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52
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Plana JC. La quimioterapia y el corazón. Rev Esp Cardiol 2011; 64:409-15. [DOI: 10.1016/j.recesp.2010.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Accepted: 12/29/2010] [Indexed: 10/18/2022]
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53
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Tamura H, Watanabe T, Nishiyama S, Sasaki S, Arimoto T, Takahashi H, Shishido T, Miyashita T, Miyamoto T, Nitobe J. Increased Left Atrial Volume Index Predicts a Poor Prognosis in Patients With Heart Failure. J Card Fail 2011; 17:210-6. [DOI: 10.1016/j.cardfail.2010.10.006] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Revised: 10/07/2010] [Accepted: 10/20/2010] [Indexed: 11/28/2022]
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54
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Nguyen PK, Schnittger I, Heidenreich PA. A comparison of echocardiographic measures of diastolic function for predicting all-cause mortality in a predominantly male population. Am Heart J 2011; 161:530-7. [PMID: 21392608 DOI: 10.1016/j.ahj.2010.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 12/04/2010] [Indexed: 01/19/2023]
Abstract
BACKGROUND Prior studies demonstrating the prognostic value of echocardiographic measures of diastolic function have been limited by sample size, have included only select clinical populations, and have not incorporated newer measures of diastolic function nor determined their independent prognostic value. The objective of this study is to determine the independent prognostic value of established and new echocardiographic parameters of diastolic function. METHODS We included 3,604 consecutive patients referred to 1 of 3 echocardiography laboratories over a 2-year period. We obtained measurements of mitral inflow velocities, pulmonary vein filling pattern, mitral annulus motion (e'), and propagation velocity (V(p)). The primary end point was 1-year all-cause mortality. RESULTS The mean age of the patients was 68 years, and 95% were male. There were 277 deaths during a mean follow-up of 248 ± 221 days. For patients with reduced left ventricular ejection fraction (LVEF), all measured parameters except for e' were associated with mortality (P < .05) on univariate analysis. For patients with preserved LVEF, the E-wave velocity was significantly associated with mortality (P < .05) on univariate analysis. The deceleration time/E-wave velocity ratio, V(p), and pulmonary vein filling pattern were borderline significant (P < .10). With multivariate analysis, only V(p) was associated with survival for both reduced (P = .02) and preserved LVEF groups (P = .01). CONCLUSION In a large, clinically diverse population, most measures of diastolic function were predictive of all-cause mortality without adjustment for patient characteristics. On multivariate analysis, only V(p) was independently associated with total mortality. This association with mortality may be related to factors other than diastolic function and warrants further investigation.
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Affiliation(s)
- Patricia K Nguyen
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Palo Alto, CA, USA.
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55
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Garcia D, Del Alamo JC, Tanne D, Yotti R, Cortina C, Bertrand E, Antoranz JC, Perez-David E, Rieu R, Fernandez-Aviles F, Bermejo J. Two-dimensional intraventricular flow mapping by digital processing conventional color-Doppler echocardiography images. IEEE TRANSACTIONS ON MEDICAL IMAGING 2010; 29:1701-13. [PMID: 20562044 DOI: 10.1109/tmi.2010.2049656] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
Doppler echocardiography remains the most extended clinical modality for the evaluation of left ventricular (LV) function. Current Doppler ultrasound methods, however, are limited to the representation of a single flow velocity component. We thus developed a novel technique to construct 2D time-resolved (2D+t) LV velocity fields from conventional transthoracic clinical acquisitions. Combining color-Doppler velocities with LV wall positions, the cross-beam blood velocities were calculated using the continuity equation under a planar flow assumption. To validate the algorithm, 2D Doppler flow mapping and laser particle image velocimetry (PIV) measurements were carried out in an atrio-ventricular duplicator. Phase-contrast magnetic resonance (MR) acquisitions were used to measure in vivo the error due to the 2D flow assumption and to potential scan-plane misalignment. Finally, the applicability of the Doppler technique was tested in the clinical setting. In vitro experiments demonstrated that the new method yields an accurate quantitative description of the main vortex that forms during the cardiac cycle (mean error for vortex radius, position and circulation). MR image analysis evidenced that the error due to the planar flow assumption is close to 15% and does not preclude the characterization of major vortex properties neither in the normal nor in the dilated LV. These results are yet to be confirmed by a head-to-head clinical validation study. Clinical Doppler studies showed that the method is readily applicable and that a single large anterograde vortex develops in the healthy ventricle while supplementary retrograde swirling structures may appear in the diseased heart. The proposed echocardiographic method based on the continuity equation is fast, clinically-compliant and does not require complex training. This technique will potentially enable investigators to study of additional quantitative aspects of intraventricular flow dynamics in the clinical setting by high-throughput processing conventional color-Doppler images.
