stony Brook, New York 11794, USA (D.L.P., K.P., W.M.B., K.C., M.H., M.M., M.J.)
| | - Prateek Prasanna
- Stony Brook University Department of Biomedical Informatics, 1 Lauterbur Drive, Stony Brook, New York 11794, USA (D.L.P., P.P.)
| | - Virginia Hill
- Northwestern University Feinberg School of Medicine Department of Radiology, 676 North Clair Street, Chicago, Illinois 60611, USA (V.H.)
| |
Collapse
|
29
|
Mørch J, Kolnes EH, Greve G, Omdal TR, Ebbing C, Kessler J, Khan U. Increasing region of interest width reduces neonatal circumferential strain. Echocardiography 2024; 41:e15873. [PMID: 38985125 DOI: 10.1111/echo.15873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/10/2024] [Accepted: 06/10/2024] [Indexed: 07/11/2024] Open
Abstract
OBJECTIVE There is growing interest in speckle tracking echocardiography-derived strain as a measure of left ventricular function in neonates. However, knowledge gaps remain regarding the effect of image acquisition and processing parameters on circumferential strain measurements. The aim of this study was to evaluate the effect of using different region of interest (ROI) widths on speckle tracking derived circumferential strain in healthy neonates. METHODS Thirty healthy-term-born neonates were examined with speckle-tracking echocardiography in the short-axis view. Circumferential strain values were acquired and compared using two different ROI widths. Furthermore, strain values in the different vendor-defined wall layers were also compared. RESULTS Increasing ROI width led to a decrease in global circumferential strain (GCS) in the midwall and epicardial layers, the respective decreases in strain being -23.4 ± .6% to -22.0 ± 1.1%, p < .0001 and 18.5 ± 1.7% to -15.6 ± 2.0%, p < .0001. Segmental analyses were consistent with these results, apart from two segments in the midwall. There was no statistically significant effect on strain for the endocardial layer. A gradient was seen where strain increased from the epicardial to endocardial layers. CONCLUSION Increasing ROI width led to a decrease in GCS in the midwall and epicardium. There is an increase in circumferential strain when moving from the epicardial toward the endocardial layer. Clinicians wishing to implement circumferential strain into their practice should consider ROI width variation as a potential confounder in their measurements.
Collapse
Affiliation(s)
- Johannes Mørch
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Tom Roar Omdal
- Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Cathrine Ebbing
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Jörg Kessler
- Department of Obstetrics and Gynecology, Haukeland University Hospital, Bergen, Norway
| | - Umael Khan
- Department of Internal Medicine, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
30
|
Bae JY, Fallahi A, Miller W, Leon MB, Abraham TP, Bangalore S, Hsi DH. A call to consider an aortic stenosis screening program. Trends Cardiovasc Med 2024; 34:297-301. [PMID: 37105278 DOI: 10.1016/j.tcm.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 04/16/2023] [Accepted: 04/23/2023] [Indexed: 04/29/2023]
Abstract
Aortic stenosis (AS) is the most common age-related valvular condition with a prevalence of 13.1% in patients older than 75 years of age. Based on the severity of AS and symptoms, current guidelines recommend interval monitoring with transthoracic echocardiogram (TTE). However, no guidelines exist regarding screening asymptomatic persons for AS. Prevalence of AS is comparable to conditions such as colorectal cancer, lung cancer, breast cancer, and abdominal aortic aneurysm where dedicated screening programs are offered resulting in reduction of overall morbidity and mortality. We review recent advancements in treatment options, and we propose an AS screening program for high-risk individuals without known history of AS including all persons over age 75 and persons aged 70 years and older with dialysis dependent end-stage renal disease (ESRD).
Collapse
Affiliation(s)
- Ju Young Bae
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale New Haven Health Bridgeport Hospital, Bridgeport, CT, United States
| | - Arzhang Fallahi
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States
| | - Wayne Miller
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States
| | - Martin B Leon
- Columbia University Medical Center/New York Presbyterian Hospital, University of Columbia College of Physicians and Surgeons, New York, NY, United States
| | - Theodore P Abraham
- University of California San Francisco Medical Center, CA, United States
| | - Sripal Bangalore
- New York University Grossman School of Medicine, New York, NY, United States
| | - David H Hsi
- Heart & Vascular Institute, Stamford Hospital, Stamford, CT, United States.
| |
Collapse
|
31
|
Yuasa N, Harada T, Kagami K, Ishii H, Obokata M. The roles of exercise stress echocardiography for the evaluation of heart failure with preserved ejection fraction in the heart failure pandemic era. J Med Ultrason (2001) 2024; 51:437-445. [PMID: 38926301 DOI: 10.1007/s10396-024-01468-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/30/2024] [Indexed: 06/28/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) accounts for nearly 70% of all HF and has become the dominant form of HF. The increased prevalence of HFpEF has contributed to a rise in the number of HF patients, known as the "heart failure pandemic". In addition to the fact that HF is a progressive disease and a delayed diagnosis may worsen clinical outcomes, the emergence of disease-modifying treatments such as sodium-glucose transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists has made appropriate and timely identification of HFpEF even more important. However, diagnosis of HFpEF remains challenging in patients with a lower degree of congestion. In addition to normal EF, this is related to the fact that left ventricular (LV) filling pressures are often normal at rest but become abnormal during exercise. Exercise stress echocardiography can identify such exercise-induced elevations in LV filling pressures and facilitate the diagnosis of HFpEF. Exercise stress echocardiography may also be useful for risk stratification and assessment of exercise tolerance as well as cardiovascular responses to exercise. Recent attention has focused on dedicated dyspnea clinics to identify early HFpEF among patients with unexplained dyspnea and to investigate the causes of dyspnea. This review discusses the role of exercise stress echocardiography in the diagnosis and evaluation of HFpEF.
