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Löffler F, Westhoff-Bleck M, Welte T, Park DH, Olsson KM, Behrendt L, Klimeš F, Bauersachs J, Wacker F, Pöhler GH. Doppler-derived pulmonary pulse transit time measurements in chronic obstructive pulmonary disease: Reproducibility and cardiopulmonary function. Echocardiography 2024; 41:e15821. [PMID: 38706373 DOI: 10.1111/echo.15821] [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: 01/05/2024] [Revised: 03/22/2024] [Accepted: 04/11/2024] [Indexed: 05/07/2024] Open
Abstract
INTRODUCTION Doppler-derived pulmonary pulse transit time (pPTT) is an auspicious hemodynamic marker in chronic pulmonary diseases. The aim is to compare four distinct pPTT measurements and its relation to right cardiac and pulmonary function. METHODS Prospectively, 25 chronic obstructive pulmonary disease (COPD) patients (four patients excluded) and 32 healthy subjects underwent repeated distinct pPTT measurements, standard echocardiography, and pulmonary function testing on the same day. pPTT was defined as the interval from the R or Q-wave in the electrocardiogram to the corresponding pulse wave Doppler peak late systolic (S) 2 or diastolic (D) pulmonary vein flow velocity (pPTT R-S, Q-S, R-D, Q-D). Reproducibility was assessed using Bland-Altman analysis, coefficient of variation (COV), intraclass correlation coefficient (ICC), and power calculations. Associations with right ventricular RV tissue and pulse wave Doppler velocities (RV E', RV S', RV A', RV E, RV A, RV E/E', RV E/A), TAPSE, right ventricular fractional area change, left ventricular systolic and diastolic function (LV ejection fraction, E, A, E/A, E/E', septal E', lateral E'), LA diameters, as well as forced expiratory volume in 1 s, forced vital capacity (FVC) predicted (%), and in liters were analyzed. RESULTS There was no significant difference and no bias between pPTT measures (p range: .1-.9). COV was in COPD 1.2%-2.3%, in healthy subjects 1.0%-3.1%. ICC ranged from .92 (COPD) to .96 (healthy subjects). In COPD significant correlations were found for pPTT R-S, Q-S and R-D with RV E`, (all > ρ: .49, < p = .0364), pPTT R-S, Q-S with RV E/E` (both > ρ: .49, < p = .0291), pPTT Q-S with RV S´ (ρ: .58, p = .0134), RV A (ρ: .59, p = .0339) and heart rate > ρ: -.39, < p = .0297). pPTT R-S, R-D showed significant correlations with FVC predicted (%) (ρ: .48 p = .0224) and FVC (l) (ρ:.47 p = .0347). CONCLUSIONS All pPTT measures exhibited high reproducibility. In COPD patients pPTT measures correlate with diastolic right ventricular function. Defining Q as starting point seems clinically advantageous considering electromechanical desynchrony in patients with conduction disorders.
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Affiliation(s)
- Friederike Löffler
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | | | - Tobias Welte
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Da-Hee Park
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Karen M Olsson
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Lea Behrendt
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Filip Klimeš
- Department of Pneumology, Hannover Medical School, Hannover, Germany
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
| | - Johann Bauersachs
- Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany
| | - Frank Wacker
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
| | - Gesa Helen Pöhler
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research (DZL), Hannover, Germany
- Institute for Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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Douflé G, Dragoi L, Morales Castro D, Sato K, Donker DW, Aissaoui N, Fan E, Schaubroeck H, Price S, Fraser JF, Combes A. Head-to-toe bedside ultrasound for adult patients on extracorporeal membrane oxygenation. Intensive Care Med 2024; 50:632-645. [PMID: 38598123 DOI: 10.1007/s00134-024-07333-7] [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: 11/10/2023] [Accepted: 01/20/2024] [Indexed: 04/11/2024]
Abstract
Bedside ultrasound represents a well-suited diagnostic and monitoring tool for patients on extracorporeal membrane oxygenation (ECMO) who may be too unstable for transport to other hospital areas for diagnostic tests. The role of ultrasound, however, starts even before ECMO initiation. Every patient considered for ECMO should have a thorough ultrasonographic assessment of cardiac and valvular function, as well as vascular anatomy without delaying ECMO cannulation. The role of pre-ECMO ultrasound is to confirm the indication for ECMO, identify clinical situations for which ECMO is not indicated, rule out contraindications, and inform the choice of ECMO configuration. During ECMO cannulation, the use of vascular and cardiac ultrasound reduces the risk of complications and ensures adequate cannula positioning. Ultrasound remains key for monitoring during ECMO support and troubleshooting ECMO complications. For instance, ultrasound is helpful in the assessment of drainage insufficiency, hemodynamic instability, biventricular function, persistent hypoxemia, and recirculation on venovenous (VV) ECMO. Lung ultrasound can be used to monitor signs of recovery on VV ECMO. Brain ultrasound provides valuable diagnostic and prognostic information on ECMO. Echocardiography is essential in the assessment of readiness for liberation from venoarterial (VA) ECMO. Lastly, post decannulation ultrasound mainly aims at identifying post decannulation thrombosis and vascular complications. This review will cover the role of head-to-toe ultrasound for the management of adult ECMO patients from decision to initiate ECMO to the post decannulation phase.
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Affiliation(s)
- Ghislaine Douflé
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada.
- Department of Anesthesia and Pain Management, Toronto General Hospital, 585 University Avenue, Toronto, ON, M5G 2N2, Canada.
| | - Laura Dragoi
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada
| | - Diana Morales Castro
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada
| | - Kei Sato
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Dirk W Donker
- Intensive Care Center, University Medical Center Utrecht (UMCU), Utrecht, The Netherlands
- Cardiovascular and Respiratory Physiology, TechMed Centre, University of Twente, Enschede, The Netherlands
| | - Nadia Aissaoui
- Service de Médecine intensive-réanimation, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Cité, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine of the University of Toronto, Toronto, ON, Canada
| | - Hannah Schaubroeck
- Department of Intensive Care Medicine, Department of Internal Medicine and Pediatrics, Ghent University Hospital, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Susanna Price
- Departments of Cardiology and Intensive Care, Royal Brompton & Harefield NHS Foundation Trust, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - John F Fraser
- Critical Care Research Group, The Prince Charles Hospital, Level 3 Clinical Sciences Building, Chermside, QLD, 4032, Australia
- Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Alain Combes
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, APHP Sorbonne Université, Hôpital Pitié Salpêtrière, Paris, France
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
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Di Mauro M, Guarracini S, Mazzocchetti L, Capuzzi D, Salute L, Di Marco M, Lorusso R, Calafiore AM. Transcatheter bicaval valve system for the treatment of severe isolated tricuspid regurgitation. Features from a single-Centre experience. Int J Cardiol 2024; 402:131864. [PMID: 38367886 DOI: 10.1016/j.ijcard.2024.131864] [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: 10/28/2023] [Revised: 01/20/2024] [Accepted: 02/12/2024] [Indexed: 02/19/2024]
Abstract
BACKGROUND The isolated tricuspid valve (TR) has evolved into an entity in its own right. In contrast to TR treatment in left valve surgery, the benefit of surgery for isolated TR remains controversial. In this context, transcatheter valve interventions (TTVI) are becoming increasingly important. In this report, we present our experience with TricValve in a single center. METHODS From March 2022 to September 2023, 13 patients with at least severe isolated TR were scheduled for TricValve implantation. The mean age was 81 years (77-87), 5 were female and 8 were male. All patients were older than 70 years and had at least severe TR, hepatic or peripheral congestion and high surgical risk. RESULTS No procedure failure or device embolization was recorded. One case died in hospital 6 days after implantation and 1 case died after 124 days from irreversible renal and hepatic failure. The survival rate was 80.2% ± 12.8; the proportion of patients in NYHA class I increased significantly to 45% at follow-up. Among the 11 survivors, the median NT -proBNP decreased from 2873 to 148 pg/mL at follow-up (p = 0.003). In addition, a significant reduction in furosemide dosage from 125 mg to 50 mg at follow-up was observed over time. Finally, TR grade improved significantly along with RV size. CONCLUSIONS This procedure appears to be safe and effective in carefully selected patients. Given the extreme simplicity of the procedure, the TricValve will increasingly represent one of the most viable treatment options for this patient group in the future.
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Affiliation(s)
- Michele Di Mauro
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy; Cardiac Department, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands.
| | - Stefano Guarracini
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | | | - Donato Capuzzi
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | - Lorenzo Salute
- Department of Cardiovascular Disease, "Pierangeli" Hospital, Pescara, Italy
| | - Massimo Di Marco
- Department of Cardiology, Santo Spirito Hospital, Pescara, Italy
| | - Roberto Lorusso
- Cardiac Department, Cardiovascular Research Institute Maastricht (CARIM), Maastricht, the Netherlands; Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, the Netherlands
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Jafari-Giv Z, Vajhi A, Farzad-Mohajeri S, Hassankhani M, Alian Samakkhah S, Hemmati A, Mohammadzade-Akbari A, Noroozzadegan M. Positive correlation between echocardiographic tricuspid E peak velocity and central venous pressure in dogs: A preliminary study. Vet Radiol Ultrasound 2024; 65:294-302. [PMID: 38513141 DOI: 10.1111/vru.13357] [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: 09/16/2023] [Revised: 01/29/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
In the absence of vascular obstruction, central venous pressure (CVP) is a hydrostatic pressure in the cranial and caudal vena cava, providing valuable information about cardiac function and intravascular volume status. It is also a component in evaluating volume resuscitation in patients with septic shock and monitoring patients with right heart disease, pericardial disease, or volume depletion. Central venous pressure is calculated in dogs by invasive central venous catheterization, which is considered high-risk and impractical in critically ill patients. This study aimed to investigate the feasibility of using echocardiographic tricuspid E/E' as a noninvasive method to estimate CVP in anesthetized healthy dogs under controlled hypovolemic conditions. Ten male mixed-breed dogs were included in the study after a thorough health assessment. For hypovolemia induction, blood withdrawal was performed, and echocardiographic factors of the tricuspid valve, including peak E and E' velocities, were measured during CVP reduction. Repeated measures analysis of variance and Bonferroni post hoc tests were employed to compare the average difference between measured echocardiographic indices and CVP values derived from catheterization and intermittent measurement methods. Spearman's ρ correlation coefficient was used to evaluate the correlation between echocardiographic indices and CVP. E peak velocity had a significant negative correlation with venous blood pressure phases (r = -0.44, P = .001), indicating a decrease in peak E velocity with progressive CVP reduction. However, tricuspid valve E' peak velocity and E/E' did not correlate with CVP, suggesting that these parameters are not reliable for CVP estimation in dogs.
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Affiliation(s)
- Zahra Jafari-Giv
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Alireza Vajhi
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Saeed Farzad-Mohajeri
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
- Department of Regenerative Medicine, Institute of Biomedical Research, University of Tehran, Tehran, Iran
| | - Mahdi Hassankhani
- Department of Internal Medicine, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - Shohreh Alian Samakkhah
- Department of Food Hygiene, Faculty of Veterinary Medicine, Amol University of Special Modern Technologies (AUSMT), Amol, Iran
| | - Amin Hemmati
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
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Holmberg E, Tamás É, Nylander E, Engvall J, Granfeldt H. Right ventricular function in severe aortic stenosis assessed by echocardiography and MRI. Clin Physiol Funct Imaging 2024; 44:211-219. [PMID: 37984438 DOI: 10.1111/cpf.12867] [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: 12/16/2022] [Revised: 08/12/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
BACKGROUND The prevalence of aortic valve stenosis (AS) is increasing due to an ageing population. Despite that right ventricular function has prognostic value for postoperative outcome, the right ventricle (RV) is not extensively studied and often not routinely assessed in AS. Our aim was to explore the relation between severe AS and RV function in a surgical aortic valve replacement (SAVR) cohort, comparing two imaging modalities for RV evaluation. METHODS Patients with severe AS, underwent cardiovascular magnetic resonance imaging (CMR) and transthoracic echocardiography (TTE) before SAVR. RV dysfunction was defined as one or more of the following: tricuspid annular plane systolic excursion (TAPSE) < 17 mm, RV free wall strain (RVFWS) > -20% by TTE and RV ejection fraction (RVEF) <50% by CMR. RESULTS Sixteen (33%) patients were found to have RV dysfunction. Patients with RV dysfunction showed significantly lower indexed aortic valve area, left ventricular (LV) ejection fraction as well as RV and LV stroke volumes compared to patients with maintained RV function. All patients with reduced RVEF also had changes in TAPSE or RVFWS and a larger number of patients had a reduced longitudinal RV function despite a normal RVEF. CONCLUSION In a SAVR cohort one-third of the patients had RV dysfunction, defined by RVEF, TAPSE or RVFW strain. Echocardiography detected subtle changes in RV function before RVEF was reduced. It is likely that the more pronounced the AS, the more frequent the occurrence of RV dysfunction.
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Affiliation(s)
- Erica Holmberg
- Department of Thoracic and Cardiovascular Surgery, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Éva Tamás
- Department of Thoracic and Cardiovascular Surgery, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Eva Nylander
- Department of Clinical Physiology, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Jan Engvall
- Department of Clinical Physiology, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Hans Granfeldt
- Department of Thoracic and Cardiovascular Surgery, Linköping, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Yuchi Y, Suzuki R, Ishida N, Satomi S, Saito T, Teshima T, Matsumoto H. Comparative Study of Cardiovascular Effects of Selected Pulmonary Vasodilators in Canine Models of Mitral Valve Disease. BIOLOGY 2024; 13:311. [PMID: 38785793 PMCID: PMC11118215 DOI: 10.3390/biology13050311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2024] [Revised: 04/26/2024] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
Previous reports have shown that various oral pulmonary vasodilators are effective against canine pulmonary hypertension (PH). However, no studies have compared their hemodynamic effects. We aimed to compare the hemodynamic effects of 15 µg/kg beraprost sodium, 1.0 mg/kg sildenafil, and their combination, in dogs with experimentally induced mitral regurgitation. This experimental crossover study evaluated the hemodynamic and functional effects of oral pulmonary vasodilators by application of right-sided heart catheterization and echocardiography. Beraprost significantly decreased pulmonary and systemic vascular resistance. Additionally, beraprost increased right-ventricular stroke volume and left-ventricular cardiac output without worsening left-heart size and left-atrial pressure. The pulmonary vasodilatory effects of sildenafil were stronger, and its systemic vasodilatory effects were weaker than those of beraprost. However, sildenafil significantly increased the left-ventricular volume, left-atrial pressure indicator, and right-ventricular cardiac output. Combination therapy resulted in the strongest pulmonary and systemic vasodilating effects without worsening the left-heart size and left-atrial pressure indicators. Both beraprost and sildenafil were effective against canine PH; however, sildenafil was associated with the risk of worsening left-heart loading. Combination therapy with beraprost and sildenafil synergistically dilated pulmonary and systemic vessels, indicating a more potent treatment option for severe PH cases.