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Affiliation(s)
- Damien Garcia
- CRCHUM-Research Centre, University of Montreal Hospital, Montreal, QC H2L2W5, Canada
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56
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Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelisa A. Recommendations for the evaluation of left ventricular diastolic function by echocardiography. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 10:165-93. [PMID: 19270053 DOI: 10.1093/ejechocard/jep007] [Citation(s) in RCA: 1492] [Impact Index Per Article: 106.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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57
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Mendoza DD, Codella NCF, Wang Y, Prince MR, Sethi S, Manoushagian SJ, Kawaji K, Min JK, LaBounty TM, Devereux RB, Weinsaft JW. Impact of diastolic dysfunction severity on global left ventricular volumetric filling - assessment by automated segmentation of routine cine cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2010; 12:46. [PMID: 20673372 PMCID: PMC2924850 DOI: 10.1186/1532-429x-12-46] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2010] [Accepted: 07/31/2010] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To examine relationships between severity of echocardiography (echo) -evidenced diastolic dysfunction (DD) and volumetric filling by automated processing of routine cine cardiovascular magnetic resonance (CMR). BACKGROUND Cine-CMR provides high-resolution assessment of left ventricular (LV) chamber volumes. Automated segmentation (LV-METRIC) yields LV filling curves by segmenting all short-axis images across all temporal phases. This study used cine-CMR to assess filling changes that occur with progressive DD. METHODS 115 post-MI patients underwent CMR and echo within 1 day. LV-METRIC yielded multiple diastolic indices - E:A ratio, peak filling rate (PFR), time to peak filling rate (TPFR), and diastolic volume recovery (DVR80 - proportion of diastole required to recover 80% stroke volume). Echo was the reference for DD. RESULTS LV-METRIC successfully generated LV filling curves in all patients. CMR indices were reproducible (< or = 1% inter-reader differences) and required minimal processing time (175 +/- 34 images/exam, 2:09 +/- 0:51 minutes). CMR E:A ratio decreased with grade 1 and increased with grades 2-3 DD. Diastolic filling intervals, measured by DVR80 or TPFR, prolonged with grade 1 and shortened with grade 3 DD, paralleling echo deceleration time (p < 0.001). PFR by CMR increased with DD grade, similar to E/e' (p < 0.001). Prolonged DVR80 identified 71% of patients with echo-evidenced grade 1 but no patients with grade 3 DD, and stroke-volume adjusted PFR identified 67% with grade 3 but none with grade 1 DD (matched specificity = 83%). The combination of DVR80 and PFR identified 53% of patients with grade 2 DD. Prolonged DVR80 was associated with grade 1 (OR 2.79, CI 1.65-4.05, p = 0.001) with a similar trend for grade 2 (OR 1.35, CI 0.98-1.74, p = 0.06), whereas high PFR was associated with grade 3 (OR 1.14, CI 1.02-1.25, p = 0.02) DD. CONCLUSIONS Automated cine-CMR segmentation can discern LV filling changes that occur with increasing severity of echo-evidenced DD. Impaired relaxation is associated with prolonged filling intervals whereas restrictive filling is characterized by increased filling rates.
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Affiliation(s)
- Dorinna D Mendoza
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NY, NY, USA
| | - Noel CF Codella
- Department of Radiology, Weill Cornell Medical College, NY, NY, USA
| | - Yi Wang
- Department of Radiology, Weill Cornell Medical College, NY, NY, USA
| | - Martin R Prince
- Department of Radiology, Weill Cornell Medical College, NY, NY, USA
| | - Sonia Sethi
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NY, NY, USA
| | - Shant J Manoushagian
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NY, NY, USA
| | - Keigo Kawaji
- Department of Radiology, Weill Cornell Medical College, NY, NY, USA
| | - James K Min
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NY, NY, USA
- Department of Radiology, Weill Cornell Medical College, NY, NY, USA
| | - Troy M LaBounty
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NY, NY, USA
| | - Richard B Devereux
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NY, NY, USA
| | - Jonathan W Weinsaft
- Division of Cardiology, Department of Medicine, Weill Cornell Medical College, NY, NY, USA
- Department of Radiology, Weill Cornell Medical College, NY, NY, USA
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Unverdorben M, von Holt K, Winkelmann BR. Smoking and atherosclerotic cardiovascular disease: part III: functional biomarkers influenced by smoking. Biomark Med 2010; 3:807-23. [PMID: 20477716 DOI: 10.2217/bmm.09.69] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Smoking cigarettes induces rapidly occurring and reversible functional changes in the cardiovascular system, which precede morphologic changes. These functional changes are also related to atherosclerotic disease development and thus may qualify as prognostic parameters in chronic smokers. As opposed to smoking-induced morphologic changes functional alterations occur and revert within minutes, thus, allowing for the detection of smoking-induced effects on the cardiovascular system within minutes following exposure to mainstream smoke. Some alterations represent 'direct' changes (e.g., endothelial function), others reflect changes in a different organ system (e.g., the autonomous nervous system influencing heart rate variability), while some represent the sum of alterations in many organs and systems (e.g., exercise performance influenced by the autonomous nervous and by endothelial and cardiac function). Since a specific functional parameter usually changes with at least one or several others, caution should be exercised when trying to establish a direct cause relationship between the alteration of a single parameter and a clinical outcome.