Collapse
Affiliation(s)
- Naoki Yuasa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Kazuki Kagami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan.
| |
Collapse
|
32
|
Tatavarthy M, Stathopoulos J, Oktay AA. Prevention and treatment of hypertensive left ventricular hypertrophy. Curr Opin Cardiol 2024; 39:251-258. [PMID: 38603529 DOI: 10.1097/hco.0000000000001135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
PURPOSE OF REVIEW Left ventricular (LV) hypertrophy (LVH) is a well recognized target organ adaptation to longstanding uncontrolled hypertension and other cardiovascular risk factors. It is also a strong and independent predictor of many cardiovascular disorders. RECENT FINDINGS This focused review explores the current concepts in screening, diagnosis, prevention, and treatment of LVH in patients with hypertension. Currently, the primary screening and diagnostic tools for LVH are ECG and 2D echocardiography. Implementing machine learning in the diagnostic modalities can improve sensitivity in the detection of LVH. Lifestyle modifications, blood pressure control with antihypertensive therapy, and management of comorbidities aid in preventing and reversing LV remodeling. SUMMARY LVH is a common and often silent complication of hypertension. Prevention and reversal of LV remodeling are crucial for cardiovascular risk reduction in patients with hypertension.
Collapse
Affiliation(s)
| | | | - Ahmet Afşin Oktay
- Division of Cardiology, Rush University Medical Center, Chicago, Illinois, USA
| |
Collapse
|
33
|
Aneni EC, Sinusas AJ, Emokpae MC, Thorn SL, Yaggi HK, Miller EJ. Links Between Obstructive Sleep Apnea and Myocardial Blood Flow Changes Impacting Adverse Cardiovascular Disease-related Outcomes. Curr Cardiol Rep 2024; 26:723-734. [PMID: 38806976 DOI: 10.1007/s11886-024-02072-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/13/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE OF REVIEW Recent studies have demonstrated an association between obstructive sleep apnea (OSA) and abnormal myocardial blood flow (MBF), myocardial flow reserve (MFR), and coronary microvascular dysfunction (CMD). Here, we review the evidence and describe the potential underlying mechanisms linking OSA to abnormal MBF. Examining relevant studies, we assess the impact of OSA-specific therapy, such as continuous positive airway pressure (CPAP), on MBF. RECENT FINDINGS Recent studies suggest an association between moderate to severe OSA and abnormal MBF/MFR. OSA promotes functional and structural abnormalities of the coronary microcirculation. OSA also promotes the uncoupling of MBF to cardiac work. In a handful of studies with small sample sizes, CPAP therapy improved MBF/MFR. Moderate to severe OSA is associated with abnormal MFR, suggesting an association with CMD. Evidence suggests that CPAP therapy improves MBF. Future studies must determine the clinical impact of improved MBF with CPAP.
Collapse
Affiliation(s)
- Ehimen C Aneni
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8017, USA.
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8017, USA
- Department of Bioengineering, Yale University, 17 Hillhouse Avenue, New Haven, CT, 06520-8292, USA
| | - Morgan C Emokpae
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8017, USA
| | - Stephanie L Thorn
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8017, USA
| | - H Klar Yaggi
- Section of Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, 300 Cedar Street, New Haven, CT, 06520-8057, USA
| | - Edward J Miller
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520-8017, USA
| |
Collapse
|
34
|
Amin S, Baron SJ, Galper BZ. Aortic valve replacement today: Outcomes, costs, and opportunities for improvement. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 64:78-86. [PMID: 38388246 DOI: 10.1016/j.carrev.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 01/19/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024]
Abstract
The introduction of transcatheter aortic valve replacement (TAVR) just two decades ago has transformed the treatment of severe symptomatic aortic stenosis. TAVR has not only extended the option of aortic valve replacement to patients deemed ineligible for surgery, it has also demonstrated similar or better short- and intermediate-term clinical outcomes compared with surgical aortic valve replacement (SAVR) in patients at all levels of surgical risk. These benefits have been achieved with similar or lower costs compared with SAVR, at least in the first 1-2 years for intermediate- and low-risk patients. Longer-term data will further inform clinical and shared decision-making. SUMMARY FOR ANNOTATED TABLE OF CONTENTS: In just over two decades, transcatheter aortic valve replacement has emerged as a frontline approach for appropriately selected patients with severe aortic stenosis. A growing body of evidence documents similar or better clinical outcomes and cost-effectiveness for transcatheter compared with surgical aortic valve replacement. Whether the mode is transcatheter or surgical, aortic valve replacement remains underutilized in patients with clear indications for intervention.
Collapse
Affiliation(s)
- Sameer Amin
- L.A. Care Health Plan, 1055 W. 7th St, 10th Floor, Los Angeles, CA 90017, United States
| | - Suzanne J Baron
- Interventional Cardiovascular Research, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Outcomes Research, Baim Institute for Clinical Research, 930 W. Commonwealth Ave., Boston, MA 02215, United States
| | - Benjamin Z Galper
- Structural Heart Disease Program, Mid-Atlantic Permanente Medical Group, 8008 Westpark Dr., McLean, VA 22102, United States; Cardiac Catheterization Laboratory, Virginia Hospital Center, 1701 N. George Mason Dr., Arlington, VA 22205, United States.
| |
Collapse
|
35
|
Albulushi A, Al Hajri R, Hovseth C, Jawa Z, El Hadad MG, Sallam M, Al-Mukhaini M. Advancements and challenges in cardiac amyloidosis imaging: A comprehensive review of novel techniques and clinical applications. Curr Probl Cardiol 2024; 49:102733. [PMID: 38955249 DOI: 10.1016/j.cpcardiol.2024.102733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/04/2024]
Abstract
Cardiac amyloidosis, characterized by amyloid fibril deposition in the myocardium, leads to restrictive cardiomyopathy and heart failure. This review explores recent advancements in imaging techniques for diagnosing and managing cardiac amyloidosis, highlighting their clinical applications, strengths, and limitations. Echocardiography remains a primary, non-invasive imaging modality but lacks specificity. Cardiac MRI (CMR), with Late Gadolinium Enhancement (LGE) and T1 mapping, offers superior tissue characterization, though at higher costs and limited availability. Scintigraphy with Tc-99m-PYP reliably diagnoses transthyretin (TTR) amyloidosis but is less effective for light chain (AL) amyloidosis, necessitating complementary diagnostics. Amyloid-specific PET tracers, such as florbetapir and flutemetamol, provide precise imaging and quantitative assessment for both TTR and AL amyloidosis. Challenges include differentiating between TTR and AL amyloidosis, early disease detection, and standardizing imaging protocols. Future research should focus on developing novel tracers, integrating multimodality imaging, and leveraging AI to enhance diagnostic accuracy and personalized treatment. Advancements in imaging have improved cardiac amyloidosis management. A multimodal approach, incorporating echocardiography, CMR, scintigraphy, and PET tracers, offers comprehensive assessment. Continued innovation in tracers and AI applications promises further enhancements in diagnosis, early detection, and patient outcomes.