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Affiliation(s)
- Yunosuke Yuchi
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan; (Y.Y.); (S.S.); (T.S.); (T.T.); (H.M.)
- Garden Veterinary Hospital, Tokyo 153-0063, Japan
| | - Ryohei Suzuki
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan; (Y.Y.); (S.S.); (T.S.); (T.T.); (H.M.)
| | - Narumi Ishida
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan; (Y.Y.); (S.S.); (T.S.); (T.T.); (H.M.)
| | - Shuji Satomi
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan; (Y.Y.); (S.S.); (T.S.); (T.T.); (H.M.)
| | - Takahiro Saito
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan; (Y.Y.); (S.S.); (T.S.); (T.T.); (H.M.)
| | - Takahiro Teshima
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan; (Y.Y.); (S.S.); (T.S.); (T.T.); (H.M.)
| | - Hirotaka Matsumoto
- Laboratory of Veterinary Internal Medicine, School of Veterinary Medicine, Faculty of Veterinary Science, Nippon Veterinary and Life Science University, Tokyo 180-8602, Japan; (Y.Y.); (S.S.); (T.S.); (T.T.); (H.M.)
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Kadoglou NPE, Khattab E, Velidakis N, Gkougkoudi E, Myrianthefs MM. The Role of Echocardiography in the Diagnosis and Prognosis of Pulmonary Hypertension. J Pers Med 2024; 14:474. [PMID: 38793056 PMCID: PMC11122427 DOI: 10.3390/jpm14050474] [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: 03/15/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/26/2024] Open
Abstract
The right heart catheterisation constitutes the gold standard for pulmonary hypertension (PH) diagnosis. However, echocardiography remains a reliable, non-invasive, inexpensive, convenient, and easily reproducible modality not only for the preliminary screening of PH but also for PH prognosis. The aim of this review is to describe a cluster of echocardiographic parameters for the detection and prognosis of PH and analyse the challenges of echocardiography implementation in patients with suspected or established PH. The most important echocardiographic index is the calculation of pulmonary arterial systolic pressure (PASP) through the tricuspid regurgitation (TR). It has shown high correlation with invasive measurement of pulmonary pressure, but several drawbacks have questioned its accuracy. Besides this, the right ventricular outflow track acceleration time (RVOT-AT) has been proposed for PH diagnosis. A plethora of echocardiographic indices: right atrial area, pericardial effusion, the tricuspid annular plane systolic excursion (TAPSE), the TAPSE/PASP ratio, tricuspid annular systolic velocity (s'), can reflect the severity and prognosis of PH. Recent advances in echocardiography with 3-dimensional right ventricular (RV) ejection fraction, RV free wall strain and right atrial strain may further assist the prognosis of PH.
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Affiliation(s)
- Nikolaos P. E. Kadoglou
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Elina Khattab
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
| | - Nikolaos Velidakis
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Evaggelia Gkougkoudi
- Medical School, University of Cyprus, 215/6 Old Road Lefkosias-Lemesou, Aglatzia, Nicosia 2029, Cyprus; (E.K.); (N.V.); (E.G.)
| | - Michael M. Myrianthefs
- Cardiology Department, Nicosia General Hospital, Lemesou 215, Strovolos, Nicosia 2029, Cyprus;
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Zhao ML, Lu ZJ, Yang L, Ding S, Gao F, Liu YZ, Yang XL, Li X, He SY. The cardiovascular system at high altitude: A bibliometric and visualization analysis. World J Cardiol 2024; 16:199-214. [PMID: 38690218 PMCID: PMC11056872 DOI: 10.4330/wjc.v16.i4.199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 02/14/2024] [Accepted: 04/01/2024] [Indexed: 04/23/2024] Open
Abstract
BACKGROUND When exposed to high-altitude environments, the cardiovascular system undergoes various changes, the performance and mechanisms of which remain controversial. AIM To summarize the latest research advancements and hot research points in the cardiovascular system at high altitude by conducting a bibliometric and visualization analysis. METHODS The literature was systematically retrieved and filtered using the Web of Science Core Collection of Science Citation Index Expanded. A visualization analysis of the identified publications was conducted employing CiteSpace and VOSviewer. RESULTS A total of 1674 publications were included in the study, with an observed annual increase in the number of publications spanning from 1990 to 2022. The United States of America emerged as the predominant contributor, while Universidad Peruana Cayetano Heredia stood out as the institution with the highest publication output. Notably, Jean-Paul Richalet demonstrated the highest productivity among researchers focusing on the cardiovascular system at high altitude. Furthermore, Peter Bärtsch emerged as the author with the highest number of cited articles. Keyword analysis identified hypoxia, exercise, acclimatization, acute and chronic mountain sickness, pulmonary hypertension, metabolism, and echocardiography as the primary research hot research points and emerging directions in the study of the cardiovascular system at high altitude. CONCLUSION Over the past 32 years, research on the cardiovascular system in high-altitude regions has been steadily increasing. Future research in this field may focus on areas such as hypoxia adaptation, metabolism, and cardiopulmonary exercise. Strengthening interdisciplinary and multi-team collaborations will facilitate further exploration of the pathophysiological mechanisms underlying cardiovascular changes in high-altitude environments and provide a theoretical basis for standardized disease diagnosis and treatment.
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Affiliation(s)
- Mao-Lin Zhao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Zhong-Jie Lu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Li Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Sheng Ding
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Feng Gao
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Yuan-Zhang Liu
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xue-Lin Yang
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Xia Li
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, College of Medicine, Southwest Jiaotong University, Chengdu 610083, Sichuan Province, China
| | - Si-Yi He
- Department of Cardiovascular Surgery, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan Province, China.
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Kwon HW, Song MK, Lee SY, Kim GB, Kwak JG, Cho S, Kim WH, Bae EJ. Risk Factors for Coronary Artery Complications After Prosthetic Pulmonary Valve Implantation in Patients With Congenital Heart Disease. Circ J 2024; 88:652-662. [PMID: 38325847 DOI: 10.1253/circj.cj-23-0752] [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] [Indexed: 02/09/2024]
Abstract
BACKGROUND Coronary artery complications (CACs) in patients who undergoing prosthetic pulmonary valve implantation for congenital heart disease can lead to fetal outcomes. However, the incidence of and risk factors for CACs in these patients remain unknown.Methods and Results: A retrospective cohort study was conducted on patients who underwent cardiac computed tomography or invasive coronary angiography after prosthetic pulmonary valve implantation at Seoul National University Hospital from June 1986 to May 2021. Among 341 patients, 25 (7.3%) were identified with CACs, and 2 of them died. Among the patients with CACs, congenital coronary anomalies and an interarterial course of the coronary artery were identified in 11 (44%) and 18 (72%) patients, respectively. Interarterial and intramural courses of the coronary artery were associated with a 4.4- and 10.6-fold increased risk of CACs, respectively. Among patients with tetralogy of Fallot and pulmonary atresia, the aortic root was rotated further clockwise in patients with coronary artery compression compared to those without it (mean [±SD] 128.0±19.9° vs. 113.5±23.7°; P=0.024). The cut-off rotation angle of the aorta for predicting the occurrence of coronary artery compression was 133°. CONCLUSIONS Perioperative coronary artery evaluation and prevention of CACs are required in patients undergoing prosthetic pulmonary valve implantation, particularly in those with coronary artery anomalies or severe clockwise rotation of the aortic root.
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Affiliation(s)
- Hye Won Kwon
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Mi Kyoung Song
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sang Yun Lee
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Gi Beom Kim
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
| | - Jae Gun Kwak
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Sungkyu Cho
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Woong-Han Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine
| | - Eun Jung Bae
- Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine
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Pena Polanco N, Hughes DL, Ramzy M, Srivastava A, Andrzejewski M, Schott CK, Duarte-Rojo A. Point-of-care ultrasound in the treatment of acute kidney injury in patients with cirrhosis. Liver Transpl 2024:01445473-990000000-00366. [PMID: 38648286 DOI: 10.1097/lvt.0000000000000383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Affiliation(s)
- Nathalie Pena Polanco
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Dempsey L Hughes
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Mark Ramzy
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Aniruddha Srivastava
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Margaret Andrzejewski
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Christopher K Schott
- Departments of Critical Care Medicine and Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Critical Care Medicine, Veterans Affairs of Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
| | - Andres Duarte-Rojo
- Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Division of Gastroenterology and Hepatology, Department of Medicine, Northwestern Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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Di Gioia G, Crispino SP, Maestrini V, Monosilio S, Ortolina D, Segreti A, Squeo MR, Lemme E, Nenna A, Pelliccia A. Lack of cardiac remodelling in elite endurance athletes: an unexpected and not so rare finding. Eur J Appl Physiol 2024:10.1007/s00421-024-05489-0. [PMID: 38647676 DOI: 10.1007/s00421-024-05489-0] [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: 09/24/2023] [Accepted: 04/11/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Endurance elite athletes are expected to present a cardiac remodelling, characterized by eccentric hypertrophy (EH), may be associated with higher sportive performances. However, not all can present a cardiac remodelling. The study aimed to identify endurance athletes without cardiac remodelling characterizing their physiologic and clinical features. METHODS We studied 309 endurance athletes (cycling, rowing, canoeing, triathlon, athletics, long-distance swimming, cross-country skiing, mid-long distance track, pentathlon, biathlon, long-distance skating and Nordic-combined) examined during period of training, by clinical evaluation, ECG, echocardiogram and exercise-stress test. Sport career achievements (Olympic\World championship medals or national\world records) were recorded. RESULTS EH was found in most of athletes, (n = 126, 67% of males; n = 85, 68.5% of females). A significant proportion,, exhibited normal geometry (NG) ( n = 59, 31.3% in males; n = 39, 31.4% in females). At stress test, significant differences between EH and NG athletes were found in peak power (317.1 ± 71.2W in NG vs. 342.2 ± 60.6W in EH, p = 0.014 in males and 225.1 ± 38.7W in NG vs. 247.1 ± 37W in EH, p = 0.003 in females), rest heart rate (66.1 ± 13 in NG vs. 58.6 ± 11.6 in EH, p = 0.001 in males and 68 ± 13.2 in NG vs. 59.2 ± 11.2 in EH, p = 0.001 in females) with similar ventricular extrasystoles (p = 0.363 in males and p = 0.492 in females). However, no significant differences in athletic achievements were registered. CONCLUSION Our study demonstrates a relatively high prevalence of NG in endurance athletes, in addition to the expected EH. Athletes with NG perform worse in exercise-stress test and exhibit some less advantageous functional heart characteristics. However, the type of heart geometry is not associated with negative clinical findings.
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Affiliation(s)
- Giuseppe Di Gioia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy.
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy.
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, 15, 00135, Rome, Italy.
| | - Simone Pasquale Crispino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Viviana Maestrini
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Piazzale Aldo Moro, 5, 00185, Rome, Italy
| | - Sara Monosilio
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Davide Ortolina
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Andrea Segreti
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Piazza Lauro De Bosis, 15, 00135, Rome, Italy
| | - Maria Rosaria Squeo
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Erika Lemme
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128, Rome, Italy
| | - Antonio Pelliccia
- Institute of Sports Medicine and Science, National Italian Olympic Committee, Largo Piero Gabrielli, 1, 00197, Rome, Italy
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Tolvaj M, Kovács A, Radu N, Cascella A, Muraru D, Lakatos B, Fábián A, Tokodi M, Tomaselli M, Gavazzoni M, Perelli F, Merkely B, Badano LP, Surkova E. Significant Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Detection of Right Ventricular Systolic Dysfunction and Its Association With Outcomes. J Am Soc Echocardiogr 2024:S0894-7317(24)00173-1. [PMID: 38641069 DOI: 10.1016/j.echo.2024.04.005] [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: 11/26/2023] [Revised: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIMS Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes. METHODS We analyzed two- and three-dimensional echocardiography data from 2 centers including 750 patients followed up for all-cause mortality. Right ventricular dysfunction was defined as RVEF <45%, with guideline-recommended thresholds (TAPSE <17 mm, FAC <35%, FWLS >-20%) considered. RESULTS Among patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using receiver-operating characteristic analysis, FWLS exhibited the highest area under the curve of discrimination for RV dysfunction (RVEF <45%) with 59% sensitivity and 92% specificity. Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least 2 parameters are impaired and gradually better if only one or none of them are impaired (log-rank P < .005). CONCLUSION Guideline-recommended cutoff values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cutoff. Our results emphasize a multiparametric approach in the assessment of RV function, especially if 3D echocardiography is not available.
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Affiliation(s)
- Máté Tolvaj
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Department of Experimental Cardiology and Surgical Techniques, Semmelweis University, Budapest, Hungary.
| | - Noela Radu
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania
| | - Andrea Cascella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Francesco Perelli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Elena Surkova
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
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63
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Strom JB, Mukherjee M, Beussink-Nelson L, Gardin JM, Freed BH, Shah SJ, Afilalo J. Reference Values for Indexed Echocardiographic Chamber Sizes in Older Adults: The Multi-Ethnic Study of Atherosclerosis. J Am Heart Assoc 2024; 13:e034029. [PMID: 38567667 DOI: 10.1161/jaha.123.034029] [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: 12/15/2023] [Accepted: 03/07/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Normalization of echocardiographic chamber measurements for body surface area may result in misclassification of individuals with obesity or sarcopenia. Normalization for alternative measures of body size may be preferable, but there remains a dearth of information on their normative values and association with cardiovascular function metrics. METHODS AND RESULTS A total of 3032 individuals underwent comprehensive 2-dimensional echocardiography at Exam 6 in MESA (Multi-Ethnic Study of Atherosclerosis). In the subgroup of 608 individuals free of cardiopulmonary disease (69.5±7.0 years, 46% male, 48% White, 17% Chinese, 15% Black, 21% Hispanic), normative values were derived for left and right cardiac chamber measurements across a variety of ratiometric (body surface area, body mass index, height) and allometric (height1.6, height2.7) scaling parameters. Normative upper and lower reference values were provided for each scaling parameter stratified across age groups, sex, and race or ethnicity. Among scaling parameters, body surface area and height were associated with the least variability across race and ethnicity categories and height2.7 was associated with the least variability across sex categories. CONCLUSIONS In this diverse cohort of community-dwelling older adults, we provide normative values for common echocardiographic parameters across a variety of indexation methods.