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Affiliation(s)
- Martin Unverdorben
- Clinical Research Institute, Center for Cardiovascular Diseases, Heinz-Meise-Strasse 100, 36199 Rotenburg an der Fulda, Germany.
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59
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Shanks M, Ng ACT, van de Veire NRL, Antoni ML, Bertini M, Delgado V, Nucifora G, Holman ER, Choy JB, Leung DY, Schalij MJ, Bax JJ. Incremental prognostic value of novel left ventricular diastolic indexes for prediction of clinical outcome in patients with ST-elevation myocardial infarction. Am J Cardiol 2010; 105:592-7. [PMID: 20185002 DOI: 10.1016/j.amjcard.2009.10.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Revised: 10/23/2009] [Accepted: 10/28/2009] [Indexed: 12/17/2022]
Abstract
This study examined the prognostic value of novel diastolic indexes in ST-elevation acute myocardial infarction (AMI), derived from strain and strain rate analysis using 2-dimensional speckle tracking imaging. Echocardiograms were obtained within 48 hours of admission in 371 consecutive patients with first ST-elevation AMI (59.7 +/- 11.6 years old). Indexes of diastolic function including mean strain rate during isovolumic relaxation (SR(IVR)), mean early diastolic strain rate (SR(E)) and mean diastolic strain at peak transmitral E wave (E) were obtained from 3 apical views. Mean early diastolic velocity from 4 basal segments by color-coded tissue Doppler imaging was measured. Indexes of diastolic filling including E/SR(IVR), E/SR(E), E/diastolic strain at E, and E/early diastolic velocity were calculated. The primary end point (composite of death, hospitalization for heart failure, repeat MI, and repeat revascularization) occurred in 84 patients (22.6%) during a mean follow-up of 17.3 +/- 12.2 months. Mean SR(IVR) (p <0.001), multivessel disease (p <0.001), Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention (p = 0.004), and left ventricular ejection fraction (p = 0.008) were independent predictors of the combined end point on Cox regression analysis. Mean SR(IVR) showed incremental prognostic value over baseline clinical and echocardiographic variables (global chi-square increase from 41.0 to 51.6, p <0.001). After dividing patient population based on median SR(IVR), patients with SR(IVR) < or =0.24/second had significantly higher event rates than others (hazard ratio 2.74, 95% confidence interval 1.61 to 4.67, p <0.001). In conclusion, SR(IVR) was incremental to left ventricular ejection fraction, Thrombolysis In Myocardial Infarction grade 0 to 1 flow after percutaneous coronary intervention, and multivessel disease and superior to other diastolic indexes in predicting future cardiovascular events after AMI. SR(IVR) may be useful in identifying high-risk patients soon after AMI.
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Affiliation(s)
- Miriam Shanks
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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60
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Rossi A, Temporelli PL, Quintana M, Dini FL, Ghio S, Hillis GS, Klein AL, Marsan NA, Prior DL, Yu CM, Poppe KK, Doughty RN, Whalley GA. Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure). Eur J Heart Fail 2010; 11:929-36. [PMID: 19789395 DOI: 10.1093/eurjhf/hfp112] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
AIMS Left atrial (LA) size is considered a marker of poor prognosis in heart failure (HF) patients. Prior studies have recruited relatively few subjects limiting their power to adequately analyse the interaction between LA size, left ventricular (LV) systolic and diastolic function, and prognosis. METHOD AND RESULTS The MeRGE collaboration combines prospective data from 18 studies in HF patients. In this analysis of data from 1157 patients, the primary endpoint was death or hospitalization for worsening HF. In multivariate analysis (Cox proportion hazard model), LA area was associated with prognosis (HR 1.03 per cm(2), 95% CI 1.02, 1.05; P < 0.0001) independently of age, NYHA class, LV ejection fraction, and restrictive filling pattern (RFP). When LA area was used as a categorical variable, the HR associated with larger LA area (above median) was 1.4 (95% CI 1.13, 1.74) and when LA area index was used, the HR was 2.36 (95% CI 1.80, 3.08). When the patients with and without RFP were divided on the basis of either LA area or LA area index, significantly higher event rates were observed in those with larger LA area. CONCLUSION Left atrial area is a powerful predictor of outcome among HF patients with predominantly impaired systolic function, and is independent of, and provides additional prognostic information beyond LV systolic and diastolic function.