Collapse
Affiliation(s)
- Arif Albulushi
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman.
| | - Ruqaya Al Hajri
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| | - Chad Hovseth
- Division of Cardiovascular Medicine, Nebraska Medicine, Omaha, NE, USA
| | - Zabah Jawa
- Department of Radiology and Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
| | | | - Mansour Sallam
- Division of Cardiology, Armed Forces Hospital, Muscat, Oman
| | - Mohammed Al-Mukhaini
- Department of Adult Cardiology, National Heart Center, The Royal Hospital, Muscat, Oman
| |
Collapse
|
36
|
Huecker M, Schutzman C, French J, El-Kersh K, Ghafghazi S, Desai R, Frick D, Thomas JJ. Accurate Modeling of Ejection Fraction and Stroke Volume With Mobile Phone Auscultation: Prospective Case-Control Study. JMIR Cardio 2024; 8:e57111. [PMID: 38924781 PMCID: PMC11237790 DOI: 10.2196/57111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 03/19/2024] [Accepted: 04/10/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Heart failure (HF) contributes greatly to morbidity, mortality, and health care costs worldwide. Hospital readmission rates are tracked closely and determine federal reimbursement dollars. No current modality or technology allows for accurate measurement of relevant HF parameters in ambulatory, rural, or underserved settings. This limits the use of telehealth to diagnose or monitor HF in ambulatory patients. OBJECTIVE This study describes a novel HF diagnostic technology using audio recordings from a standard mobile phone. METHODS This prospective study of acoustic microphone recordings enrolled convenience samples of patients from 2 different clinical sites in 2 separate areas of the United States. Recordings were obtained at the aortic (second intercostal) site with the patient sitting upright. The team used recordings to create predictive algorithms using physics-based (not neural networks) models. The analysis matched mobile phone acoustic data to ejection fraction (EF) and stroke volume (SV) as evaluated by echocardiograms. Using the physics-based approach to determine features eliminates the need for neural networks and overfitting strategies entirely, potentially offering advantages in data efficiency, model stability, regulatory visibility, and physical insightfulness. RESULTS Recordings were obtained from 113 participants. No recordings were excluded due to background noise or for any other reason. Participants had diverse racial backgrounds and body surface areas. Reliable echocardiogram data were available for EF from 113 patients and for SV from 65 patients. The mean age of the EF cohort was 66.3 (SD 13.3) years, with female patients comprising 38.3% (43/113) of the group. Using an EF cutoff of ≤40% versus >40%, the model (using 4 features) had an area under the receiver operating curve (AUROC) of 0.955, sensitivity of 0.952, specificity of 0.958, and accuracy of 0.956. The mean age of the SV cohort was 65.5 (SD 12.7) years, with female patients comprising 34% (38/65) of the group. Using a clinically relevant SV cutoff of <50 mL versus >50 mL, the model (using 3 features) had an AUROC of 0.922, sensitivity of 1.000, specificity of 0.844, and accuracy of 0.923. Acoustics frequencies associated with SV were observed to be higher than those associated with EF and, therefore, were less likely to pass through the tissue without distortion. CONCLUSIONS This work describes the use of mobile phone auscultation recordings obtained with unaltered cellular microphones. The analysis reproduced the estimates of EF and SV with impressive accuracy. This technology will be further developed into a mobile app that could bring screening and monitoring of HF to several clinical settings, such as home or telehealth, rural, remote, and underserved areas across the globe. This would bring high-quality diagnostic methods to patients with HF using equipment they already own and in situations where no other diagnostic and monitoring options exist.
Collapse
Affiliation(s)
- Martin Huecker
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Craig Schutzman
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Joshua French
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Karim El-Kersh
- Department of Pulmonary and Critical Care Medicine, The University of Arizona, Phoenix, AZ, United States
| | - Shahab Ghafghazi
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Ravi Desai
- Lehigh Valley Health Network Cardiology and Critical Care, Allentown, PA, United States
| | - Daniel Frick
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| | - Jarred Jeremy Thomas
- Department of Emergency Medicine, University of Louisville, Louisville, KY, United States
| |
Collapse
|
37
|
Ji X, Zhang J, Xie Y, Wang W, Zhang Y, Xie M, Zhang L. Speckle-Tracking Echocardiography in Right Ventricular Function of Clinically Well Patients with Heart Transplantation. Diagnostics (Basel) 2024; 14:1305. [PMID: 38928720 PMCID: PMC11203351 DOI: 10.3390/diagnostics14121305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/31/2024] [Accepted: 06/17/2024] [Indexed: 06/28/2024] Open
Abstract
Heart transplantation (HT) is the mainstream therapy for end-stage heart disease. However, the cardiac graft function can be affected by several factors. It is important to monitor HT patients for signs of graft dysfunction. Transthoracic echocardiography is a simple, first-line, and non-invasive method for the assessment of cardiac function. The emerging speckle-tracking echocardiography (STE) could quickly and easily provide additive information over traditional echocardiography. STE longitudinal deformation parameters are markers of early impairment of ventricular function. Although once called the "forgotten ventricle", right ventricular (RV) assessment has gained attention in recent years. This review highlights the potentially favorable role of STE in assessing RV systolic function in clinically well HT patients.