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Affiliation(s)
- Jordan B Strom
- Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center Harvard Medical School 375 Longwood Avenue, 4th Floor Boston MA USA
| | | | | | | | - Benjamin H Freed
- Northwestern University Feinberg School of Medicine Chicago IL USA
| | - Sanjiv J Shah
- Northwestern University Feinberg School of Medicine Chicago IL USA
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Ogawa M, Kuwajima K, Yamane T, Hasegawa H, Yagi N, Shiota T. Prognostic Implication of Right Ventricular Free Wall Longitudinal Strain and Right Atrial Pressure Estimated By Echocardiography in Patients With Severe Functional Tricuspid Regurgitation. J Am Heart Assoc 2024; 13:e033196. [PMID: 38609840 DOI: 10.1161/jaha.123.033196] [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: 10/23/2023] [Accepted: 03/14/2024] [Indexed: 04/14/2024]
Abstract
BACKGROUND The interaction between right ventricular (RV) function and pulmonary hypertension is crucial for prognosis of patients with severe functional tricuspid regurgitation. RV free wall longitudinal strain (RVFWLS) has been reported to detect RV systolic dysfunction earlier than other conventional parameters. Although pulmonary artery systolic pressure measured by Doppler echocardiography is often underestimated in severe functional tricuspid regurgitation, right atrial pressure (RAP) estimated by echocardiography may be viewed as a prognostic factor. Impact of RAP and RVFWLS on outcome in patients with severe functional tricuspid regurgitation remains unclear. The aim of the present study was to investigate prognostic implication of RAP, RVFWLS, and their combination in this population. METHODS AND RESULTS We retrospectively examined 377 patients with severe functional tricuspid regurgitation. RAP, pulmonary artery systolic pressure, RV fractional area change, and RVFWLS were analyzed. RAP of 15 mm Hg was classified as elevated RAP. All-cause death at 2-year follow-up was defined as the primary end point. RVFWLS provided better prognostic information than RV fractional area change by receiver operating characteristic curve analysis. In the multivariable Cox regression analysis, elevated RAP and RVFWLS of ≤18% were independent predictors of clinical outcome. Patients with RVFWLS of ≤18% had higher risk of all-cause death than those without by Kaplan-Meier curve analysis. Furthermore, when patients were stratified into 4 groups by RAP and RVFWLS, the group with elevated RAP and RVFWLS of ≤18% had the worst outcome. CONCLUSIONS Elevated RAP and RVFWLS of ≤18% were independent predictors of all-cause death. The combination of elevated RAP and RVFWLS effectively stratified the all-cause death.
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Affiliation(s)
- Mana Ogawa
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Ken Kuwajima
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Takafumi Yamane
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Hiroko Hasegawa
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Nobuichiro Yagi
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
| | - Takahiro Shiota
- Cedars-Sinai Medical Center Smidt Heart Institute Los Angeles CA USA
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65
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Soh MS, Jang JH, Park JS, Shin JH. Effects of high-gravity acceleration forces and anti-gravity maneuver on the cardiac function of fighter pilots. Sci Rep 2024; 14:8749. [PMID: 38627423 PMCID: PMC11021439 DOI: 10.1038/s41598-024-59274-2] [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: 04/17/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
The fighter pilots exposed to high gravitational (G) acceleration must perform anti-G maneuvers similar to the Valsalva maneuver. However, the effects of high-G acceleration and anti-G maneuvers on cardiac function have rarely been studied. This study aimed to investigate the effects of high-G forces on cardiac function of fighter pilots. Fighter pilots who underwent regular health check-ups and echocardiography were included (n = 29; 100% men, 41 ± 10 years old; mean flight time, 1821 ± 1186 h). Trainees who had not experienced any flights were included in the control group (n = 16; 100% men, 36 ± 17 years old). Echocardiographic data included left ventricular chamber size, systolic and diastolic functions, right ventricular systolic pressure (RVSP), inferior vena cava (IVC) collapsibility, and tricuspid annular plane systolic excursion (TAPSE). No significant differences in left ventricular ejection fraction, RVSP, or IVC collapsibility were observed between two groups. In the multivariate linear regression analysis with total flight time as an independent continuous variable for fighter pilots, TAPSE was positively correlated with total flight time. The experience of fighter pilots who were exposed to high-G acceleration forces and anti-G maneuvers did not cause cardiac structural changes, but the exposure might be associated with right heart function changes.
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Affiliation(s)
- Moon-Seung Soh
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Jae-Hyuk Jang
- Division of Cardiology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea.
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Celeski M, Segreti A, Polito D, Valente D, Vicchio L, Di Gioia G, Ussia GP, Incalzi RA, Grigioni F. Traditional and Advanced Echocardiographic Evaluation in Chronic Obstructive Pulmonary Disease: The Forgotten Relation. Am J Cardiol 2024; 217:102-118. [PMID: 38412881 DOI: 10.1016/j.amjcard.2024.02.022] [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: 10/01/2023] [Revised: 01/22/2024] [Accepted: 02/12/2024] [Indexed: 02/29/2024]
Abstract
Chronic obstructive pulmonary disease (COPD) is a significant preventable and treatable clinical disorder defined by a persistent, typically progressive airflow obstruction. This disease has a significant negative impact on mortality and morbidity worldwide. However, the complex interaction between the heart and lungs is usually underestimated, necessitating more attention to improve clinical outcomes and prognosis. Indeed, COPD significantly impacts ventricular function, right and left chamber architecture, tricuspid valve functionality, and pulmonary blood vessels. Accordingly, more emphasis should be paid to their diagnosis since cardiac alterations may occur very early before COPD progresses and generate pulmonary hypertension (PH). Echocardiography enables a quick, noninvasive, portable, and accurate assessment of such changes. Indeed, recent advancements in imaging technology have improved the characterization of the heart chambers and made it possible to investigate the association between a few cardiac function indexes and clinical and functional aspects of COPD. This review aims to describe the intricate relation between COPD and heart changes and provide basic and advanced echocardiographic methods to detect early right ventricular and left ventricular morphologic alterations and early systolic and diastolic dysfunction. In addition, it is crucial to comprehend the clinical and prognostic significance of functional tricuspid regurgitation in COPD and PH and the currently available transcatheter therapeutic approaches for its treatment. Moreover, it is also essential to assess noninvasively PH and pulmonary resistance in patients with COPD by applying new echocardiographic parameters. In conclusion, echocardiography should be used more frequently in assessing patients with COPD because it may aid in discovering previously unrecognized heart abnormalities and selecting the most appropriate treatment to improve the patient's symptoms, quality of life, and survival.
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Affiliation(s)
- Mihail Celeski
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Andrea Segreti
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy.
| | - Dajana Polito
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Daniele Valente
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Luisa Vicchio
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | - Giuseppe Di Gioia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy; Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy; Institute of Sports Medicine and Science, Italian National Olympic Committee, Rome, Italy
| | - Gian Paolo Ussia
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
| | | | - Francesco Grigioni
- Research Unit of Cardiovascular Science, Department of Medicine and Surgery, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, 21 - 00128, Rome, Italy; Cardiology Unit, Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200 - 00128, Rome, Italy
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67
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Song W, Wu L, Sun C, Kong X, Wang H. New-onset atrial fibrillation following arteriovenous fistula increases adverse clinical events in dialysis patients with end-stage renal disease. Front Cardiovasc Med 2024; 11:1386304. [PMID: 38682103 PMCID: PMC11045994 DOI: 10.3389/fcvm.2024.1386304] [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: 02/15/2024] [Accepted: 03/18/2024] [Indexed: 05/01/2024] Open
Abstract
Background End-stage renal disease (ESRD) patients have a high potential cardiovascular burden, and cardiovascular disease (CVD) is the leading cause of death in maintenance haemodialysis (MHD) patients. Arteriovenous fistula (AVF) is the preferred vascular access for MHD patients, but AVF significantly affects the haemodynamics of the cardiovascular system, leading to or exacerbating CVD, including atrial fibrillation (AF). This study aimed to evaluate the impact of AVF on cardiac function, especially of the left atrium (LA), in patients with ESRD and to further explore the relationship between AVF establishment and the occurrence of AF. Methods We selected 1,107 ESRD patients on haemodialysis using AVF and 550 patients with tunneled-cuffed catheters (TCC) admitted between January 2016 and December 2022 for follow-up to compare the rate of AF between the two groups. A total of 153 patients in the AVF group with complete information (clinical data, echocardiographic and biochemical indices, and other data) were enrolled and retrospectively analysed for risk factors for the development of AF and were followed up for adverse clinical outcomes (including all-cause death, cardiac death, readmission due to heart failure, and stroke). Results The incidence of new-onset AF was higher in the AVF group than the TCC group after dialysis access was established (16.30% vs. 5.08%, P < 0.001). Echocardiography showed that the LA anteroposterior diameter increased (P < 0.001) and the incidence of AF increased from 11.76% to 26.14% (P = 0.001) after AVF establishment. Multivariate logistic regression analysis showed that age and LA enlargement were independent risk factors for new-onset AF after AVF establishment (P < 0.05). Adverse clinical outcomes were more common in patients with AF than in patients without AF (P < 0.001). Multivariate Cox risk regression analysis suggested that new-onset AF (HR = 4.08, 95% CI: 2.00-8.34, P < 0.001) and left ventricular systolic dysfunction (HR = 2.42, 95% CI: 1.20-4.88, P = 0.01) after AVF establishment were independent risk factors for adverse clinical outcomes. Conclusion LA enlargement after AVF establishment is associated with a significant increase in the incidence of AF, in addition, AF which is as an important influential factor in patients with MHD combined other systemic diseases might increase adverse clinical events. Clinical Trial Registration (NCT06199609).
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Affiliation(s)
- Wenhui Song
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Lizhou Wu
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Chong Sun
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
| | - Xianglei Kong
- Department of Nephrology, Shandong Key Laboratory of Rheumatic Disease and Translational Medicine, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Shandong Institute of Nephrology, Jinan, China
| | - Haiyan Wang
- Department of Medical Ultrasound, Shandong Medicine and Health Key Laboratory of Abdominal Medical Imaging, The First Affiliated Hospital of Shandong First Medical University & Shandong Provincial Qianfoshan Hospital, Jinan, China
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Tonini A, Vergara C, Regazzoni F, Dede' L, Scrofani R, Cogliati C, Quarteroni A. A mathematical model to assess the effects of COVID-19 on the cardiocirculatory system. Sci Rep 2024; 14:8304. [PMID: 38594376 PMCID: PMC11004160 DOI: 10.1038/s41598-024-58849-3] [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: 10/30/2023] [Accepted: 04/03/2024] [Indexed: 04/11/2024] Open
Abstract
Impaired cardiac function has been described as a frequent complication of COVID-19-related pneumonia. To investigate possible underlying mechanisms, we represented the cardiovascular system by means of a lumped-parameter 0D mathematical model. The model was calibrated using clinical data, recorded in 58 patients hospitalized for COVID-19-related pneumonia, to make it patient-specific and to compute model outputs of clinical interest related to the cardiocirculatory system. We assessed, for each patient with a successful calibration, the statistical reliability of model outputs estimating the uncertainty intervals. Then, we performed a statistical analysis to compare healthy ranges and mean values (over patients) of reliable model outputs to determine which were significantly altered in COVID-19-related pneumonia. Our results showed significant increases in right ventricular systolic pressure, diastolic and mean pulmonary arterial pressure, and capillary wedge pressure. Instead, physical quantities related to the systemic circulation were not significantly altered. Remarkably, statistical analyses made on raw clinical data, without the support of a mathematical model, were unable to detect the effects of COVID-19-related pneumonia in pulmonary circulation, thus suggesting that the use of a calibrated 0D mathematical model to describe the cardiocirculatory system is an effective tool to investigate the impairments of the cardiocirculatory system associated with COVID-19.
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Affiliation(s)
- Andrea Tonini
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy.
| | - Christian Vergara
- LABS, Dipartimento di Chimica, Materiali e Ingegneria Chimica, Politecnico di Milano, Milan, Italy
| | | | - Luca Dede'
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | - Roberto Scrofani
- UOC Cardiochirurgia Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Chiara Cogliati
- Internal Medicine, L. Sacco Hospital, Milan, Italy
- Department of Biomedical and Clinical Sciences, Università di Milano, Milan, Italy
| | - Alfio Quarteroni
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
- Institute of Mathematics, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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Welle GA, Hahn RT, Lindenfeld J, Lin G, Nkomo VT, Hausleiter J, Lurz PC, Pislaru SV, Davidson CJ, Eleid MF. New Approaches to Assessment and Management of Tricuspid Regurgitation Before Intervention. JACC Cardiovasc Interv 2024; 17:837-858. [PMID: 38599687 DOI: 10.1016/j.jcin.2024.02.034] [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: 08/22/2023] [Revised: 01/22/2024] [Accepted: 02/13/2024] [Indexed: 04/12/2024]
Abstract
Severe tricuspid regurgitation (TR) is a progressive condition associated with substantial morbidity, poor quality of life, and increased mortality. Patients with TR commonly have coexisting conditions including congestive heart failure, pulmonary hypertension, chronic lung disease, atrial fibrillation, and cardiovascular implantable electronic devices, which can increase the complexity of medical and surgical TR management. As such, the optimal timing of referral for isolated tricuspid valve (TV) intervention is undefined, and TV surgery has been associated with elevated risk of morbidity and mortality. More recently, an unprecedented growth in TR treatment options, namely the development of a wide range of transcatheter TV interventions (TTVI) is stimulating increased interest and referral for TV intervention across the entire medical community. However, there are no stepwise algorithms for the optimal management of symptomatic severe TR before TTVI. This article reviews the contemporary assessment and management of TR with addition of a medical framework to optimize TR before referral for TTVI.
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Affiliation(s)
- Garrett A Welle
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA. https://twitter.com/GarrettWelleMD
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, New York, USA. https://twitter.com/hahn_rt
| | - Joann Lindenfeld
- Division of Cardiology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charles J Davidson
- Division of Cardiology, Northwestern University Medical Center, Chicago, Illinois, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Russo I, Dun W, Mehta S, Ahmed S, Tzimas C, Fukuma N, Tsai EJ. Extracellular Matrix Instability and Chronic Inflammation Underlie Maladaptive Right Ventricular Pressure Overload Remodeling and Failure in Male Mice. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.03.588013. [PMID: 38617374 PMCID: PMC11014567 DOI: 10.1101/2024.04.03.588013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Background Right ventricular dysfunction (RVD) portends increased death risk for heart failure (HF) and pulmonary arterial hypertension (PAH) patients, regardless of left ventricular function or etiology. In both, RVD arises from the chronic RV pressure overload, and represents advanced cardiopulmonary disease. RV remodeling responses and survival rates of HF and PAH patients, however, differ by sex. Men develop more severe RVD and die at younger ages than do women. Mechanistic details of this sexual dimorphism in RV remodeling are incompletely understood. We sought to elucidate the cardiac pathophysiology underlying the sex-specific RV remodeling phenotypes, RV failure (RVF) versus compensated RVD. Methods We subjected male (M-) and female (F-) adult mice to moderate pulmonary artery banding (PAB) for 9wks. Mice underwent serial echocardiography, cardiac MRI, RV pressure-volume loop recordings, histologic and molecular analyses. Results M-PAB developed severe RVD with RVF, increased RV collagen deposition and degradation, extracellular matrix (ECM) instability, and activation and recruitment of macrophages. Despite the same severity and chronicity of RV pressure overload, F-PAB had more stable ECM, lacked chronic inflammation, and developed mild RVD without RVF. Conclusions ECM destabilization and chronic activation of recruited macrophages are associated with maladaptive RV remodeling and RVF in male PAB mice. Adaptive RV remodeling of female PAB mice lacked these histopathologic changes. Our findings suggest that these two pathophysiologic processes likely contribute to the sexual dimorphism of RV pressure overload remodeling. Further mechanistic studies are needed to assess their pathogenic roles and potential as targets for RVD therapy and RVF prevention. CLINICAL PERSPECTIVE What is new?: In a mouse model of pure PH, males but not females showed an association between ECM instability, chronic inflammation with activation of recruited macrophages, and severe RV dysfunction and failure.What are the clinical implications?: In male HF and PH patients, enhancing ECM stability and countering the recruitment and activation of macrophages may help preserve RV function such that RVF can be prevented or delayed. Further preclinical mechanistic studies are needed to assess the therapeutic potential of such approaches. RESEARCH PERSPECTIVE What new question does this study raise? What question should be addressed next?: What mechanisms regulate RV ECM stability and macrophage recruitment and activation in response to chronic RV pressure overload? Are these regulatory mechanisms dependent upon or independent of sex hormone signaling?