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Affiliation(s)
- Andrea Rossi
- Section of Cardiology, Department of Surgical and Biomedical Sciences, University of Verona, Ospedale Maggiore, 37126 Verona, Italy.
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61
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Sanders D, Dudley M, Groban L. Diastolic dysfunction, cardiovascular aging, and the anesthesiologist. Anesthesiol Clin 2009; 27:497-517. [PMID: 19825489 DOI: 10.1016/j.anclin.2009.07.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
As the number of persons aged 65 years and older continues to increase, the anesthesiologist will more frequently encounter this demographic. Cardiovascular changes that occur in this patient population present difficult anesthetic challenges and place these patients at high risk of perioperative morbidity and mortality. The anesthesiologist should be knowledgeable about these age-related cardiovascular changes, the pathophysiology underlying them, and the appropriate perioperative management. Whether presenting for cardiac or general surgery, the anesthesiologist must identify patients with altered physiology as a result of aging or diastolic dysfunction and be prepared to modify the care plan accordingly. With a directed preoperative assessment that focuses on certain aspects of the cardiovascular system, and the assistance of powerful echocardiographic tools such as tissue Doppler, this can be achieved.
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Affiliation(s)
- David Sanders
- Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA
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62
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Teo SG, Yang H, Chai P, Yeo TC. Impact of left ventricular diastolic dysfunction on left atrial volume and function: a volumetric analysis. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:38-43. [PMID: 19828485 DOI: 10.1093/ejechocard/jep153] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
AIMS Diastolic dysfunction may result in elevation of left ventricular (LV) and atrial pressures, resulting in left atrial (LA) remodelling. We examined the effects of LV diastolic dysfunction on LA volume and function. METHODS AND RESULTS We measured LA volume and function in 83 patients with normal LV systolic function. The LV diastolic function grade was defined using traditional Doppler measures of diastolic function. LA volumes were measured using the ellipsoid method. Maximum LA volume (Vol(max)) was indexed to the body surface area(.) The passive filling, conduit and active emptying volumes were estimated and corrected for indexed LA Vol(max). Indexed LA Vol(max) was strongly associated with LV diastolic function grade (Spearman P < 0.01, r(s) = 0.79). An indexed LA Vol(max) > 19.7 mL/m(2) predicted diastolic dysfunction with 97% sensitivity and 96% specificity. Compared with normal controls, corrected passive filling and conduit volumes were lower, and corrected active emptying volume was higher in patients with Grade I diastolic dysfunction (0.38 vs. 0.51, P = 0.02; 1.65 vs. 3.29, P < 0.001; 0.59 vs. 0.44, P = 0.001), resulting in a similar corrected total emptying volume (0.97 vs. 0.96, P= ns). Patients with higher grades of diastolic dysfunction, however, had lower corrected passive filling, conduit, active, and total emptying volumes. CONCLUSION LA remodelling occurs in patients with LV diastolic dysfunction and LA volume expressed the severity of diastolic dysfunction. Initially, the LA compensates for changes in LV diastolic properties by augmenting active atrial contraction. As the severity of diastolic dysfunction increases, this compensatory mechanism fails as atrial mechanical dysfunction sets in, resulting in lower total atrial emptying volume.
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Affiliation(s)
- Swee Guan Teo
- Department of Cardiology, National University Health System, 5 Lower Kent Ridge Rd., Singapore, Singapore, 119074.