Collapse
Affiliation(s)
- Xiang Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Junmin Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuji Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenyuan Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yiwei Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (X.J.); (J.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| |
Collapse
|
38
|
Papadopoulos CH, Kadoglou NPE, Theodosis-Georgilas A, Karabinos I, Loizos S, Papadopoulos KG, Chrysocheris M, Ninios V, Frogoudaki A, Drakopoulou M, Angelaki M, Rallidis L, Kassinos N, Sahpekidis V, Makavos G, Yiangou K, Karagiannis S, Zois N, Patrianakos A, Ikonomidis I, Tsiapras D, Kouris N, Aggeli K, Pappas K, Prappa E, Stefanidis A. Transoesophageal echocardiography beyond the echo-laboratory. An expert consensus paper of the working group of echocardiography of the hellenic society of cardiology. Hellenic J Cardiol 2024:S1109-9666(24)00128-3. [PMID: 38901557 DOI: 10.1016/j.hjc.2024.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 06/09/2024] [Accepted: 06/12/2024] [Indexed: 06/22/2024] Open
Abstract
Transoesophageal echocardiography (TOE) is a well-established and valid imaging modality, providing more accurate and of higher quality information than transthoracic echocardiography (TTE) for several specific diagnoses and recently a useful guide of an increasing number of catheter-based and surgical interventions. The present paper represents an effort by the Echocardiography Working Group (WG) of the Hellenic Society of Cardiology to state the essential steps of the TOE exam performed beyond the echo lab: a) in the operating rooms intraoperatively during either transcatheter interventions, or cardiothoracic surgery and b) in the intensive care unit for critically ill patients' monitoring. This paper includes information and tips and tricks about the pre-procedural evaluation, the procedural echocardiographic guidance, and post-procedural evaluation of the result and potential complications.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | - Vlasis Ninios
- 2nd Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | - Maria Drakopoulou
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | - Maria Angelaki
- 1st Cardiology Department, Korgialenio - Benakio Red Cross Hospital, Athens, Greece
| | | | | | | | | | | | | | - Nikolaos Zois
- Private Practice, Cardiology Department, University Hospital of Ioannina, Greece
| | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Konstantina Aggeli
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | | | - Efstathia Prappa
- Cardiology Department, General Hospital of Evaggelismos, Athens, Greece
| | | |
Collapse
|
39
|
Tore D, Faletti R, Palmisano A, Salto S, Rocco K, Santonocito A, Gaetani C, Biondo A, Bozzo E, Giorgino F, Landolfi I, Menchini F, Esposito A, Fonio P, Gatti M. Cardiac computed tomography with late contrast enhancement: A review. Heliyon 2024; 10:e32436. [PMID: 38933964 PMCID: PMC11200357 DOI: 10.1016/j.heliyon.2024.e32436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 05/19/2024] [Accepted: 06/04/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiac computed tomography (CCT) has assumed an increasingly significant role in the evaluation of coronary artery disease (CAD) during the past few decades, whereas cardiovascular magnetic resonance (CMR) remains the gold standard for myocardial tissue characterization. The discovery of late myocardial enhancement following intravenous contrast administration dates back to the 1970s with ex-vivo CT animal investigations; nevertheless, the clinical application of this phenomenon for cardiac tissue characterization became prevalent for CMR imaging far earlier than for CCT imaging. Recently the technical advances in CT scanners have made it possible to take advantage of late contrast enhancement (LCE) for tissue characterization in CCT exams. Moreover, the introduction of extracellular volume calculation (ECV) on cardiac CT images combined with the possibility of evaluating cardiac function in the same exam is making CCT imaging a multiparametric technique more and more similar to CMR. The aim of our review is to provide a comprehensive overview on the role of CCT with LCE in the evaluation of a wide range of cardiac conditions.
Collapse
Affiliation(s)
- Davide Tore
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Riccardo Faletti
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Anna Palmisano
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Sara Salto
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Katia Rocco
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Ambra Santonocito
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Clara Gaetani
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Andrea Biondo
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Elena Bozzo
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Fabio Giorgino
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Ilenia Landolfi
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Francesca Menchini
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Antonio Esposito
- Clinical and Experimental Radiology Unit, Experimental Imaging Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Fonio
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, AOU Città Della Salute e Della Scienza di Torino, University of Turin, Turin, Italy
| |
Collapse
|
40
|
Xiaoyong T, Yuping C, Wei H, Juan C, Feng Q, Zhuo L. Evaluafion of the efficacy of wall shear stress in carotid artery stenting. Heliyon 2024; 10:e31383. [PMID: 38828314 PMCID: PMC11140617 DOI: 10.1016/j.heliyon.2024.e31383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 06/05/2024] Open
Abstract
Objective To characterize the value of carotid wall shear stress (WSS) following carotid artery stenting (CAS) in patients with carotid stenosis. Methods Twenty-eight patients with carotid stenosis treated with CAS between March 2021 to May 2022 in the eighth medical center of the PLA General Hospital were selected for our study. Carotid ultrasound was performed before the operation, one week post-operation, and six months post-operation. Carotid artery WSS was detected by blood flow vector imaging, and the changes in WSS before and after the operation were collected. Genetic testing of drugs was detected for patients with restenosis. Results Pre-operative WSS of the proximal, narrowest region, and distal carotid arteries in patients with ischemic carotid artery stenosis was 7.88 ± 3.18Pa, 14.36 ± 6.66Pa, and 1.55 ± 1.15Pa, respectively. Comparatively, pre-operative WSS of the proximal, narrowest region and distal carotid arteries in patients without ischemic symptoms was 5.02 ± 1.99Pa, 9.68 ± 4.23Pa, and 1.10 ± 0.68Pa, respectively, with a significant difference between the two groups (p < 0.001). Overall WSS of the proximal, narrowest region, and distal carotid arteries in patients before CAS was 6.68 ± 3.0Pa, 12.47 ± 5.98Pa, and 1.39 ± 0. 96Pa. WSS of the proximal, narrowest region, and distal carotid was 4.15 ± 1.42Pa, 6.71 ± 2.64Pa, and1.86 ± 1.13Pa one week after CAS, compared to 4.44 ± 1.91Pa, 7.90 ± 4.38Pa, and 2. 36 ± 1.09Pa six months after CAS. WSS of the proximal and narrowest region of the carotid artery was reduced after carotid stenting, and the difference was statistically significant (p < 0.001). There was no statistically significant difference in WSS between one week and six months after stenting (P > 0.05). Conclusion We employed early carotid WSS as a means of evaluating the efficacy of carotid artery stenting. Changes in carotid WSS are closely associated with carotid artery stenosis, providing valuable hemodynamic information for CAS treatment. This technique holds great application value in pre-operative evaluation and long-term follow-up.