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Torres Macho J, Duffot Falcó M. Ultrasound assessment of the inferior vena cava in heart failure. Med Clin (Barc) 2024:S0025-7753(24)00136-2. [PMID: 38580571 DOI: 10.1016/j.medcli.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Juan Torres Macho
- Unidad de Ecografía Clínica, Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España.
| | - Mercedes Duffot Falcó
- Unidad de Ecografía Clínica, Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
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Li HT, Yuan P, Jiang R, Zhao QH, Sun YY, Zhang J, Gong SG, Li JL, Qiu HL, Wu WH, Luo CJ, Xu J, Wang L, Liu JM. Sleep-disordered breathing and nocturnal hypoxemia in chronic thromboembolic pulmonary disease. Intern Med J 2024. [PMID: 38563467 DOI: 10.1111/imj.16359] [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: 06/07/2023] [Accepted: 02/25/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND AND AIMS Sleep-disordered breathing (SDB) and nocturnal hypoxemia were known to be present in patients with chronic thromboembolic pulmonary hypertension (CTEPH), but the difference between SDB and nocturnal hypoxemia in patients who have chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) at rest remains unknown. METHODS Patients who had CTEPH (n = 80) or CTEPD without PH (n = 40) and who had undergone sleep studies from July 2020 to October 2022 at Shanghai Pulmonary Hospital were enrolled. Nocturnal mean SpO2 (Mean SpO2) <90% was defined as nocturnal hypoxemia, and the percentage of time with a saturation below 90% (T90%) exceeding 10% was used to evaluate the severity of nocturnal hypoxemia. Logistic and linear regression analyses were performed to investigate the difference and potential predictor of SDB or nocturnal hypoxemia between CTEPH and CTEPD without PH. RESULTS SDB was similarly prevalent in CTEPH and CTEPD without PH (P = 0.104), both characterised by obstructive sleep apnoea (OSA). Twenty-two patients with CTEPH were diagnosed with nocturnal hypoxemia, whereas only three were diagnosed with CTEPD without PH (P = 0.021). T90% was positively associated with mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance in patients with CTEPH and CTEPD without PH (P < 0.001); T90% was also negatively related to cardiac output in these patients. Single-breath carbon monoxide diffusing capacity, sex and mPAP were all correlated with nocturnal hypoxemia in CTEPH and CTEPD without PH (all P < 0.05). CONCLUSION Nocturnal hypoxemia was worse in CTEPD with PH; T90%, but not SDB, was independently correlated with the hemodynamics in CTEPD with or without PH.
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Affiliation(s)
- Hui-Ting Li
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ping Yuan
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Rong Jiang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Qin-Hua Zhao
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Yuan-Yuan Sun
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jian Zhang
- Department of Respiratory and Critical Care Medicine, the 416 Hospital of Nuclear Industry/the Second Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China
| | - Su-Gang Gong
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jin-Ling Li
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Hong-Ling Qiu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Wen-Hui Wu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ci-Jun Luo
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jiang Xu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Lan Wang
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jin-Ming Liu
- Department of Cardio-Pulmonary Circulation, Shanghai Pulmonary Hospital, School of Medicine, Tongji University, Shanghai, China
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D'Alto M, Di Maio M, Argiento P, Romeo E, Rea G, Liccardo B, Del Giudice C, Vergara A, Caiazza E, Del Vecchio GE, Di Vilio A, Gargani L, D'Andrea A, Bossone E, Golino P, Picano E, Naeije R. Right heart failure as a cause of pulmonary congestion in pulmonary arterial hypertension. Eur J Heart Fail 2024; 26:817-824. [PMID: 38404257 DOI: 10.1002/ejhf.3172] [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: 10/06/2023] [Revised: 01/04/2024] [Accepted: 02/09/2024] [Indexed: 02/27/2024] Open
Abstract
AIMS Recent studies have shown that lung ultrasound-assessed pulmonary congestion is worse in heart failure when pulmonary vascular resistance (PVR) is increased, suggesting a paradoxical relationship between right heart failure and increased lung water content. Accordingly, we wondered if lung ultrasound would reveal otherwise clinically silent pulmonary congestion in patients with pulmonary arterial hypertension (PAH). METHODS AND RESULTS All patients referred for suspicion of PAH in a tertiary centre from January 2020 to December 2022 underwent a complete diagnostic work-up including echocardiography, lung ultrasound and right heart catheterization. Pulmonary congestion was identified by lung ultrasound B-lines using an 8-site scan. The study enrolled 102 patients with idiopathic PAH (mean age 53 ± 13 years; 71% female). World Health Organization functional classes I, II, and III were found in 2%, 52%, and 46% of them, respectively. N-terminal pro-brain natriuretic peptide (NT-proBNP) was 377 pg/ml (interquartile range [IQR] 218-906). B-lines were identified in 77 out of 102 patients (75%), with a median of 3 [IQR 1-5]. At univariable analysis, B-lines were positively correlated with male sex, age, NT-proBNP, systolic pulmonary artery pressure (sPAP), right atrial pressure (RAP), PVR, left ventricular end-diastolic volume and tricuspid annular plane systolic excursion (TAPSE), and negatively with cardiac output and stroke volume. At multivariable analysis, RAP (p < 0.001), TAPSE/sPAP (p = 0.001), and NT-proBNP (p = 0.04) were independent predictors of B-lines. CONCLUSION Lung ultrasound commonly discloses pulmonary congestion in PAH. This finding is related to right ventricular to pulmonary artery uncoupling, and may tentatively be explained by increased central venous pressure impeding lymphatic outflow.
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Affiliation(s)
- Michele D'Alto
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Marco Di Maio
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Paola Argiento
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Emanuele Romeo
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Gaetano Rea
- Unit of Radiology, A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Biagio Liccardo
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Carmen Del Giudice
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Andrea Vergara
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Eleonora Caiazza
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Gerardo Elia Del Vecchio
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Alessandro Di Vilio
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Luna Gargani
- Department of Surgical Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | - Antonello D'Andrea
- Unit of Cardiology and Intensive Coronary Care, Umberto I Hospital, Nocera Inferiore, Salerno, Italy
| | - Eduardo Bossone
- Department of Public Health, University of Naples 'Federico II', Naples, Italy
| | - Paolo Golino
- Department of Cardiology, University of Campania 'L. Vanvitelli', A.O.R.N. dei Colli, Monaldi Hospital, Naples, Italy
| | - Eugenio Picano
- Biomedicine Department of the National Research Council, Pisa, Italy
| | - Robert Naeije
- Department of Pathophysiology, Free University of Brussels, Brussels, Belgium
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Kim M, Uhm JS, Park JW, Bae S, Jung IH, Heo SJ, Kim D, Yu HT, Kim TH, Joung B, Lee MH. The Effects of Radiofrequency Catheter Ablation for Atrial Fibrillation on Right Ventricular Function. Korean Circ J 2024; 54:203-217. [PMID: 38654567 PMCID: PMC11040267 DOI: 10.4070/kcj.2023.0312] [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: 11/25/2023] [Revised: 01/21/2024] [Accepted: 02/07/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND AND OBJECTIVE The effects of radiofrequency catheter ablation (RFCA) for atrial fibrillation (AF) on right ventricular (RV) function are not well known. METHODS Patients who underwent RFCA for AF and underwent pre- and post-procedural echocardiography were enrolled consecutively. Fractional area change (FAC), RV free-wall longitudinal strain (RVFWSL), and RV 4-chamber strain including the ventricular septum (RV4CSL) were measured. Changes in FAC, RVFWSL, and RV4CSL before and after RFCA were compared among paroxysmal AF (PAF), persistent AF (PeAF), and long-standing persistent AF (LSPeAF) groups. RESULTS A total of 164 participants (74 PAF, 47 PeAF, and 43 LSPeAF; age, 60.8 ± 9.8 years; men, 74.4%) was enrolled. The patients with PeAF and LSPeAF had worse RV4CSL (p<0.001) and RVFWSL (p<0.001) than those with PAF and reference values. Improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared with the PAF and LSPeAF groups (ΔRV4CSL, 8.4% [5.1, 11.6] in PeAF vs. 1.0% [-1.0, 4.1] in PAF, 1.9% [-0.2, 4.4] in LSPeAF, p<0.001; ΔRVFWSL, 9.0% [6.9, 11.5] in PeAF vs. 0.9% [-1.4, 4.9] in PAF, 1.0% [-1.0, 3.6] in LSPeAF, p<0.001). In patients without recurrence, improvements in RVFWSL and RV4CSL after RFCA were significant in the PeAF group compared to the LSPeAF group. CONCLUSIONS RV systolic function is more impaired in patients with PeAF and LSPeAF than in those with PAF. RV systolic function is more improved after RFCA in patients with PeAF than in those with PAF or LSPeAF.
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Affiliation(s)
- Minkwan Kim
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Jae-Sun Uhm
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
| | - Je-Wook Park
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - In Hyun Jung
- Division of Cardiology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Seok-Jae Heo
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Korea
| | - Daehoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hee Tae Yu
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Tae-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Boyoung Joung
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Hyoung Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Lawrie A, Chin K, Fong Y, Gargano C, Gitton X, He C, Kiely DG, Zhou L, Zhou L, Maron BA, Quinn D, Rosenkranz S, Stamatiadis D, Toshner M, Wilkins MR, Howard L, Preston IR. Two prospective, multicenter studies for the identification of biomarker signatures for early detection of pulmonary hypertension (PH): The CIPHER and CIPHER-MRI studies. Pulm Circ 2024; 14:e12386. [PMID: 38868397 PMCID: PMC11167234 DOI: 10.1002/pul2.12386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 04/18/2024] [Accepted: 05/05/2024] [Indexed: 06/14/2024] Open
Abstract
A blood test identifying patients at increased risk of pulmonary hypertension (PH) could streamline the investigative pathway. The prospective, multicenter CIPHER study aimed to develop a microRNA-based signature for detecting PH in breathless patients and enrolled adults with a high suspicion of PH who had undergone right heart catheterization (RHC). The CIPHER-MRI study was added to assess the performance of this CIPHER signature in a population with low probability of having PH who underwent cardiac magnetic resonance imaging (cMRI) instead of RHC. The microRNA signature was developed using a penalized linear regression (LASSO) model. Data were modeled both with and without N-terminal pro-brain natriuretic peptide (NT-proBNP). Signature performance was assessed against predefined thresholds (lower 98.7% CI bound of ≥0.73 for sensitivity and ≥0.53 for specificity, based on a meta-analysis of echocardiographic data), using RHC as the true diagnosis. Overall, 926 CIPHER participants were screened and 888 were included in the analysis. Of 688 RHC-confirmed PH cases, approximately 40% were already receiving PH treatment. Fifty microRNA (from 311 investigated) were algorithmically selected to be included in the signature. Sensitivity [97.5% CI] of the signature was 0.85 [0.80-0.89] for microRNA-alone and 0.90 [0.86-0.93] for microRNA+NT-proBNP, and the corresponding specificities were 0.33 [0.24-0.44] and 0.28 [0.20-0.39]. Of 80 CIPHER-MRI participants with evaluable data, 7 were considered PH-positive by cMRI whereas 52 were considered PH-positive by the microRNA signature. Due to low specificity, the CIPHER miRNA-based signature for PH (either with or without NT-proBNP in model) did not meet the prespecified diagnostic threshold for the primary analysis.
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Affiliation(s)
- Allan Lawrie
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Kelly Chin
- Division of Pulmonary and Critical Care MedicineUT Southwestern Medical CenterDallasTexasUSA
| | - Yiu‐Lian Fong
- Statistics and Decision SciencesJanssen Pharmaceuticals Inc.RaritanNew JerseyUSA
| | - Cynthia Gargano
- Statistics and Decision SciencesJanssen Pharmaceuticals Inc.RaritanNew JerseyUSA
| | - Xavier Gitton
- Compound DevelopmentActelion Pharmaceuticals Ltd, a Johnson & Johnson CompanyAllschwilSwitzerland
| | - Cheng He
- Research and DevelopmentMiRXES LabSingaporeSingapore
| | - David G. Kiely
- NIHR Biomedical Research Centre Sheffield and Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire HospitalSheffield Teaching Hospitals NHS Foundation TrustSheffieldUK
| | - Li Zhou
- Research and DevelopmentMiRXES LabSingaporeSingapore
| | - Lihan Zhou
- Research and DevelopmentMiRXES LabSingaporeSingapore
| | - Bradley A. Maron
- Department of MedicineUniversity of Maryland School of MedicineBaltimoreMarylandUSA
- The University of Maryland‐Institute for Health ComputingBethesdaMarylandUSA
| | - Debbie Quinn
- Clinical Science, Actelion Pharmaceuticals Ltd, a Johnson & Johnson CompanyAllschwilSwitzerland
| | - Stephan Rosenkranz
- Department of CardiologyHeart Center at the University Hospital CologneCologneGermany
- Cologne Cardiovascular Research Center (CCRC)University of CologneCologneGermany
| | - Dimitri Stamatiadis
- Clinical Science, Actelion Pharmaceuticals Ltd, a Johnson & Johnson CompanyAllschwilSwitzerland
| | - Mark Toshner
- Department of Medicine, VPD Heart & Lung Research InstituteUniversity of CambridgeCambridgeUK
| | | | - Luke Howard
- National Heart and Lung InstituteImperial College LondonLondonUK
| | - Ioana R. Preston
- Pulmonary, Critical Care and Sleep DivisionTufts Medical CenterBostonMassachusettsUSA
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76
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Enenche AA, Kweki AG, Aiwuyo HO, Nevolina A, Akinti OM, Perry JC, Ayinalem Y, Osarenkhoe JO, Ukenenye E, Poluyi CO, Danbauchi Sulei S. Echocardiographic Assessment of Right Ventricular Function in Patients With Liver Cirrhosis. Cureus 2024; 16:e57410. [PMID: 38694655 PMCID: PMC11062624 DOI: 10.7759/cureus.57410] [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] [Accepted: 04/01/2024] [Indexed: 05/04/2024] Open
Abstract
BACKGROUND In patients with chronic liver disease, the common endpoint of its course is liver cirrhosis which is a cause of cardiovascular morbidity and mortality. These abnormalities in the cardiovascular system, especially the heart, can be detected by echocardiography. Identifying and acting on these abnormalities can have an impact on their management thereby reducing morbidity and mortality of patients with liver cirrhosis. The aim of this study was to determine the prevalence of right ventricular systolic and diastolic dysfunction in liver cirrhosis patients. METHODS AND MATERIALS A hospital-based cross-sectional study was conducted among adult patients of the gastroenterology unit (ward and clinic) diagnosed with liver cirrhosis. A total of 243 patients were recruited and 210 were evaluated for this study. This study was carried out over one year. Cardiology studies, including electrocardiography and echocardiography, were conducted on patients to assess right ventricular function. RESULTS Among the participants, 44.8% had right ventricular hypertrophy and 3.8% had right ventricular dilatation. Using Tricuspid Annular Plane Systolic Excursion (TAPSE), 17.1% were found to have right ventricular systolic dysfunction and 51.4% had systolic dysfunction using FAC. Diastolic dysfunction was found in 61% of the participants and grade 2 diastolic dysfunction was the commonest. CONCLUSION From this study, a high prevalence of right ventricular systolic and diastolic dysfunction was recorded among patients with liver cirrhosis.