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63
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Recognizing the prognostic importance of diastolic dysfunction in patients after acute myocardial infarction. CURRENT CARDIOVASCULAR IMAGING REPORTS 2009. [DOI: 10.1007/s12410-009-0039-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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64
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Larsson M, Bjällmark A, Johnson J, Winter R, Brodin LA, Lundbäck S. State diagrams of the heart--a new approach to describing cardiac mechanics. Cardiovasc Ultrasound 2009; 7:22. [PMID: 19473478 PMCID: PMC2693107 DOI: 10.1186/1476-7120-7-22] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 05/27/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cardiac time intervals have been described as a measure of cardiac performance, where prolongation, shortening and delay of the different time intervals have been evaluated as markers of cardiac dysfunction. A relatively recently developed method with improved ability to measure cardiac events is Tissue Doppler Imaging (TDI), allowing accurate measurement of myocardial movements. METHODS We propose the state diagram of the heart as a new visualization tool for cardiac time intervals, presenting comparative, normalized data of systolic and diastolic performance, providing a more complete overview of cardiac function. This study aimed to test the feasibility of the state diagram method by presenting examples demonstrating its potential use in the clinical setting and by performing a clinical study, which included a comparison of the state diagram method with established echocardiography methods (E/E' ratio, LVEF and WMSI). The population in the clinical study consisted of seven patients with non ST-elevation myocardial infarction (NSTEMI) and seven control subjects, individually matched according to age and gender. The state diagram of the heart was generated from TDI curves from seven positions in the myocardium, visualizing the inter- and intraventricular function of the heart by displaying the cardiac phases. RESULTS The clinical examples demonstrated that the state diagram allows for an intuitive visualization of pathological patterns as ischemia and dyssynchrony. Further, significant differences in percentage duration between the control group and the NSTEMI group were found in eight of the totally twenty phases (10 phases for each ventricle), e.g. in the transition phases (Pre-Ejection and Post-Ejection). These phases were significantly longer (> 2.18%) for the NSTEMI group than for the control group (p < 0.05). No significant differences between the groups were found for the established echocardiography methods. CONCLUSION The test results clearly indicate that the state diagram has potential to be an efficient tool for visualization of cardiac dysfunction and for detection of NSTEMI.
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Affiliation(s)
- Matilda Larsson
- School for Technology and Health, Royal Institute of Technology, Alfred Nobels Allé 10, SE-14152 Huddinge, Sweden.
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65
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Somaratne JB, Whalley GA, Poppe KK, Gamble GD, Doughty RN. Pseudonormal Mitral Filling Is Associated with Similarly Poor Prognosis as Restrictive Filling in Patients with Heart Failure and Coronary Heart Disease: A Systematic Review and Meta-analysis of Prospective Studies. J Am Soc Echocardiogr 2009; 22:494-8. [DOI: 10.1016/j.echo.2009.02.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Indexed: 10/21/2022]
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66
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Velocity propagation of early diastole is a valuable tool for left ventricular remodelling after the first myocardial infarction. Coron Artery Dis 2009; 20:124-9. [DOI: 10.1097/mca.0b013e328316e955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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67
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Nagueh SF, Appleton CP, Gillebert TC, Marino PN, Oh JK, Smiseth OA, Waggoner AD, Flachskampf FA, Pellikka PA, Evangelista A. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography. J Am Soc Echocardiogr 2009; 22:107-33. [PMID: 19187853 DOI: 10.1016/j.echo.2008.11.023] [Citation(s) in RCA: 2282] [Impact Index Per Article: 152.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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68
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Khumri TM, Reid KJ, Kosiborod M, Spertus JA, Main ML. Usefulness of left ventricular diastolic dysfunction as a predictor of one-year rehospitalization in survivors of acute myocardial infarction. Am J Cardiol 2009; 103:17-21. [PMID: 19101223 DOI: 10.1016/j.amjcard.2008.08.049] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2008] [Revised: 08/19/2008] [Accepted: 08/19/2008] [Indexed: 12/22/2022]
Abstract
Presence of severe left ventricular (LV) diastolic function has been shown to independently predict risk of heart failure or death after acute myocardial infarction (AMI). We aimed to determine whether common echocardiographic parameters and (LV) diastolic function evaluated during AMI hospitalization can predict the risk of rehospitalization, up to 1 year after AMI. One hundred ninety consecutive patients with AMI, who were prospectively enrolled in a longitudinal post-AMI registry, had survived for 1 year, and had a clinically indicated echocardiogram during the index admission, were included in the study. The independent effect of diastolic dysfunction on 1-year all-cause rehospitalization was assessed using multivariable proportional hazards regression. Average age was 62.5 years, 93% were Caucasian, 66% were men, and mean LV ejection fraction was 46%. At 1 year, 78 patients (41%) had been rehospitalized >or=1 time. In multivariable analysis, presence of severe LV diastolic dysfunction was the only echocardiographic variable that predicted increased risk of rehospitalization 1 year after AMI (hazard ration 3.31, 95% confidence interval 1.26 to 8.69). Seventy-eight percent of patients with severe LV diastolic dysfunction (restrictive diastolic physiology) compared with 30% with normal diastolic function (p = 0.0052) and 37% with nonrestrictive physiology during the index admission were rehospitalized. In conclusion, severe LV diastolic dysfunction is the only echocardiographic predictor of rehospitalization in survivors of AMI and routine assessment of diastolic function during AMI hospitalization can provide additional prognostic risk stratification at dismissal.