Collapse
Affiliation(s)
- Tao Xiaoyong
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chen Yuping
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Huang Wei
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Chen Juan
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Qiu Feng
- Senior Department of Neurology, The First Medical Center of PLA General Hospital, Beijing, China
| | - Li Zhuo
- Department of Ultrasonography, The Eighth Medical Center of PLA General Hospital, Beijing, China
| |
Collapse
|
41
|
Di Bella S, Sanson G, Monticelli J, Zerbato V, Principe L, Giuffrè M, Pipitone G, Luzzati R. Clostridioides difficile infection: history, epidemiology, risk factors, prevention, clinical manifestations, treatment, and future options. Clin Microbiol Rev 2024; 37:e0013523. [PMID: 38421181 DOI: 10.1128/cmr.00135-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024] Open
Abstract
SUMMARYClostridioides difficile infection (CDI) is one of the major issues in nosocomial infections. This bacterium is constantly evolving and poses complex challenges for clinicians, often encountered in real-life scenarios. In the face of CDI, we are increasingly equipped with new therapeutic strategies, such as monoclonal antibodies and live biotherapeutic products, which need to be thoroughly understood to fully harness their benefits. Moreover, interesting options are currently under study for the future, including bacteriophages, vaccines, and antibiotic inhibitors. Surveillance and prevention strategies continue to play a pivotal role in limiting the spread of the infection. In this review, we aim to provide the reader with a comprehensive overview of epidemiological aspects, predisposing factors, clinical manifestations, diagnostic tools, and current and future prophylactic and therapeutic options for C. difficile infection.
Collapse
Affiliation(s)
- Stefano Di Bella
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Gianfranco Sanson
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| | - Jacopo Monticelli
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy
| | - Verena Zerbato
- Infectious Diseases Unit, Trieste University Hospital (ASUGI), Trieste, Italy
| | - Luigi Principe
- Microbiology and Virology Unit, Great Metropolitan Hospital "Bianchi-Melacrino-Morelli", Reggio Calabria, Italy
| | - Mauro Giuffrè
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
- Department of Internal Medicine (Digestive Diseases), Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Giuseppe Pipitone
- Infectious Diseases Unit, ARNAS Civico-Di Cristina Hospital, Palermo, Italy
| | - Roberto Luzzati
- Clinical Department of Medical, Surgical and Health Sciences, Trieste University, Trieste, Italy
| |
Collapse
|
42
|
Kisiel-Sekura O, Wójciak M, Siennicka A, Tkaczyszyn M, Drozd M, Jankowska EA, Doroszko A, Banasiak W, Węgrzynowska-Teodorczyk K. Physical Fitness Is Directly Related to Exercise Capacity and Ventilatory Response to Exercise in Men with HFrEF. J Clin Med 2024; 13:3465. [PMID: 38929994 PMCID: PMC11204934 DOI: 10.3390/jcm13123465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/07/2024] [Accepted: 06/11/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Heart failure (HF) patients experience reduced functional fitness level (determining the performance of routine, daily activities) and diminished exercise capacity (linked to more effortful activities). Aim: The aim of the study is to assess this relationship using functional fitness tests compared to peak VO2 and VE/VCO2 slope in the context of exercise capacity and ventilatory response to exercise. Methods: A total of 382 men with stable HFrEF (age: 61 ± 10, NYHA class I/II/III/IV: 16/50/32/2%, LVEF: 30.5 ± 8.3%) underwent cardiopulmonary exercise testing (CPX) and a Senior Fitness Test (SFT). Afterwards, the patients were divided according to the 2capacity with peak VO2 ≥ 18 mL/kg/min, those with higher or lower ventilatory responses (VE/VCO2 slope ≥ 35 vs. <35) to the exercise were compared. Results: Patients who covered shorter distances in the 6 min walking test showed worse results in the functional tests ('stand up and go', 'chair stand' and 'arm curl') and CPX (lower peak VO2, shorter exercise time and higher VE/VCO2 slope). Subjects classified into Class D demonstrated the worst results in all elements of SFT; those in Class A demonstrated the best results. Significant differences that were analogous occurred also between classes B and C. Among the participants who reached peak VO2 ≥ 18 mL/kg/min (n = 170), those with VE/VCO2 slope ≥ 35 were characterized by worse physical fitness as compared to those with VE/VCO2 < 35. Conclusion: Reduced exercise tolerance led to worsening physical function in patients with HFrEF. Moreover, limitations in physical fitness seem to be distinctive for those patients showing excessive ventilatory response to exercise slope VE/VCO2 (≥35). The Senior Fitness Test may be considered as a useful tool for assessing comprehensive functional and clinical status and risk stratification in patients with HFrEF, especially those with extremely low exercise capacity.