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Affiliation(s)
- Augustine A Enenche
- Internal Medicine, Jos University Teaching Hospital, Jos, NGA
- Internal Medicine/Cardiology, Dalhatu Araf Specialist Hospital, Lafia, NGA
| | - Anthony G Kweki
- Internal Medicine/Cardiology, Colchester Hospital, East Suffolk and North Essex NHS Foundation Trust, Colchester, GBR
| | - Henry O Aiwuyo
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Anna Nevolina
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Oluwasegun M Akinti
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Jamal C Perry
- Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Yonael Ayinalem
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - John O Osarenkhoe
- Medicine and Surgery, Igbinedion University Teaching Hospital, Benin City, NGA
| | - Emmanuel Ukenenye
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
| | - Charles O Poluyi
- Internal Medicine, Brookdale University Hospital Medical Center, Brooklyn, USA
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Shima H, Tsujino I, Nakamura J, Nakaya T, Sugimoto A, Sato T, Watanabe T, Ohira H, Suzuki M, Tsuneta S, Chiba Y, Murayama M, Yokota I, Konno S. Exploratory analysis of the accuracy of echocardiographic parameters for the assessment of right ventricular function and right ventricular-pulmonary artery coupling. Pulm Circ 2024; 14:e12368. [PMID: 38774813 PMCID: PMC11108640 DOI: 10.1002/pul2.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 03/12/2024] [Accepted: 04/07/2024] [Indexed: 05/24/2024] Open
Abstract
Echocardiography is a widely used modality for the assessment of right ventricular (RV) function; however, few studies have comprehensively compared the accuracy of echocardiographic parameters using invasively obtained reference values. Therefore, this exploratory study aimed to compare the accuracy of echocardiographic parameters of RV function and RV-pulmonary artery (PA) coupling. We calculated four indices of RV function (end-systolic elastance [Ees] for systolic function [contractility], τ for relaxation, and β and end-diastolic elastance [Eed] for stiffness), and an index of RV-PA coupling (Ees/arterial elastance [Ea]), using pressure catheterization, cardiac magnetic resonance imaging, and a single-beat method. We then compared the correlations of RV indices with echocardiographic parameters. In 63 participants (54 with pulmonary hypertension (PH) and nine without PH), Ees and τ correlated with several echocardiographic parameters, such as RV diameter and area, but the correlations were moderate (|correlation coefficients (ρ)| < 0.5 for all parameters). The correlations of β and Eed with echocardiographic parameters were weak, with |ρ| < 0.4. In contrast, Ees/Ea closely correlated with RV free wall longitudinal strain (RVFW-LS)/estimated systolic PA pressure (eSPAP) (ρ = -0.72). Ees/Ea also correlated with tricuspid annular plane systolic excursion/eSPAP, RV diameter, and RV end-systolic area, with |ρ | >0.65. In addition, RVFW-LS/eSPAP yielded high sensitivity (0.84) and specificity (0.75) for detecting reduced Ees/Ea. The present study indicated a limited accuracy of echocardiographic parameters in assessing RV systolic and diastolic function. In contrast to RV function, they showed high accuracy for assessing RV-PA coupling, with RVFW-LS/eSPAP exhibiting the highest accuracy.
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Affiliation(s)
- Hideki Shima
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Toshitaka Nakaya
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Ayako Sugimoto
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Taku Watanabe
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Hiroshi Ohira
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Masaru Suzuki
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
| | - Satonori Tsuneta
- Department of Diagnostic and Interventional RadiologyHokkaido University HospitalSapporoJapan
| | - Yasuyuki Chiba
- Department of Cardiovascular MedicineHokkaido University Graduate School of MedicineSapporoJapan
| | - Michito Murayama
- Department of Medical Laboratory Science, Faculty of Health SciencesHokkaido UniversitySapporoJapan
- Diagnostic Center for SonographyHokkaido University HospitalSapporoJapan
| | - Isao Yokota
- Department of BiostatisticsHokkaido University Graduate School of MedicineSapporoJapan
| | - Satoshi Konno
- Department of Respiratory Medicine, Faculty of MedicineHokkaido UniversitySapporoJapan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of MedicineHokkaido UniversitySapporoJapan
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78
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Martinez Manzano JM, Prendergast A, John T, Leguizamon R, McLaren I, Khan R, Geller A, Wattanachayakul P, Malin J, Jarrett SA, Lo KB, Benzaquen S, Witzke C. Association of mildly elevated pulmonary vascular resistance with major cardiovascular events in pulmonary hypertension and chronic kidney disease: A retrospective cohort analysis. Pulm Circ 2024; 14:e12401. [PMID: 38887741 PMCID: PMC11181768 DOI: 10.1002/pul2.12401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/27/2024] [Accepted: 06/05/2024] [Indexed: 06/20/2024] Open
Abstract
Pulmonary hypertension (PH) is associated with adverse outcomes in chronic kidney disease (CKD) patients. Our study suggests mildly elevated pulmonary vascular resistance ( > 2 to ≤ 3) is independently associated with major adverse cardiovascular events at 1-year follow-up. Early diagnosis of precapillary PH in CKD patients can potentially improve clinical outcomes.
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Affiliation(s)
| | | | - Tara John
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Raul Leguizamon
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Ian McLaren
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Rasha Khan
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Andrew Geller
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | | | - John Malin
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Simone A. Jarrett
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Kevin Bryan Lo
- Department of MedicineJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Sadia Benzaquen
- Department of Pulmonary and Critical CareJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
| | - Christian Witzke
- Department of CardiologyJefferson Einstein HospitalPhiladelphiaPennsylvaniaUSA
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79
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Chernyshov A, Grue JF, Nyberg J, Grenne B, Dalen H, Aase SA, Østvik A, Lovstakken L. Automated Segmentation and Quantification of the Right Ventricle in 2-D Echocardiography. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:540-548. [PMID: 38290912 DOI: 10.1016/j.ultrasmedbio.2023.12.018] [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: 09/13/2023] [Revised: 12/04/2023] [Accepted: 12/18/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVE The right ventricle receives less attention than its left counterpart in echocardiography research, practice and development of automated solutions. In the work described here, we sought to determine that the deep learning methods for automated segmentation of the left ventricle in 2-D echocardiograms are also valid for the right ventricle. Additionally, here we describe and explore a keypoint detection approach to segmentation that guards against erratic behavior often displayed by segmentation models. METHODS We used a data set of echo images focused on the right ventricle from 250 participants to train and evaluate several deep learning models for segmentation and keypoint detection. We propose a compact architecture (U-Net KP) employing the latter approach. The architecture is designed to balance high speed with accuracy and robustness. RESULTS All featured models achieved segmentation accuracy close to the inter-observer variability. When computing the metrics of right ventricular systolic function from contour predictions of U-Net KP, we obtained the bias and 95% limits of agreement of 0.8 ± 10.8% for the right ventricular fractional area change measurements, -0.04 ± 0.54 cm for the tricuspid annular plane systolic excursion measurements and 0.2 ± 6.6% for the right ventricular free wall strain measurements. These results were also comparable to the semi-automatically derived inter-observer discrepancies of 0.4 ± 11.8%, -0.37 ± 0.58 cm and -1.0 ± 7.7% for the aforementioned metrics, respectively. CONCLUSION Given the appropriate data, automated segmentation and quantification of the right ventricle in 2-D echocardiography are feasible with existing methods. However, keypoint detection architectures may offer higher robustness and information density for the same computational cost.
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Affiliation(s)
- Artem Chernyshov
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
| | - Jahn Frederik Grue
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - John Nyberg
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørnar Grenne
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olav's Hospital, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olav's Hospital, Trondheim, Norway
| | | | - Andreas Østvik
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway; Department of Health Research, SINTEF Digital, Trondheim, Norway
| | - Lasse Lovstakken
- Department of Circulation and Medical Imaging, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
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80
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Petty K, Daubenspeck D. Rescue ECMO for Isolated Right Ventricular Dysfunction in a Trauma Patient. J Cardiothorac Vasc Anesth 2024; 38:1031-1036. [PMID: 38105124 DOI: 10.1053/j.jvca.2023.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Affiliation(s)
- Kyle Petty
- University of Chicago, Department of Anesthesia and Critical Care, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637.
| | - Danisa Daubenspeck
- Assistant Professor of Anesthesia and Critical Care, University of Chicago, Department of Anesthesia and Critical Care, 5841 South Maryland Avenue, MC 4028, Chicago, IL 60637.
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81
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Beck S, Aziz Shamri H, Coffey S, Anakin M, Whalley G. Image quality and technical limitations in emergency department cardiac point-of-care ultrasound: A retrospective cohort study. Emerg Med Australas 2024; 36:295-301. [PMID: 38044805 DOI: 10.1111/1742-6723.14353] [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: 09/20/2023] [Revised: 11/05/2023] [Accepted: 11/09/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE To assess the image quality and common technical limitations seen on cardiac point-of-care ultrasound (POCUS) performed and archived in a single New Zealand ED. METHODS A retrospective cohort study of clinically indicated cardiac POCUS, archived from 1 October 2019 to 20 May 2020. Archived examinations were retrospectively reviewed by an ED POCUS expert, and an expert cardiac sonographer to determine diagnostic image quality, technical limitations present and opportunities for image quality improvement. Image quality of credentialed examinations was compared to uncredentialed examinations and examinations that were undocumented in the medical record. RESULTS A total of 211 cardiac POCUS examinations were included. The impact of image quality on diagnostic interpretation was only documented in <2% of examinations. There was no difference in median global image quality scores for uncredentialed and credentialed examinations (8.5 vs 9, P = 0.55) and median score for undocumented examinations (5.5) was lower than credentialed examinations (P < 0.01). Common technical limitations identified were off-axis imaging and artefacts limiting image quality. CONCLUSION In the present study of clinically indicated cardiac POCUS, low image quality was common but the impact of image quality on diagnostic interpretation was very rarely documented in the medical record. Local quality assurance and training should be directed at credentialed and uncredentialed clinicians including strategies to improve off-axis imaging and managing artefacts where possible. Standardised documentation of image quality that may impact diagnostic accuracy should be encouraged.
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Affiliation(s)
- Sierra Beck
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Emergency Department, Dunedin Hospital, Te Whatu Ora, Dunedin, New Zealand
| | - Haziq Aziz Shamri
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Sean Coffey
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Cardiology Department, Dunedin Hospital, Te Whatu Ora, Dunedin, New Zealand
| | - Megan Anakin
- Medical Education Unit, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Gillian Whalley
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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82
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Murayama M, Sugimori H, Yoshimura T, Kaga S, Shima H, Tsuneta S, Mukai A, Nagai Y, Yokoyama S, Nishino H, Nakamura J, Sato T, Tsujino I. Deep learning to assess right ventricular ejection fraction from two-dimensional echocardiograms in precapillary pulmonary hypertension. Echocardiography 2024; 41:e15812. [PMID: 38634241 DOI: 10.1111/echo.15812] [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: 02/04/2024] [Revised: 03/10/2024] [Accepted: 03/25/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Precapillary pulmonary hypertension (PH) is characterized by a sustained increase in right ventricular (RV) afterload, impairing systolic function. Two-dimensional (2D) echocardiography is the most performed cardiac imaging tool to assess RV systolic function; however, an accurate evaluation requires expertise. We aimed to develop a fully automated deep learning (DL)-based tool to estimate the RV ejection fraction (RVEF) from 2D echocardiographic videos of apical four-chamber views in patients with precapillary PH. METHODS We identified 85 patients with suspected precapillary PH who underwent cardiac magnetic resonance imaging (MRI) and echocardiography. The data was divided into training (80%) and testing (20%) datasets, and a regression model was constructed using 3D-ResNet50. Accuracy was assessed using five-fold cross validation. RESULTS The DL model predicted the cardiac MRI-derived RVEF with a mean absolute error of 7.67%. The DL model identified severe RV systolic dysfunction (defined as cardiac MRI-derived RVEF < 37%) with an area under the curve (AUC) of .84, which was comparable to the AUC of RV fractional area change (FAC) and tricuspid annular plane systolic excursion (TAPSE) measured by experienced sonographers (.87 and .72, respectively). To detect mild RV systolic dysfunction (defined as RVEF ≤ 45%), the AUC from the DL-predicted RVEF also demonstrated a high discriminatory power of .87, comparable to that of FAC (.90), and significantly higher than that of TAPSE (.67). CONCLUSION The fully automated DL-based tool using 2D echocardiography could accurately estimate RVEF and exhibited a diagnostic performance for RV systolic dysfunction comparable to that of human readers.
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Affiliation(s)
- Michito Murayama
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroyuki Sugimori
- Department of Biomedical Science and Engineering, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takaaki Yoshimura
- Clinical AI Human Resources Development Program, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Global Center for Biomedical Science and Engineering, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Department of Health Sciences and Technology, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Department of Medical Physics, Hokkaido University Hospital, Sapporo, Japan
| | - Sanae Kaga
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Japan
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Hideki Shima
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Satonori Tsuneta
- Department of Radiology, Graduate School of Dental Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Aoi Mukai
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Yui Nagai
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Japan
| | - Shinobu Yokoyama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Hisao Nishino
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Japan
| | - Junichi Nakamura
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Takahiro Sato
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Ichizo Tsujino
- Department of Respiratory Medicine, Faculty of Medicine, Hokkaido University, Sapporo, Japan
- Division of Respiratory and Cardiovascular Innovative Research, Faculty of Medicine, Hokkaido University, Sapporo, Japan
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83
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Kusner J, Krasuski RA. Pulmonary Hypertension in Adult Congenital Heart Disease-Related Heart Failure. Heart Fail Clin 2024; 20:209-221. [PMID: 38462325 DOI: 10.1016/j.hfc.2023.12.010] [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] [Indexed: 03/12/2024]
Abstract
Already a challenging condition to define, adult congenital heart disease (ACHD) -associated heart failure (HF) often incorporates specific anatomies, including intracardiac and extracardiac shunts, which require rigorous diagnostic characterization and heighten the importance of clinicians proactively considering overall hemodynamic impacts of using specific therapies. The presence of elevated pulmonary vascular resistance dramatically increases the complexity of managing patients with ACHD-HF. Total circulatory management in patients with ACHD-HF requires input from multidisciplinary care teams and thoughtful and careful utilization of medical, interventional, and surgical approaches.