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Affiliation(s)
- Taiyeb M Khumri
- Saint Luke's Mid America Heart Institute, Kansas City, Missouri, USA
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69
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Khumri TM, Walker BL, Magalski A, Morris BA, Coggins TR, Kusnetzky LL, House JA, Main ML. Combined Assessment of Myocardial Perfusion and Diastolic Function Enhances Risk Stratification in Patients with Anterior Wall Myocardial Infarction. Echocardiography 2009; 26:61-5. [DOI: 10.1111/j.1540-8175.2008.00750.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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70
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Nunes MCP, Barbosa MM, Ribeiro ALP, Colosimo EA, Rocha MO. Left Atrial Volume Provides Independent Prognostic Value in Patients With Chagas Cardiomyopathy. J Am Soc Echocardiogr 2009; 22:82-8. [DOI: 10.1016/j.echo.2008.11.015] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Indexed: 10/21/2022]
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71
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Seo Y, Ishizu T, Kawano S, Watanabe S, Ishimitsu T, Aonuma K. Combined approach with Doppler echocardiography and B-type natriuretic peptide to stratify prognosis of patients with decompensated systolic heart failure. J Cardiol 2008; 52:224-31. [DOI: 10.1016/j.jjcc.2008.07.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Revised: 06/29/2008] [Accepted: 07/03/2008] [Indexed: 10/21/2022]
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72
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Barmeyer A, Müllerleile K, Mortensen K, Meinertz T. Diastolic dysfunction in exercise and its role for exercise capacity. Heart Fail Rev 2008; 14:125-34. [PMID: 18758943 DOI: 10.1007/s10741-008-9105-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2008] [Accepted: 07/23/2008] [Indexed: 01/08/2023]
Abstract
Diastolic dysfunction is frequent in elderly subjects and in patients with left ventricular hypertrophy, vascular disease and diabetes mellitus. Patients with diastolic dysfunction demonstrate a reduced exercise capacity and might suffer from congestive heart failure (CHF). Presence of symptoms of CHF in the setting of a normal systolic function is referred to as heart failure with normal ejection fraction (HFNEF) or, if evidence of an impaired diastolic function is observed, as diastolic heart failure (DHF). Reduced exercise capacity in diastolic dysfunction results from a number of pathophysiological alterations such as slowed myocardial relaxation, reduced myocardial distensibility, elevated filling pressures, and reduced ventricular suction forces. These alterations limit the increase of ventricular diastolic filling and cardiac output during exercise and lead to pulmonary congestion. In healthy subjects, exercise training can enhance diastolic function and exercise capacity and prevent deterioration of diastolic function in the course of aging. In patients with diastolic dysfunction, exercise capacity can be enhanced by exercise training and pharmacological treatment, whereas improvement of diastolic function can only be observed in few patients.
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Affiliation(s)
- A Barmeyer
- Department of Cardiology/Angiology, Center for Cardiology and Cardiovascular Surgery, University Hospital Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany.
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73
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Barbieri A, Bursi F, Politi L, Rossi L, Fiocchi F, Ligabue G, Pingitore A, Positano V, Torricelli P, Modena MG. Echocardiographic Diastolic Dysfunction and Magnetic Resonance Infarct Size in Healed Myocardial Infarction Treated with Primary Angioplasty. Echocardiography 2008; 25:575-83. [DOI: 10.1111/j.1540-8175.2008.00679.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Møller JE, Whalley GA, Dini FL, Doughty RN, Gamble GD, Klein AL, Quintana M, Yu CM. Independent prognostic importance of a restrictive left ventricular filling pattern after myocardial infarction: an individual patient meta-analysis: Meta-Analysis Research Group in Echocardiography acute myocardial infarction. Circulation 2008; 117:2591-8. [PMID: 18474816 DOI: 10.1161/circulationaha.107.738625] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Restrictive mitral filling pattern (RFP), the most severe form of diastolic dysfunction, is a predictor of outcome after acute myocardial infarction (AMI). Low power has precluded a definite conclusion on the independent importance of RFP, especially when overall systolic function is preserved. We undertook an individual patient meta-analysis to determine whether RFP is predictive of mortality independently of LV ejection fraction (LVEF), end-systolic volume index, and Killip class in patients after AMI. METHODS AND RESULTS Twelve prospective studies (3396 patients) assessing the relationship between prognosis and Doppler echocardiographic LV filling pattern in patients after AMI were included. Individual patient data from each study were extracted and collated into a single database for analysis. RFP was associated with higher all-cause mortality (hazard ratio, 2.67; 95% CI, 2.23 to 3.20; P<0.001) and remained an independent predictor in multivariate analysis with age, gender, and LVEF. The overall prevalence of RFP was 20% but was highest (36%) in the quartile of patients with lowest LVEF (<39%) and lowest (9%) in patients with the highest LVEF (>53%; P<0.0001). RFP remained significant within each quartile of LVEF, and no interaction was found for RFP and LVEF (P=0.42). RFP also predicted mortality in patients with above- and below-median end-systolic volume index (1575 patients) and in different Killip classes (1746 patients). Importantly, when diabetes, current medication, and prior AMI were included in the model, RFP remained an independent predictor of outcome. CONCLUSIONS Restrictive filling is an important independent predictor of mortality after AMI regardless of LVEF, end-systolic volume index, and Killip class.