Collapse
Affiliation(s)
- Olga Kisiel-Sekura
- Centre for Heart Diseases, 4th Military Hospital, 50-981 Wroclaw, Poland
| | - Magdalena Wójciak
- Centre for Heart Diseases, 4th Military Hospital, 50-981 Wroclaw, Poland
| | - Agnieszka Siennicka
- Department of Physiology, Wroclaw Medical University, 50-367 Wroclaw, Poland
| | - Michał Tkaczyszyn
- Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Marcin Drozd
- Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Ewa A. Jankowska
- Institute of Heart Diseases, Wroclaw Medical University, 50-367 Wroclaw, Poland
- Institute of Heart Diseases, University Hospital, 50-556 Wroclaw, Poland
| | - Adrian Doroszko
- Centre for Heart Diseases, 4th Military Hospital, 50-981 Wroclaw, Poland
- Faculty of Medicine, Wroclaw University of Science and Technology, 51-377 Wroclaw, Poland
| | - Waldemar Banasiak
- Centre for Heart Diseases, 4th Military Hospital, 50-981 Wroclaw, Poland
- Faculty of Medicine, Wroclaw University of Science and Technology, 51-377 Wroclaw, Poland
| | - Kinga Węgrzynowska-Teodorczyk
- Centre for Heart Diseases, 4th Military Hospital, 50-981 Wroclaw, Poland
- Faculty of Physiotherapy, Wroclaw University of Health and Sport Sciences, 51-612 Wroclaw, Poland
| |
Collapse
|
43
|
Vogt A, Plehn A, Atti C, Nussbaum M, Tongers J, Sedding D, Dutzmann J. Left ventricular structure and function following renal sympathetic denervation in patients with HFpEF: an echocardiographic 9-year long-term follow-up. Front Cardiovasc Med 2024; 11:1408547. [PMID: 38919545 PMCID: PMC11196750 DOI: 10.3389/fcvm.2024.1408547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/23/2024] [Indexed: 06/27/2024] Open
Abstract
Background High blood pressure is a major risk factor for cardiac remodeling and left ventricular hypertrophy, increasing cardiovascular risk and leading to heart failure with preserved ejection fraction (HFpEF). Since renal sympathetic denervation (RDN) reduces blood pressure in the long term, we aimed to investigate the long-term effect of RDN in patients with HFpEF in the present analysis. Methods Patients previously enrolled in a local RDN registry who underwent high-frequency RDN with the use of the Symplicity Flex® renal denervation system between 2011 and 2014 were followed up. The patients were assessed by 24-h ambulatory blood pressure measurement, transthoracic echocardiography, and laboratory tests. We used the echocardiographic and biomarker criteria of the Heart Failure Association (HFA)-PEFF (Pre-test assessment, Echocardiography and Natriuretic Peptide Score, Funkctional testing, and Final aetiology) score to identify patients with HFpEF. Results Echocardiographic assessment was available for 70 patients at a 9-year long-term follow-up. Of these patients, 21 had HFpEF according to the HFA-PEFF score. We found a significant reduction of the HFA-PEFF score from 5.48 ± 0.51 points at baseline to 4.33 ± 1.53 points at the 9-year follow-up (P < 0.01). This decrease was due to a greater reduction in morphological and biomarker subcategories [from 1.95 ± 0.22 to 1.43 ± 0.51 points (P < 0.01) and from 1.52 ± 0.52 to 0.90 ± 0.63 points (P < 0.01), respectively] than in the functional one. Morphologically, there was a reduction in left ventricular hypertrophy and left atrial dilation. Conclusions The present analysis suggests that RDN may lead to a regression of the extent of HFpEF beyond a reduction in blood pressure and thus possibly contribute to an improvement in prognosis. More detailed information will be provided by ongoing randomized sham-controlled trials.
Collapse
Affiliation(s)
- Alexander Vogt
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Alexander Plehn
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
- Praxisklinik Salzatal, Salzatal, Germany
| | - Carlo Atti
- Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Michael Nussbaum
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Jörn Tongers
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Daniel Sedding
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Jochen Dutzmann
- Department of Internal Medicine III, University Hospital Halle (Saale), Halle (Saale), Germany
| |
Collapse
|
44
|
Nishiura N, Kubo S, Fujita M, Mushiake K, Ono S, Osakada K, Maruo T, Kadota K. Indications and outcomes of the MitraClip G4 device with controlled gripper actuation system. Cardiovasc Interv Ther 2024:10.1007/s12928-024-01018-0. [PMID: 38833119 DOI: 10.1007/s12928-024-01018-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/27/2024] [Indexed: 06/06/2024]
Abstract
The MitraClip G4 device has controlled gripper actuation (CGA) system, which allows the anterior and posterior grippers operate separately in transcatheter edge-to-edge repair (TEER). We investigated the indications and outcomes of the use of CGA system during TEER for significant mitral regurgitation (MR). We reviewed 158 patients undergoing TEER with MitraClip G4 from September 2020 to July 2023. The CGA indications were: (1) for grasping and (2) for leaflet insertion confirmation. Leaflet grasping was completed with CGA in 18 patients (11 and 7 patients for grasping and leaflet insertion confirmation, respectively). Patients with flail leaflets or coaptation gap more frequently required CGA, indicating more complex mitral valve anatomy. The procedural success and adverse event rates (death, leaflet tear and single leaflet device attachment) were not different between the CGA and non-CGA groups. In patients requiring CGA, single leaflet device attachment was observed in 1 patient and leaflet tear in 1 patient during follow-up. In these two cases, CGA was required for grasping, and the clip was moved over a large distance (6.5 and 12.4 mm, respectively). In patients who had undergone CGA for confirmation, no device-related adverse event or MR recurrence was noted. In patients with complex mitral valve anatomy, CGA may be a safe and effective method for confirming leaflet insertion. It should be noted that when using CGA for leaflet grasping, especially when the clip is moved significantly, attention should be paid to leaflet adverse events.
Collapse
Affiliation(s)
- Naoki Nishiura
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan
| | - Shunsuke Kubo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan.