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Affiliation(s)
- Jonathan Kusner
- Department of Medicine, Duke University Medical Center, 2301 Erwin Road, Durham, NC 27705, USA
| | - Richard A Krasuski
- Department of Cardiovascular Medicine, Duke University Medical Center, Box 3012, Durham, NC 27710, USA.
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84
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Wilson R, Eguchi S, Orihara Y, Pfeiffer M, Peterson B, Ruzieh M, Gao Z, Gorcsan J, Boehmer J. Association between right ventricular global longitudinal strain and mortality in intermediate-risk pulmonary embolism. Echocardiography 2024; 41:e15815. [PMID: 38634182 DOI: 10.1111/echo.15815] [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: 02/05/2024] [Revised: 03/31/2024] [Accepted: 04/01/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Right ventricular (RV) systolic dysfunction has been identified as a prognostic marker for adverse clinical events in patients presenting with acute pulmonary embolism (PE). However, challenges exist in identifying RV dysfunction using conventional echocardiography techniques. Strain echocardiography is an evolving imaging modality which measures myocardial deformation and can be used as an objective index of RV systolic function. This study evaluated RV Global Longitudinal Strain (RVGLS) in patients with intermediate risk PE as a parameter of RV dysfunction, and compared to traditional echocardiographic and CT parameters evaluating short-term mortality. METHODS Retrospective single center cohort study of 251 patients with intermediate-risk PE between 2010 and 2018. The primary outcome was all-cause mortality at 30 days. Statistical analysis evaluated each parameter comparing survivors versus non-survivors at 30 days. Receiver operating characteristic (ROC) curves and Kaplan-Meier curves were used for comparison of the two cohorts. RESULTS Altogether 251 patients were evaluated. Overall mortality rate was 12.4%. Utilizing an ROC curve, an absolute cutoff value of 17.7 for RVGLS demonstrated a sensitivity of 93% and specificity of 70% for observed 30-day mortality. Individuals with an RVGLS ≤17.7 had a 25 times higher mortality rate than those with RVGLS above 17.7 (HR 25.24, 95% CI = 6.0-106.4, p < .001). Area under the curve was (.855), RVGLS outperformed traditional echocardiographic parameters, CT findings, and cardiac biomarkers on univariable and multivariable analysis. CONCLUSIONS Reduced RVGLS values on initial echocardiographic assessment of patients with intermediate-risk PE identified patients at higher risk for mortality at 30 days.
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Affiliation(s)
- Ryan Wilson
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Shunsuke Eguchi
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Yoshiyuki Orihara
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Michael Pfeiffer
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Brandon Peterson
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - Mohammed Ruzieh
- Division of Cardiovascular Medicine, College of Medicine, University of Florida, Gainsville, Florida, USA
| | - Zhaohui Gao
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - John Gorcsan
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
| | - John Boehmer
- Division of Cardiology, Heart and Vascular Institute, College of Medicine, Pennsylvania State University, Hershey, Pennsylvania, USA
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85
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Hayashi H, Kirschner M, Vinogradsky A, Ning Y, Kurlansky P, Yuzefpolskaya M, Colombo PC, Sayer GT, Uriel N, Naka Y, Takeda K. Acute right ventricular geometric change predicts outcomes in HeartMate 3 patients. J Heart Lung Transplant 2024; 43:642-651. [PMID: 38070663 DOI: 10.1016/j.healun.2023.11.020] [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: 01/13/2023] [Revised: 10/24/2023] [Accepted: 11/27/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND The physiological response of the right ventricle (RV) following left ventricular assist device (LVAD) implantation is difficult to predict. We aimed to investigate RV geometric and functional changes after LVAD insertion and their effects on clinical outcomes. METHODS We retrospectively reviewed 188 patients who underwent HeartMate 3 implantation at our center between November 2014 and September 2021. The RV end-diastolic diameter (RVEDD) and RV end-diastolic area (RVEDA) were measured on preoperative and predischarge transthoracic echocardiography. The nonadapted group included patients with increased RVEDD and RVEDA at discharge. The composite outcome was defined as death or readmission due to worsening right heart failure. RESULTS There were 82 patients (44%) who had a nonadapted and 106 patients (56%) who had an adapted RV. Preoperatively, the nonadapted group had smaller RVEDD (46 vs 49 mm, p < 0.001) and RVEDA (27 vs 31 cm2, p < 0.001). At discharge, the nonadapted group had larger RVEDD (51 vs 43 mm, p < 0.001) and RVEDA (33 vs 27 cm2, p < 0.001). Kaplan-Meier analysis demonstrated worse 3-year survival (77% vs 91%, p = 0.006) and freedom from composite outcome (58% vs 85%, p < 0.001) in the nonadapted group. A multivariable Cox proportional hazards model showed that nonadaption (hazard ratio [HR] 3.09, 95% confidence interval [CI] 1.29-7.40, p = 0.01) and age (HR 3.73, 95% CI 1.42-9.77, p = 0.007) were independent predictors of composite outcome. CONCLUSIONS Acute RV dimensional changes after LVAD insertion may represent intrinsic RV function and may be a useful prognostic marker.
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Affiliation(s)
- Hideyuki Hayashi
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York.
| | - Michael Kirschner
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Alice Vinogradsky
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Yuming Ning
- Department of Surgery, Center for Innovation and Outcomes Research, Columbia University Medical Center, New York, New York
| | - Paul Kurlansky
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
| | - Melana Yuzefpolskaya
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Paolo C Colombo
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Gabriel T Sayer
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, New York
| | - Yoshifumi Naka
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York; Department of Surgery, Division of Cardiothoracic Surgery, Weill Cornell Medical Center, New York, New York
| | - Koji Takeda
- Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, New York, New York
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Özde Ş, Kayapınar O, Doğru M, Aktüre G, Kaya A, Coşkun G, Keskin M, Özde C. Evaluation of the Early Effects of Childhood Asthma and Its Treatment on Cardiac Function as Revealed by Two-Dimensional Speckle-Tracking Echocardiography. Pediatr Cardiol 2024; 45:858-866. [PMID: 36038783 DOI: 10.1007/s00246-022-02941-w] [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: 01/18/2022] [Accepted: 05/16/2022] [Indexed: 11/24/2022]
Abstract
There is minimal information available regarding the early effects of bronchial asthma (BA) and its treatment on cardiac function in children. We used two-dimensional speckle-tracking echocardiography (2D-STE) to evaluate cardiac function before and after the treatment of childhood BA. We enrolled 44 children with moderate and severe BA who had not been treated over the preceding 3 months or who were newly diagnosed. All children received the same treatment (that recommended by the Global Initiative for Asthma [GINA] in 2017). All children also underwent transthoracic 2D-STE before treatment and 6 months later. Clinical data were compared before and after treatment. After treatment, significant increases were evident in right ventricular (RV) systolic and diastolic strain, as well as the systolic strain rate. Before and after treatment, the RV global longitudinal systolic strains were - 22.8 ± 3.6 and - 25.1 ± 4.5, respectively (p = 0.036); the RV global longitudinal diastolic strains were - 18.5 ± 6.0 and - 21.5 ± 5.2, respectively (p = 0.038); and the RV systolic strain rates were - 1.26 ± 0.4 and - 1.12 ± 0.3, respectively (p = 0.025). After treatment, significant increases were observed in the right atrial (RA) peak longitudinal strain and strain rate. Before and after treatment, the RA peak atrial longitudinal strains were 32.5 ± 10.8 and 44.7 ± 11.2, respectively (p = 0.042) and the RA longitudinal strain rates were - 1.6 ± 0.3 and - 2.0 ± 0.5, respectively (p = 0.041). RV and RA subclinical dysfunction may develop in children with early-stage BA. However, asthma treatment appears to improve such dysfunction. In children with BA, clinical and subclinical changes in cardiac functions can be easily detected via 2D-STE.
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Affiliation(s)
| | | | | | | | - Adnan Kaya
- Duzce Universitesi Tip Fakultesi, Duzce, Turkey
| | | | | | - Cem Özde
- Duzce Universitesi Tip Fakultesi, Duzce, Turkey
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87
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Singh Y. Echocardiography in the neonatal unit: current status and future prospects. Expert Rev Med Devices 2024; 21:307-316. [PMID: 38526192 DOI: 10.1080/17434440.2024.2334449] [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: 01/04/2024] [Accepted: 03/20/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Traditionally echocardiography was used by pediatric cardiologists to diagnose congenital heart defects in neonates. Formalized neonatal hemodynamic fellowships have been established where neonatologists acquire advanced echocardiographic skills to gain anatomical, physiological, and hemodynamic information in real time and utilize this information in making a timely and accurate physiology-based clinical decision. AREA COVERED Differences between a comprehensive formal structural echocardiography, neonatologist performed targeted echocardiography and limited assessment on point-of-care-ultrasonography for specific indications have been covered. This article is focused at providing a comprehensive review of the status of echocardiography in the neonatal units, recent advancements and its future prospects in the neonatal intensive care units. EXPERT OPINION Comprehensive guidelines providing the scope of practice, a framework for training, and robust clinical governance process for the neonatologist performed targeted echocardiography have been established. In the last decade, echocardiography has emerged as essential vital bedside diagnostic tool in providing high-quality care to the sick infants in the neonatal units, and it has proved to improve the outcomes in neonates. It is now being considered as a modern hemodynamic monitoring tool. Advances in technology, machine learning, and application of artificial intelligence in applications of echocardiography seem promising adjunct tools for rapid assessment in emergency situations.
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Affiliation(s)
- Yogen Singh
- Division of Neonatology, Loma Linda University School of Medicine, Loma Linda, CA, USA
- Division of Neonatology, University of Southern California, Los Angeles, USA
- Department of Pediatrics, University of Cambridge Clinical School of Medicine, Cambridge, UK
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88
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González-Suárez S, Corbett M, Hernández-Martínez A. Impact of graft reperfusion on cardiac function assessed by transesophageal echocardiography during liver transplantation: an observational retrospective study. J Clin Monit Comput 2024; 38:301-311. [PMID: 38032448 PMCID: PMC10995086 DOI: 10.1007/s10877-023-01110-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 11/19/2023] [Indexed: 12/01/2023]
Abstract
Cardiovascular instability is common during the reperfusion phase of orthotopic liver transplantation (OLT), and some patients experience a postreperfusion syndrome (PRS). However, there are no reports comparing the cardiac dysfunction between patients with PRS and those without. Thus, the aim of this study was to evaluate cardiac dysfunction in patients exhibiting PRS. This observational retrospective study included 34 patients who underwent OLT and were monitored with transesophageal echocardiography (TEE). The right ventricular/left ventricular (RV/LV) end diastolic area, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF) by Simpson method, pulsed Doppler of the mitral valve, and tissue Doppler motion of the mitral annulus were determined. Echocardiographic measurements were registered at the beginning of surgery and at 1 and 30 min after vascular unclamping. Patients with PRS (PRS group) were identified, and their echocardiographic parameters of ventricular function were compared with those in patients without PRS (non-PRS group). To check the evolution of diastolic-systolic dysfunction, general linear model-repeated measures were estimated. No patient presented systolic/diastolic dysfunction on the basal echocardiogram. One minute after vascular unclamping, the incidence of RV dilation was 4.5 times greater in patients with PRS (Cramer´s V > 0.6), and the incidence of RV systolic dysfunction was 62.5% in patients with PRS compared to 15.40% in patients without PRS (Cramer´s V = 0.45). The incidence of LV systolic dysfunction was 25% in patients with PRS compared to 0% in those without (Cramer´s V = 0.45), and left ventricular diastolic dysfunction was 4.8 times greater in patients with PRS (Cramer´s V = 0.45). No patient presented diastolic dysfunction type III. There were significant differences between groups in the evolutionary pattern at 1 and 30 min after unclamping for RV dilation (p = 0.008) and for TAPSE (p = 0.014). Liver graft reperfusion may alter cardiac function. Cardiac dysfunction was more frequent in patients with PRS. These patients exhibited temporary dysfunction of the RV associated with a varying degree of LV diastolic-systolic dysfunction. Trial registration: clinicaltrials.gov (NCT05175534). January 03, 2022; "retrospectively registered".
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Affiliation(s)
- Susana González-Suárez
- Department of Surgery, Universitat Autònoma de Barcelona, Unitat Docent Vall d´Hebron, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
- Department of Anesthesiology, Vall d´Hebron University Hospital, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
- Vall d´Hebron Institut de Recerca (VHIR), Cardiovascular diseases Research Group, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain.
| | - Matthew Corbett
- Department of Anesthesiology, Vall d´Hebron University Hospital, Passeig Vall d´Hebron 119-129, Barcelona, 08035, Spain
| | - Alberto Hernández-Martínez
- Department of Anesthesiology and Intensive Care, Grupo Policlínica, Ibiza. Islas Baleares. Vía Romana s/n, Ibiza, Baleares, 07800, Spain
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89
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Brenner R, Drescher T, Locher R, Bilz S, Rickli H, Brändle M, Nobel D, Weilenmann D, Ammann P, Maeder MT. Pulmonary and Systemic Hemodynamics in Patients with Hyperthyroidism. Am J Med 2024; 137:350-357. [PMID: 38104644 DOI: 10.1016/j.amjmed.2023.11.023] [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: 11/04/2023] [Revised: 11/28/2023] [Accepted: 11/29/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND There is an association between hyperthyroidism and pulmonary hypertension. However, the prevalence of pulmonary hypertension in hyperthyroidism and the underlying mechanisms are incompletely defined. METHODS Consecutive patients with severe hyperthyroidism, mostly due to Graves disease, were included in this single-center study. Echocardiographic assessment of pulmonary hemodynamics was performed at the time of hyperthyroidism diagnosis (baseline) and after normalization of thyroid hormones (follow-up; median 11 months). In a subset of patients, right heart catheterization and noninvasive assessment of central hemodynamics was performed. RESULTS Among all 99 patients, 31% had pulmonary hypertension at baseline. The estimated systolic pulmonary artery pressure correlated significantly with the estimated left ventricular filling pressure (E/e'). The invasively measured systolic pulmonary artery pressure correlated well with the estimated systolic pulmonary artery pressure. Cardiac output, E/e', left and right ventricular dimensions were significantly reduced from baseline to follow-up, whereas the estimated pulmonary vascular resistance did not differ. Diastolic blood pressure was significantly higher at follow-up, with no change in systolic blood pressure. The central systolic blood pressure, however, exhibited a trend for a reduction at follow-up, while the pulse wave velocity was significantly lower at follow-up. CONCLUSIONS Approximately one-third of patients with hyperthyroidism have evidence of pulmonary hypertension. Our data suggest that an increased cardiac output and left ventricular filling pressure are the main mechanisms underlying the elevated systolic pulmonary artery pressure in hyperthyroidism, whereas there is no evidence of significant pulmonary vascular disease.