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Acute coronary syndromes. Arch Cardiovasc Dis 2008. [DOI: 10.1016/s1875-2136(08)73705-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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76
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Whalley GA, Gamble GD, Dini FL, Klein AL, Møller JE, Quintana M, Yu CM, Doughty RN. Individual patient meta-analyses of restrictive diastolic filling pattern and mortality in patients post acute myocardial infarction and in patients with chronic heart failure. Int J Cardiol 2007; 122:207-15. [PMID: 17321616 DOI: 10.1016/j.ijcard.2006.11.080] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2006] [Accepted: 11/05/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVE Doppler echocardiographic assessment of diastolic filling provides a non-invasive estimate of left ventricular (LV) filling pressure and the most advanced diastolic filling grade, the restrictive filling pattern (RFP), has been linked to prognosis in patients post acute myocardial infarction (AMI) and with heart failure (HF). There remains some uncertainty about the prognostic role of RFP in patients with varied levels of systolic function. The objective of this collaboration is to determine whether the presence of RFP offers additional prognostic information over LV systolic function, symptoms or other clinical factors in patients post AMI or with HF. METHODS The Meta-analysis Research Group in Echocardiography (MeRGE) has been established in order to test this through two individual patient meta-analyses. Prospective studies that enrolled patients with either established HF or post AMI and included Doppler-echocardiography and outcome data will be merged into two large datasets (3739 AMI patients and 3540 HF patients) in order to evaluate the independent effects of RFP upon total and cardiovascular mortality using Kaplan-Meier survival analysis methods and Cox proportional hazards model for multi-variate analysis. Survival will be examined within different bands of LV systolic function based upon ejection fraction (EF). IMPLICATIONS This unique dataset will provide a very large cohort of patients, which will be adequately powered to provide new and prognostically important information to further aid risk stratification in these two high-risk patient groups.
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Mansouri V, Lavine SJ. Effect of External Constraint on the Index of Myocardial Performance in a Canine Model of Left Ventricular Dysfunction. Echocardiography 2007; 24:712-22. [PMID: 17651100 DOI: 10.1111/j.1540-8175.2007.00468.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND With left ventricular (LV) dysfunction, it is not clear how alterations in external constraint influence the index of myocardial performance (IMP). We have previously demonstrated that pericardial constraint is a factor in the production of the restrictive filling pattern. We hypothesized that altering pericardial constraint by changing intracardiac volume or removing the pericardium would produce similar directional changes in LV ejection time (LVET) and isovolumic relaxation time (IRT) resulting in minimal IMP changes. METHODS We studied 13 canines with chronic moderate LV dysfunction. LV pressures, transmitral and transaortic Doppler were obtained prior to and following pericardiectomy (PECT) with alterations of intracardiac volume, using inferior vena caval occlusion (IVCO) and volume loading. RESULTS With an intact pericardium, IVCO reduced LV size, LV end diastolic pressure (LVEDP), and increased deceleration time (all P < 0.05) but did not affect IMP. Volume loading increased LV size, LVEDP, and shortened deceleration time (all P < 0.05). LVET and IRT lengthened (P < 0.05), and IMP declined (0.58 +/- 0.24 to 0.52 +/- 0.13, P < 0.05). Following PECT, IVCO reduced LV volumes and LVEDP (P < 0.05), but did not change IMP. Volume loading increased LV size, stroke volume, and LVEDP (all P < 0.05). IMP declined (0.57 +/- 0.13 vs 0.51 +/- 0.14, P < 0.05) due to an increase in both LVET and IRT (P < 0.05). Comparison of stages prior to and following PECT revealed an increased LVET and stroke volume (P < 0.05) but a similar IMP. CONCLUSION Increases in intracardiac volume associated with elevated LVEDP resulted in reduced IMPs. Pericardiectomy increases LV volumes, stroke volume, and LVET but did not influence IMP.