| | - Mikitaka Fujita
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan
| | - Kazunori Mushiake
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan
| | - Sachiyo Ono
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan
| | - Kohei Osakada
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan
| | - Takeshi Maruo
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan
| | - Kazushige Kadota
- Department of Cardiovascular Medicine, Kurashiki Central Hospital, 1-1-1, Miwa, Kurashiki, Okayama, Japan
| |
Collapse
|
45
|
Khan FH, Zhao D, Ha JW, Nagueh SF, Voigt JU, Klein AL, Gude E, Broch K, Chan N, Quill GM, Doughty RN, Young A, Seo JW, García-Izquierdo E, Moñivas-Palomero V, Mingo-Santos S, Wang TKM, Bezy S, Ohte N, Skulstad H, Beladan CC, Popescu BA, Kikuchi S, Panis V, Donal E, Remme EW, Nash MP, Smiseth OA. Evaluation of left ventricular filling pressure by echocardiography in patients with atrial fibrillation. Echo Res Pract 2024; 11:14. [PMID: 38825684 PMCID: PMC11145766 DOI: 10.1186/s44156-024-00048-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Accepted: 04/25/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND Echocardiography is widely used to evaluate left ventricular (LV) diastolic function in patients suspected of heart failure. For patients in sinus rhythm, a combination of several echocardiographic parameters can differentiate between normal and elevated LV filling pressure with good accuracy. However, there is no established echocardiographic approach for the evaluation of LV filling pressure in patients with atrial fibrillation. The objective of the present study was to determine if a combination of several echocardiographic and clinical parameters may be used to evaluate LV filling pressure in patients with atrial fibrillation. RESULTS In a multicentre study of 148 atrial fibrillation patients, several echocardiographic parameters were tested against invasively measured LV filling pressure as the reference method. No single parameter had sufficiently strong association with LV filling pressure to be recommended for clinical use. Based on univariate regression analysis in the present study, and evidence from existing literature, we developed a two-step algorithm for differentiation between normal and elevated LV filling pressure, defining values ≥ 15 mmHg as elevated. The parameters in the first step included the ratio between mitral early flow velocity and septal mitral annular velocity (septal E/e'), mitral E velocity, deceleration time of E, and peak tricuspid regurgitation velocity. Patients who could not be classified in the first step were tested in a second step by applying supplementary parameters, which included left atrial reservoir strain, pulmonary venous systolic/diastolic velocity ratio, and body mass index. This two-step algorithm classified patients as having either normal or elevated LV filling pressure with 75% accuracy and with 85% feasibility. Accuracy in EF ≥ 50% and EF < 50% was similar (75% and 76%). CONCLUSIONS In patients with atrial fibrillation, no single echocardiographic parameter was sufficiently reliable to be used clinically to identify elevated LV filling pressure. An algorithm that combined several echocardiographic parameters and body mass index, however, was able to classify patients as having normal or elevated LV filling pressure with moderate accuracy and high feasibility.
Collapse
Affiliation(s)
- Faraz H Khan
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | - Debbie Zhao
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Jong-Won Ha
- Cardiology Division, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, Department of Cardiovascular Sciences, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium
| | | | - Einar Gude
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | - Kaspar Broch
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | | | - Gina M Quill
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Robert N Doughty
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Alistair Young
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Ji-Won Seo
- Cardiology Division, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | | | - Susana Mingo-Santos
- Cardiology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | | | - Stephanie Bezy
- Department of Cardiovascular Diseases, Department of Cardiovascular Sciences, University Hospitals Leuven, Catholic University of Leuven, Leuven, Belgium
| | - Nobuyuki Ohte
- Department of cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Helge Skulstad
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
| | - Carmen C Beladan
- University of Medicine and Pharmacy "Carol Davila", Emergency Institute for, Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, Euroecolab, Bucharest, 0223228, Romania
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Emergency Institute for, Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, Euroecolab, Bucharest, 0223228, Romania
| | - Shohei Kikuchi
- Department of cardiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Vasileios Panis
- Department of Cardiology, CHU Rennes and Inserm, LTSI, University of Rennes, Rennes, France
| | - Erwan Donal
- Department of Cardiology, CHU Rennes and Inserm, LTSI, University of Rennes, Rennes, France
| | - Espen W Remme
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway
- The Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Martyn P Nash
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Otto A Smiseth
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, University of Oslo, Rikshospitalet, Oslo, N-0027, Norway.
| |
Collapse
|
46
|
Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
Collapse
Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| |
Collapse
|
47
|
Geraghty JR, Saini NS, Deshpande A, Cheng T, Nazir N, Testai FD. The Role of Serum Monocytes and Tissue Macrophages in Driving Left Ventricular Systolic Dysfunction and Cardiac Inflammation Following Subarachnoid Hemorrhage. Neurocrit Care 2024; 40:1127-1139. [PMID: 38062302 DOI: 10.1007/s12028-023-01891-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 11/06/2023] [Indexed: 06/05/2024]
Abstract
BACKGROUND Neurocardiogenic injury is common after aneurysmal subarachnoid hemorrhage (aSAH) despite low prevalence of preexisting cardiac disease. Potential mechanisms include autonomic dysregulation due to excess catecholamines as well as systemic inflammation. Understanding how inflammation contributes to cardiac dysfunction may aid in identifying novel therapeutic strategies. Here, we investigated serum leukocytes as predictors of left ventricular systolic dysfunction in patients with aSAH. We also investigated increased cardiac macrophages in an animal model of SAH and whether immunomodulatory treatment could attenuate this inflammatory response. METHODS We retrospectively analyzed 256 patients with aSAH admitted to University of Illinois Hospital between 2013 and 2019. Our inclusion criteria included patients with aSAH receiving an echocardiogram within 72 h of admission. Our primary outcome was echocardiographic evidence of systolic dysfunction. We performed multinomial regression and receiver operating curve analysis. We also used the endovascular perforation model of SAH in male Sprague-Dawley rats to assess for myocardial inflammation. Two days after surgery, hearts were collected and stained for the macrophage marker Iba-1. We compared the presence and morphology of macrophages in cardiac tissue isolated from SAH animals and sham controls treated with and without the immunomodulatory agent fingolimod. RESULTS Of 256 patients with aSAH, 233 (91.0%) underwent echocardiography within 72 h of admission. Of 233, 81 (34.7%) had systolic dysfunction. Patients had baseline differences in the presence of hypertension, alcohol use, and admission Glasgow Coma Scale and Hunt-Hess score. On multivariable analysis, total leukocytes (odds ratio 1.312, p < 0.001), neutrophils (odds ratio 1.242, p = 0.012), and monocytes (odds ratio 6.112, p = 0.008) were independent predictors of reduced systolic function, whereas only monocytes (odds ratio 28.014, p = 0.030) predicted hyperdynamic function. Within the rodent heart, there were increased macrophages after SAH relative to controls, and this was attenuated by fingolimod treatment (p < 0.0001). CONCLUSIONS Increased serum leukocytes are associated with abnormal left ventricular systolic function following aSAH. The strongest independent predictor of both reduced and hyperdynamic systolic function was increased monocytes. Increased cardiac macrophages after experimental SAH can also be targeted by using immunomodulatory drugs.
Collapse
Affiliation(s)
- Joseph R Geraghty
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA.