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Affiliation(s)
| | - Tilman Drescher
- Department of Endocrinology, Kantonsspital, St.Gallen, Switzerland
| | - Rebecca Locher
- Department of Endocrinology, Kantonsspital Graubünden, Chur, Switzerland
| | - Stefan Bilz
- Department of Endocrinology, Kantonsspital, St.Gallen, Switzerland
| | | | - Michael Brändle
- Department of Endocrinology, Kantonsspital, St.Gallen, Switzerland
| | - Daniel Nobel
- Department of Internal Medicine, Spital Wil, Switzerland
| | | | | | - Micha T Maeder
- Department of Cardiology; University of Basel, Switzerland
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90
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Yamano M, Yamano T, Matoba S. Right ventricular dilatation: echocardiographic differential diagnosis. J Med Ultrason (2001) 2024; 51:275-282. [PMID: 38228943 DOI: 10.1007/s10396-023-01399-4] [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: 03/30/2023] [Accepted: 11/15/2023] [Indexed: 01/18/2024]
Abstract
The initial means of detecting right ventricular (RV) dilatation is often transthoracic echocardiography (TTE), and once the presence of RV dilatation is suspected, there is the possibility of RV volume overload, RV pressure overload, RV myocardial disease, and even nonpathological RV dilatation. With respect to congenital heart disease with RV volume overload, defects or valvular abnormalities can be easily detected with TTE, with the exception of some diseases. Volumetric assessment using three-dimensional echocardiography may be useful in determining the intervention timing in these diseases. When the disease progresses in patients with pulmonary hypertension as a result of RV pressure overload, RV dilatation becomes more prominent than hypertrophy, and RV functional parameters predict the prognosis at this stage of maladaptive remodeling. The differential diagnosis of cardiomyopathy or comparison with nonpathological RV dilatation may be difficult in the setting of RV myocardial disease. The characteristics of RV functional parameters such as two-dimensional speckle tracking may help differentiate RV cardiomyopathy from other conditions. We review the diseases presenting with RV dilatation, their characteristics, and echocardiographic findings and parameters that are significant in assessing their status or intervention timing.
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Affiliation(s)
- Michiyo Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan.
| | - Tetsuhiro Yamano
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
| | - Satoaki Matoba
- Department of Cardiovascular Medicine, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kajii-cho 465, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto, 602-8566, Japan
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91
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Celestin BE, Bagherzadeh SP, Ichimura K, Santana EJ, Sanchez PA, Tobore T, Hemnes AR, Noordegraaf AV, Salerno M, Zamanian RT, Sweatt AJ, Haddad F. Identifying consistent echocardiographic thresholds for risk stratification in pulmonary arterial hypertension. Pulm Circ 2024; 14:e12361. [PMID: 38800494 PMCID: PMC11116946 DOI: 10.1002/pul2.12361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 03/08/2024] [Indexed: 05/29/2024] Open
Abstract
Several indices of right heart remodeling and function have been associated with survival in pulmonary arterial hypertension (PAH). Outcome analysis and physiological relationships between variables may help develop a consistent grading system. Patients with Group 1 PAH followed at Stanford Hospital who underwent right heart catheterization and echocardiography within 2 weeks were considered for inclusion. Echocardiographic variables included tricuspid annular plane systolic excursion (TAPSE), right ventricular (RV) fractional area change (RVFAC), free wall strain (RVFWS), RV dimensions, and right atrial volumes. The main outcome consisted of death or lung transplantation at 5 years. Mathematical relationships between variables were determined using weighted linear regression and severity thresholds for were calibrated to a 20% 1-year mortality risk. PAH patients (n = 223) had mean (SD) age of 48.1 (14.1) years, most were female (78%), with a mean pulmonary arterial pressure of 51.6 (13.8) mmHg and pulmonary vascular resistance index of 22.5(6.3) WU/m2. Measures of right heart size and function were strongly related to each other particularly RVFWS and RVFAC (R 2 = 0.82, p < 0.001), whereas the relationship between TAPSE and RVFWS was weaker (R 2 = 0.28, p < 0.001). Death or lung transplantation at 5 years occurred in 78 patients (35%). Guided by outcome analysis, we ascertained a uniform set of parameter thresholds for grading the severity of right heart adaptation in PAH. Using these quantitative thresholds, we, then, validated the recently reported REVEAL-echo score (AUC 0.68, p < 0.001). This study proposes a consistent echocardiographic grading system for right heart adaptation in PAH guided by outcome analysis.
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Affiliation(s)
- Bettia E. Celestin
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Shadi P. Bagherzadeh
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Kenzo Ichimura
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Everton J. Santana
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
- Department of Cardiovascular Sciences, Research Unit Hypertension and Cardiovascular EpidemiologyUniversity of LeuvenLeuvenBelgium
| | - Pablo Amador Sanchez
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Tobore Tobore
- Pulmonary Hypertension section, Janssen and JanssenTitusvilleNew JerseyUSA
| | - Anna R. Hemnes
- Division of allergy, Pulmonary and Critical Care MedicineVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Anton Vonk Noordegraaf
- Pulmonary Hypertension section, Janssen and JanssenTitusvilleNew JerseyUSA
- Department of Pulmonary DiseasesVU University Medical CenterAmsterdamthe Netherlands
| | - Michael Salerno
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
| | - Roham T. Zamanian
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Andrew J. Sweatt
- Department of Medicine, Division of PathologyStanford UniversityStanfordCaliforniaUSA
- Vera Moulton Wall Center for Pulmonary Vascular DiseaseStanford School of MedicineStanfordCaliforniaUSA
| | - Francois Haddad
- Stanford Cardiovascular InstituteStanford UniversityStanfordCaliforniaUSA
- Department of Medicine, Division of Cardiovascular MedicineStanford UniversityStanfordCaliforniaUSA
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92
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Allam LE, Abdelmotteleb AA, Eldamanhoury HM, Hassan HS. Unlocking the potential of sacubitril/valsartan therapy in improving ECG and echocardiographic parameters in heart failure patients with reduced ejection fraction (HErEF). Egypt Heart J 2024; 76:41. [PMID: 38546816 PMCID: PMC10978557 DOI: 10.1186/s43044-024-00468-4] [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: 08/23/2023] [Accepted: 03/13/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND Sacubitril/valsartan therapy has been found to reduce hospitalizations, improve echocardiogram parameters, and improve mortality in HFrEF. The objective is to assess S/V therapy effect on electrocardiogram indices and how those parameters related to echocardiographic parameters. RESULTS From June 2022 until June 2023, this prospective study enrolled 100 patients (mean age 56.1, 8.2, 78% male) with non-ischemic dilated cardiomyopathy (NIDCM) used PARADIGM-HF criteria: NYHA Class II, III, or IV HF; ejection fraction EF ≤ 40%; and hospitalization for HF within previous 12 months. Before starting S/V therapy, an echo and ECG were performed, as well as 6 months following the optimal dose and if LVEF was improved by more than 5%, they were termed notable S/V treatment responders. Aside from improving echo parameters, ECG parameters improved significantly. The QRS width was reduced from 123.7 ± 20.3 to 117.1 ± 18.8 ms (p 0.00), and QTc interval was reduced from 425.4 ± 32.8 to 421.4 ± 32.3 ms (p = 0.012). QRS width was significantly reduced in patients with LBBB, RBBB, and IVCD based on QRS morphology. QRS width (r = - 0.243, p = 0.016) and QTc (r = - 0.252, p = 0.012) had a negative connection with LVEF. CONCLUSION S/V therapy, in addition to improving echo parameters and NYHA class, improves QRS width and corrected QTc interval on ECG in HFrEF patients. This is an indication of reverse electrical LV remodeling and can be used as an auxiliary prediction for tracking therapy outcomes.
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Affiliation(s)
- Lamyaa Elsayed Allam
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt.
| | - Ahmed Aly Abdelmotteleb
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt
| | - Hayam Mohamed Eldamanhoury
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt
| | - Hassan Shehata Hassan
- Department of Cardiology, Faculty of Medicine, Ain Shams University, 48 Mohammed Elnadi Street, 6th Zone, Nasr City, Cairo, 11371, Egypt
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93
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Fortmeier V, Lachmann M, Stolz L, von Stein J, Unterhuber M, Kassar M, Gerçek M, Schöber AR, Stocker TJ, Omran H, Körber MI, Hesse A, Harmsen G, Friedrichs KP, Yuasa S, Rudolph TK, Joner M, Pfister R, Baldus S, Laugwitz KL, Windecker S, Praz F, Lurz P, Hausleiter J, Rudolph V. Artificial intelligence-enabled assessment of right ventricular to pulmonary artery coupling in patients undergoing transcatheter tricuspid valve intervention. Eur Heart J Cardiovasc Imaging 2024; 25:558-572. [PMID: 37996066 DOI: 10.1093/ehjci/jead324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/09/2023] [Accepted: 10/12/2023] [Indexed: 11/25/2023] Open
Abstract
AIMS Right ventricular to pulmonary artery (RV-PA) coupling has been established as a prognostic marker in patients with severe tricuspid regurgitation (TR) undergoing transcatheter tricuspid valve interventions (TTVI). RV-PA coupling assesses right ventricular systolic function related to pulmonary artery pressure levels, which are ideally measured by right heart catheterization. This study aimed to improve the RV-PA coupling concept by relating tricuspid annular plane systolic excursion (TAPSE) to mean pulmonary artery pressure (mPAP) levels. Moreover, instead of right heart catheterization, this study sought to employ an extreme gradient boosting (XGB) algorithm to predict mPAP levels based on standard echocardiographic parameters. METHODS AND RESULTS This multicentre study included 737 patients undergoing TTVI for severe TR; among them, 55 patients from one institution served for external validation. Complete echocardiography and right heart catheterization data were available from all patients. The XGB algorithm trained on 10 echocardiographic parameters could reliably predict mPAP levels as evaluated on right heart catheterization data from external validation (Pearson correlation coefficient R: 0.68; P value: 1.3 × 10-8). Moreover, predicted mPAP (mPAPpredicted) levels were superior to echocardiographic systolic pulmonary artery pressure (sPAPechocardiography) levels in predicting 2-year mortality after TTVI [area under the curve (AUC): 0.607 vs. 0.520; P value: 1.9 × 10-6]. Furthermore, TAPSE/mPAPpredicted was superior to TAPSE/sPAPechocardiography in predicting 2-year mortality after TTVI (AUC: 0.633 vs. 0.586; P value: 0.008). Finally, patients with preserved RV-PA coupling (defined as TAPSE/mPAPpredicted > 0.617 mm/mmHg) showed significantly higher 2-year survival rates after TTVI than patients with reduced RV-PA coupling (81.5% vs. 58.8%, P < 0.001). Moreover, independent association between TAPSE/mPAPpredicted levels and 2-year mortality after TTVI was confirmed by multivariate regression analysis (P value: 6.3 × 10-4). CONCLUSION Artificial intelligence-enabled RV-PA coupling assessment can refine risk stratification prior to TTVI without necessitating invasive right heart catheterization. A comparison with conservatively treated patients is mandatory to quantify the benefit of TTVI in accordance with RV-PA coupling.
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Affiliation(s)
- Vera Fortmeier
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Mark Lachmann
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Lukas Stolz
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Matthias Unterhuber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Mohammad Kassar
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Muhammed Gerçek
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Anne R Schöber
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Thomas J Stocker
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Hazem Omran
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Maria I Körber
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Amelie Hesse
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Gerhard Harmsen
- Department of Physics, University of Johannesburg, Auckland Park, South Africa
| | - Kai Peter Friedrichs
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Shinsuke Yuasa
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Tanja K Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
| | - Michael Joner
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Department of Cardiology, German Heart Center Munich, Technical University of Munich, Munich, Germany
| | - Roman Pfister
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, University of Cologne, Cologne, Germany
| | - Karl-Ludwig Laugwitz
- First Department of Medicine, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
| | - Stephan Windecker
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital Bern, Bern University Hospital, Bern, Switzerland
| | - Philipp Lurz
- Department of Cardiology, Heart Center Leipzig, University of Leipzig, Leipzig, Germany
| | - Jörg Hausleiter
- DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany
- Medizinische Klinik und Poliklinik I, Klinikum der Universität München, Ludwig Maximilians University of Munich, Munich, Germany
| | - Volker Rudolph
- Department of General and Interventional Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Georgstraße 11, 32545 Bad Oeynhausen, Germany
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94
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Kuwata S, Izumo M, Okuno T, Shiokawa N, Sato Y, Koga M, Okuyama K, Tanabe Y, Harada T, Ishibashi Y, Akashi YJ. Impact of Renal Congestion in Patients With Secondary Mitral Regurgitation After Mitral Transcatheter Edge-to-Edge Repair. Circ J 2024; 88:510-516. [PMID: 37438144 DOI: 10.1253/circj.cj-23-0240] [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] [Indexed: 07/14/2023]
Abstract
BACKGROUND Renal congestion is a potential prognostic factor in patients with heart failure and recently, assessment has become possible with intrarenal Doppler ultrasonography (IRD). The association between renal congestion assessed by IRD and outcomes after mitral transcatheter edge-to-edge repair (TEER) is unknown, so we aimed to clarify renal congestion and its prognostic implications in patients with mitral regurgitation (MR) who underwent TEER using MitraClip system.Methods and Results: Patients with secondary MR who underwent TEER and were assessed for intrarenal venous flow (IRVF) by IRD were classified according to their IRVF pattern as continuous or discontinuous. Of the 105 patients included, 78 patients (74%) formed the continuous group and 27 (26%) were the discontinuous group. Kaplan-Meier analysis revealed significant prognostic power of the IRVF pattern for predicting the composite outcome of all-cause death and heart failure rehospitalization (log-rank P=0.0257). On multivariate Cox regression analysis, the composite endpoint was independently associated with the discontinuous IRVF pattern (hazard ratio, 3.240; 95% confidence interval, 1.300-8.076; P=0.012) adjusted using inverse probability of treatment weighting. CONCLUSIONS IRVF patterns strongly correlated with clinical outcomes without changes in renal function. Thus, they may be useful for risk stratification after mitral TEER for patients with secondary MR.