- Department of Neurology, University of Pennsylvania Perelman School of Medicine, 3400 Spruce Street, Philadelphia, PA, 19104, USA.
| | - Neil S Saini
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| | - Ashwini Deshpande
- Division of Cardiology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Tiffany Cheng
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO, USA
| | - Noreen Nazir
- Division of Cardiology, Department of Medicine, University of Illinois College of Medicine, Chicago, IL, USA
| | - Fernando D Testai
- Department of Neurology and Rehabilitation, University of Illinois College of Medicine, Chicago, IL, USA
| |
Collapse
|
48
|
Asanuma T. Myocardial motion in acute ischemia: revealing invisible deformation by echocardiography. J Echocardiogr 2024; 22:71-78. [PMID: 38615090 DOI: 10.1007/s12574-024-00650-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 03/14/2024] [Accepted: 03/16/2024] [Indexed: 04/15/2024]
Abstract
Echocardiography has been used clinically to assess regional myocardial wall motion for the diagnosis of acute myocardial ischemia or stress-induced ischemia, but it is often difficult to distinguish hypokinetic motion from normal motion. Myocardial wall motion is affected by loading conditions as well as intrinsic contractility, making it challenging to define a normal range of wall motion. Therefore, hypokinesis is usually diagnosed by comparing target areas with other areas of myocardium considered normal (relative hypokinesis). Myocardial strain analysis by tissue Doppler echocardiography and speckle-tracking echocardiography has enabled objective and quantitative evaluation of regional myocardial wall motion. Peak systolic strain decreases during acute ischemia, but subtle and invisible myocardial motion, such as early systolic lengthening (ESL) and postsystolic shortening (PSS), also occurs, and the analysis of these subtle motions can improve the diagnostic accuracy of ischemia. However, the diagnosis of ischemic myocardium by strain analysis is not widely performed in clinical practice at this time due to several limitations. This article reviews the features of myocardial motion during acute ischemia, the mechanisms of ESL and PSS, the diagnosis of ischemic myocardium using strain analysis, and current approaches and future challenges to overcome the limitations in the detection of relative hypokinesis. This article also explains the use of ESL and PSS to detect myocardial ischemic memory that remains after brief ischemia.
Collapse
Affiliation(s)
- Toshihiko Asanuma
- Division of Cardiology, Shimane University Faculty of Medicine, 89-1 Enya-Cho, Izumo, Shimane, 693-8501, Japan.
| |
Collapse
|
49
|
Crea F, Iannaccone G, La Vecchia G, Montone RA. An update on the mechanisms of Takotsubo syndrome: "At the end an acute coronary syndrome". J Mol Cell Cardiol 2024; 191:1-6. [PMID: 38641224 DOI: 10.1016/j.yjmcc.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2023] [Revised: 03/13/2024] [Accepted: 04/10/2024] [Indexed: 04/21/2024]
Abstract
Takotsubo syndrome (TTS) is an acute reversible form of myocardial dysfunction, often preceded by a physical or emotional stressful event, that acts as a trigger. Despite, recent advances in the comprehension of the mechanisms leading to TTS, its pathophysiology is far from being completely understood. However, several studies seem to suggest that an acute coronary microvascular dysfunction may represent a crucial pathogenic mechanism involved in TTS occurrence. In this article, we aim to review the complex pathophysiology of TTS and the possible different mechanisms underlying this clinical condition, focusing on the role of coronary microvascular dysfunction and the remaining knowledge's gaps in the field.
Collapse
Affiliation(s)
- Filippo Crea
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy; Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy.
| | - Giulia Iannaccone
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Giulia La Vecchia
- Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Rome, Italy
| | - Rocco A Montone
- Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| |
Collapse
|
50
|
Liu Y, Yin S, Lin Z, Zhao C, Zhang H. Two-dimensional speckle-tracking echocardiography in left ventricular systolic function in patients with systemic lupus erythematosus. Clin Rheumatol 2024; 43:1871-1880. [PMID: 38653848 DOI: 10.1007/s10067-024-06929-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 02/20/2024] [Accepted: 03/01/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVES To investigate whether two-dimensional speckle-tracking echocardiography (2DSTE) can be considered a criterion for early left ventricular (LV) systolic impairment in patients with systemic lupus erythematosus (SLE) and to further explore the association with each other. METHODS We included 38 patients with SLE and assessed the degree of disease activity according to the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) 2000 scoring criteria, together with 38 healthy controls who were matched by sex and age. Routine LV systolic function evaluation parameters were obtained by echocardiography as well as 2DSTE measurement of LV strain parameters to obtain global longitudinal strain (GLS) values, respectively. RESULTS (I) On routine LV function parameters such as ejection fractions (EF) and left ventricular end-diastolic internal diameter (LVIDd), the SLE group and the control group did not reflect differences. In contrast, on the LV strain parameter obtained from 2DSTE measurements, the GLS values in all cardiac planes were lower in the SLE group than in the control group and showed statistically significant differences. (II) Correlation analysis showed that there was a correlation between SLEDAI and GLS, especially a meaningful correlation with GLS Avg and GLS A4C, with correlation coefficients of 0.35 and 0.47, respectively. CONCLUSIONS The use of 2DSTE can detect early impaired LV systolic function in SLE patients, and GLS is progressively gaining attention as an indicator of subclinical myocardial injury and LV function in SLE patients. The correlation that exists between GLS and SLEDAI might contribute to a better assessment of cardiac involvement in SLE patients. Key Points • Cardiac involvement has become one of the major factors in the poor prognosis of SLE patients, which directly affects the mortality of SLE patients. Traditional echocardiography is difficult to detect early left ventricular function impairment, thus affecting clinicians' judgment and diagnosis. • 2DSTE can recognize subclinical myocardial injury in SLE patients at an early stage, and its derived strain parameters may be used as an indicator to evaluate myocardial involvement and reflect disease activity in SLE patients.
Collapse
Affiliation(s)
- Yuhong Liu
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Shanshan Yin
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhiming Lin
- Department of Rheumatology, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Changlin Zhao
- Department of Cardiovascular, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| | - Hui Zhang
- Department of Ultrasound, Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
| |
Collapse
|