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Affiliation(s)
- Shingo Kuwata
- Department of Cardiology, St. Marianna University School of Medicine
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine
| | - Taishi Okuno
- Department of Cardiology, St. Marianna University School of Medicine
| | - Noriko Shiokawa
- Diagnostic Medical Sonography, St. Marianna University Hospital
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine
| | - Masashi Koga
- Department of Cardiology, St. Marianna University School of Medicine
| | - Kazuaki Okuyama
- Department of Cardiology, St. Marianna University School of Medicine
| | - Yasuhiro Tanabe
- Department of Cardiology, St. Marianna University School of Medicine
| | - Tomoo Harada
- Department of Cardiology, St. Marianna University School of Medicine
| | - Yuki Ishibashi
- Department of Cardiology, St. Marianna University School of Medicine
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95
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Kobayashi M, Ferreira JP, Kevin D, Bresso E, Huttin O, Bozec E, Brunner La Rocca HP, Delles C, Clark AL, Edelmann F, González A, Heymans S, Pellicori P, Petutschnigg J, Verdonschot JAJ, Rossignol P, Cleland JGF, Zannad F, Girerd N. Proteomic profiles of left atrial volume and its influence on response to spironolactone: Findings from the HOMAGE trial and STANISLAS cohort. Eur J Heart Fail 2024. [PMID: 38528728 DOI: 10.1002/ejhf.3202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 03/27/2024] Open
Abstract
AIMS High left ventricular filling pressure increases left atrial volume and causes myocardial fibrosis, which may decrease with spironolactone. We studied clinical and proteomic characteristics associated with left atrial volume indexed by body surface area (LAVi), and whether LAVi influences the response to spironolactone on biomarker expression and clinical variables. METHODS AND RESULTS In the HOMAGE trial, where people at risk of heart failure were randomized to spironolactone or control, we analysed 421 participants with available LAVi and 276 proteomic measurements (Olink) at baseline, month 1 and 9 (mean age 73 ± 6 years; women 26%; LAVi 32 ± 9 ml/m2). Circulating proteins associated with LAVi were also assessed in asymptomatic individuals from a population-based cohort (STANISLAS; n = 1640; mean age 49 ± 14 years; women 51%; LAVi 23 ± 7 ml/m2). In both studies, greater LAVi was significantly associated with greater left ventricular masses and volumes. In HOMAGE, after adjustment and correction for multiple testing, greater LAVi was associated with higher concentrations of matrix metallopeptidase-2 (MMP-2), insulin-like growth factor binding protein-2 (IGFBP-2) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) (false discovery rates [FDR] <0.05). These associations were externally replicated in STANISLAS (all FDR <0.05). Among these biomarkers, spironolactone decreased concentrations of MMP-2 and NT-proBNP, regardless of baseline LAVi (pinteraction > 0.10). Spironolactone also significantly reduced LAVi, improved left ventricular ejection fraction, lowered E/e', blood pressure and serum procollagen type I C-terminal propeptide (PICP) concentration, a collagen synthesis marker, regardless of baseline LAVi (pinteraction > 0.10). CONCLUSION In individuals without heart failure, LAVi was associated with MMP-2, IGFBP-2 and NT-proBNP. Spironolactone reduced these biomarker concentrations as well as LAVi and PICP, irrespective of left atrial size.
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Affiliation(s)
- Masatake Kobayashi
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
- Department of Cardiology, Tokyo Medical University Hospital, Tokyo, Japan
| | - João Pedro Ferreira
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
- Cardiovascular Research and Development Center, Department of Surgery and Physiology, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Duarte Kevin
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Emmanuel Bresso
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Olivier Huttin
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Erwan Bozec
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | | | - Christian Delles
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Andrew L Clark
- Department of Cardiology, University of Hull, Castle Hill Hospital, Yorkshire, UK
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology Campus Virchow Klinikum, Charité University Medicine Berlin and German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany
| | - Arantxa González
- CIMA Universidad de Navarra, Department of Pathology, Anatomy and Physiology Universidad de Navarra and IdiSNA, Pamplona, Spain
- CIBERCV, Carlos III Institute of Health, Madrid, Spain
| | - Stephane Heymans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Pierpaolo Pellicori
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Johannes Petutschnigg
- Department of Internal Medicine and/Cardiology, Campus Virchow Klinikum, Charité University Medicine Berlin, and German Heart Center Berlin, and Berlin Institute of Health (BIH), and German Centre for Cardiovascular research (DZHK), Berlin, Germany
| | - Job A J Verdonschot
- Department of Cardiology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Patrick Rossignol
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
- Medical Specialties and Nephrology Dialysis Departments, Monaco Princess Grace Hospital and Monaco Private Hemodialysis Centre, Monaco, Monaco
| | - John G F Cleland
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique 1433, Inserm U1116, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
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96
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Ji X, Zhang Y, Xie Y, Wang W, Tan Y, Xie M, Zhang L. Feasibility Value of Right Ventricular Longitudinal Shortening Fraction and the Prognostic Implications in Patients With Heart Transplantation. J Am Heart Assoc 2024; 13:e032402. [PMID: 38456455 PMCID: PMC11009997 DOI: 10.1161/jaha.123.032402] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 12/08/2023] [Indexed: 03/09/2024]
Abstract
BACKGROUND Right ventricular longitudinal shortening fraction (RVLSF) is a 2-dimensional speckle tracking echocardiography parameter based on tricuspid annular displacement analysis that could be used to assess right ventricular (RV) systolic function. The value of RVLSF in the assessment of RV systolic function in recipients of heart transplantation (HT) and whether RVLSF can replace strain parameters remains unknown. METHODS AND RESULTS A total of 153 adult patients who underwent HT were consecutively enrolled in this prospective longitudinal study. All subjects were examined by conventional transthoracic 2-dimensional echocardiography and 2-dimensional speckle tracking echocardiography to evaluate the RV end-diastolic basal diameter, RV end-diastolic area, fractional area change, peak systolic velocity of tricuspid annulus, tricuspid annular plane systolic excursion, RV free wall strain, and RVLSF. Cox proportional hazards regression was used to test if the parameters of interest had independent prognostic value for adverse outcome prediction in patients who underwent HT. A significant positive correlation was found between the measurements of RVLSF and RV free wall strain (r=0.927, P<0.001). Compared with the event-free group, the adverse outcome group displayed reduced RVLSF and RV free wall strain and higher age (P<0.001, <0.001, =0.016, respectively) in patients who underwent HT. RVLSF and RV free wall strain were independently associated with poor prognosis in multivariable analysis (both P<0.001). CONCLUSIONS RVLSF assessment provides an effective evaluation of RV longitudinal systolic function in the transplanted hearts and has prognostic value for adverse outcomes in patients undergoing HT.
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Affiliation(s)
- Xiang Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Yiwei Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Yuji Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Wenyuan Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Yuting Tan
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical CollegeHuazhong University of Science and TechnologyWuhanChina
- Clinical Research Center for Medical Imaging in Hubei ProvinceWuhanChina
- Hubei Province Key Laboratory of Molecular ImagingWuhanChina
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97
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Izumi K, Utsunomiya H, Takeuchi M, Hamada A, Hyodo Y, Mogami A, Tsuchiya A, Takemoto H, Takahari K, Ueda Y, Itakura K, Nakano Y. Relationship between duration of atrial fibrillation and right heart structure remodeling as assessed by 3-dimensional transesophageal echocardiography. Int J Cardiol 2024; 399:131667. [PMID: 38141729 DOI: 10.1016/j.ijcard.2023.131667] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/06/2023] [Accepted: 12/18/2023] [Indexed: 12/25/2023]
Abstract
BACKGROUND Tricuspid valve (TV) remodeling occurs in patients with atrial fibrillation (AF); however, the affecting factor related to TV remodeling in AF remains to be elucidated. We sought to explore whether the AF persistence itself affects right heart remodeling. METHODS A total of 372 lone AF patients (234 paroxysmal AF [paroxAF] and 138 persistent AF [persAF]) who underwent 3-dimensional transesophageal echocardiography (3D-TEE) was retrospectively reviewed. The duration from first-detected episode of AF to the TEE exam date was defined as AF duration. RESULTS PersAF patients had a larger TV area index (625.4 vs 719.0 mm2/m2; P < 0.001) and a higher right atrium area-to-right ventricle end-systolic area ratio (RA/RVESA ratio, 1.7 vs 1.9; P = 0.005) than paroxAF patients. The prevalence of AF-tricuspid regurgitation was higher in persAF than in paroxAF patients (1.3% vs 12.3%; P < 0.001). In persAF patients, AF duration was moderately correlated with TV diameter and 3D-TEE-derived TV annular area but not in paroxAF. On multivariable analysis, AF duration was independently associated with TV annular dilatation even after adjustment for RA/RVESA ratio and tricuspid regurgitation severity (β 0.37 [95% CI: 0.77-1.81]; P < 0.001). Additionally, AF duration with cutoff values of 20 months for predicting TV annular dilatation and 37 months for predicting RA/RVESA ratio > 2.1 had both high diagnostic accuracies among persAF patients (both P < 0.01). CONCLUSIONS AF duration itself is independently associated with right heart remodeling in persAF but not in paroxAF, such as TV annular dilatation and predominant RA remodeling which may lead to subsequent TR progression and adverse outcomes.
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Affiliation(s)
- Kanako Izumi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
| | - Makoto Takeuchi
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Ayano Hamada
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yohei Hyodo
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Atsuo Mogami
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Akane Tsuchiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Hajime Takemoto
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kosuke Takahari
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yusuke Ueda
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Kiho Itakura
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
| | - Yukiko Nakano
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan
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98
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Kagawa S, Hasegawa H, Kuwajima K, Yamane T, Ogawa M, Patel D, Salseth T, Sekhon N, Skaf S, Chakravarty T, Makar M, Makkar RR, Shiota T. Long-Term Impact of Small Mitral Valve Orifice Area after Transcatheter Edge-to-Edge Mitral Valve Repair on Clinical Outcome: A Three-Dimensional Echocardiography Study. J Am Soc Echocardiogr 2024; 37:328-337. [PMID: 37972791 DOI: 10.1016/j.echo.2023.11.007] [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: 06/29/2023] [Revised: 11/07/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
BACKGROUND Iatrogenic mitral stenosis is a complication associated with transcatheter edge-to-edge mitral valve repair. Some reports revealed the impact of mean transmitral pressure gradient after procedure on long-term clinical outcomes. However, the association between prognosis and mitral valve orifice area (MVA) after the procedure has been poorly studied. This study aimed to investigate the association between postprocedural small MVA, derived from three-dimensional (3D) transesophageal echocardiography (TEE), and long-term clinical outcomes in 2 cohorts: the degenerative mitral regurgitation (MR) cohort and the functional MR cohort. METHODS This retrospective study assessed 279 consecutive patients with 3D TEE data during transcatheter edge-to-edge mitral valve repair between January 2010 and December 2016. Mitral valve orifice area after device implantation was measured by 3D planimetry. The patients with degenerative and functional MR were stratified separately into 2 groups according to postprocedural MVA: normal MVA (MVA > 1.5 cm2) group and small MVA (MVA ≤ 1.5 cm2) group. RESULTS Of the 279 patients, 142 (51%) had degenerative MR and 137 (49%) had functional MR. The number of degenerative MR patients with small MVA was 38, whereas 42 patients were in the functional MR cohort. Patients with small MVA had higher rate of all-cause mortality in the degenerative MR group (log-rank test: P = .01) but not in the functional MR group (log-rank test: P = .52). In multivariate analysis small MVA was independently associated with all-cause mortality but not postprocedural transmitral pressure gradient. Neither small MVA nor transmitral pressure gradient was associated with all-cause mortality in patients with functional MR. CONCLUSION Small MVA measured by 3D TEE after transcatheter mitral edge-to-edge repair was associated with poor prognosis in patients with degenerative MR.
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Affiliation(s)
- Shunsuke Kagawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California.
| | - Hiroko Hasegawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Ken Kuwajima
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takafumi Yamane
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Mana Ogawa
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Dhairya Patel
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tracy Salseth
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Navjot Sekhon
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Sabah Skaf
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Tarun Chakravarty
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Moody Makar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Raj R Makkar
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
| | - Takahiro Shiota
- Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California
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99
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Deschamps J, Beaubien-Souligny W. Venous Doppler for Echocardiographic Right Atrial Pressure Estimation: Ready for Primetime? Chest 2024; 165:478-481. [PMID: 38461005 DOI: 10.1016/j.chest.2023.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 03/11/2024] Open
Affiliation(s)
- Jean Deschamps
- Department of Intensive Care Medicine, Integrated Hospital Care Institute, Cleveland Clinic, Cleveland, OH.
| | - William Beaubien-Souligny
- Division of Nephrology, Centre Hospitalier de l'Université de Montréal, Innovation Hub, Centre de Recherche du CHUM, Montréal, QC, Canada
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100
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Joye S, Bhattacharya S, Kharrat A, Jasani B, Giesinger RE, McNamara PJ, Jain A. Shape of Pulmonary Artery Doppler Flow Profile and Right Ventricular Hemodynamics in Neonates. J Pediatr 2024; 266:113864. [PMID: 38052293 DOI: 10.1016/j.jpeds.2023.113864] [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: 06/20/2023] [Revised: 11/17/2023] [Accepted: 11/29/2023] [Indexed: 12/07/2023]
Abstract
OBJECTIVES To characterize pulmonary artery Doppler flow profile (PAFP) patterns among infants receiving care in neonatal intensive care units and to examine the association of PAFP patterns with pulmonary and right ventricular (RV) hemodynamics. STUDY DESIGN This is a retrospective study at 2 tertiary intensive care units over 4 years that included neonates who demonstrated a complete tricuspid regurgitation envelope on targeted neonatal echocardiography. Separate personnel reviewed TNEs to characterize PAFP patterns, divide cohort into PAFP groups, and measure quantitative indices of RV hemodynamics (RV systolic pressure, pulmonary artery acceleration time and its ratio with RV ejection time, tricuspid annular plane systolic excursion, and RV output), for intergroup comparisons. RESULTS We evaluated TNEs from 186 neonates with median gestational age of 28.5 weeks (IQR, 25.9-35.9 weeks). Four distinct PAFP patterns were identified (A) near-isosceles triangle (22%), (B) right-angled triangle (29%), (C) notching (40%), and (D) low peak velocity (<0.4 m/s; 9%). Groups A-C demonstrated a stepwise worsening in all indices of PH, whereas pattern D was associated with lower tricuspid annular plane systolic excursion and RV output. Using common definitions of pulmonary hypertension (PH), pattern A performed best to rule out PH (sensitivity range, 81%-90%) and pattern C for diagnosing PH (specificity range, 63%-78%). CONCLUSIONS Inspection of PAFP is a simple bedside echocardiography measure that provides clinically meaningful information on underlying RV hemodynamics and may aid in screening and monitoring of patients for PH in intensive care units.
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Affiliation(s)
- Sébastien Joye
- Department Woman-Mother-Child, Clinic of Neonatology, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Ashraf Kharrat
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada
| | - Bonny Jasani
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada; Division of Neonatology, The Hospital of Sick Children, Toronto, ON, Canada
| | | | | | - Amish Jain
- Department of Pediatrics, Mount Sinai Hospital, Toronto, ON, Canada; Department of Pediatrics, University of Toronto, Toronto, ON, Canada.
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