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Affiliation(s)
- Vafa Mansouri
- Cardiovascular Center, University of Florida, Jacksonville, Florida 32209, USA.
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Kirkpatrick JN, Vannan MA, Narula J, Lang RM. Echocardiography in Heart Failure. J Am Coll Cardiol 2007; 50:381-96. [PMID: 17662389 DOI: 10.1016/j.jacc.2007.03.048] [Citation(s) in RCA: 163] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2007] [Revised: 03/27/2007] [Accepted: 03/29/2007] [Indexed: 11/21/2022]
Abstract
Echocardiography is well qualified to meet the growing need for noninvasive imaging in the expanding heart failure (HF) population. The recently-released American College of Cardiology/American Heart Association guidelines for the diagnosis and management of HF labeled echocardiography "the single most useful diagnostic test in the evaluation of patients with HF...," because of its ability to accurately and noninvasively provide measures of ventricular function and assess causes of structural heart disease. It can also detect and define the hemodynamic and morphologic changes in HF over time and might be equivalent to invasive measures in guiding therapy. In this article we will discuss: 1) the clinical uses of echocardiography in HF and their prognostic value; 2) the use of echocardiography to guide treatment in HF patients; and 3) promising future techniques for echocardiographic-based imaging in HF. In addition, we will highlight some of the limitations of echocardiography.
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Affiliation(s)
- James N Kirkpatrick
- Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA.
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79
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Hashimoto I, Uese KI, Watanabe S, Watanabe K, Hirono K, Ichida F, Miyawaki T. Assessment of variables affecting flow propagation velocity of the left ventricle in healthy children. Pediatr Int 2007; 49:305-9. [PMID: 17532825 DOI: 10.1111/j.1442-200x.2007.02366.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The purpose of the present study was to establish the normal values of flow propagation velocity (FPV) in healthy children and examine the variables that affect FPV in clinical situations. METHODS Two hundred and thirty- five healthy children and adolescents were assessed (aged 0-22.6 years, mean age 7.4 +/- 5.4 years; male, n = 142; female, n = 93). FPV was obtained from an apical four-chamber view and determined as the slope of aliasing velocity of early diastolic transmitral flow on the color M-mode using Aloka SSD-5500 with 5.0 MHz transducer. Aliasing velocity was set at 50-70% of the peak transmitral flow velocity. Peak transmitral flow velocities in early diastole (E) and during atrial contraction (A), and the ratio of early to late peak velocity (E/A) were obtained. Tei index was also measured for analysis of general left ventricular performance. Left ventricular mass index (LVMI) was obtained from conventional echo measurement. E, E/A, Tei index and LVMI were compared with FPV in healthy subjects. RESULTS FPV obtained from all subjects ranged from 23.7 to 96.0 cm/s (61.3 +/- 13.6 cm/s). Normal value of FPV was less dependent on age, body size, heart rate and left ventricular dimension. In contrast, although there was no significant correlation between FPV and ejection fraction, statistically significant correlation was found between FPV, LVMI (P = 0.0008) and Tei index (P = 0.025). CONCLUSIONS FPV is independent of age, body size and heart rate and is useful to assess left ventricular relaxation in children.
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Affiliation(s)
- Ikuo Hashimoto
- Department of Pediatrics, Toyama University, Toyama, Japan.
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Somaratne JB, Whalley GA, Gamble GD, Doughty RN. Restrictive Filling Pattern is a Powerful Predictor of Heart Failure Events Postacute Myocardial Infarction and in Established Heart Failure: A Literature-Based Meta-Analysis. J Card Fail 2007; 13:346-52. [PMID: 17602980 DOI: 10.1016/j.cardfail.2007.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2006] [Revised: 01/23/2007] [Accepted: 01/25/2007] [Indexed: 11/28/2022]
Abstract
BACKGROUND Two recent literature-based meta-analyses revealed that restrictive filling pattern (RFP) was associated with a 4-fold increase in the risk of death in patients with heart failure (HF) and postacute myocardial infarction (AMI). This similar but unique analysis evaluated the link between RFP and morbidity. METHODS AND RESULTS Prospective echocardiographic studies of patients post-AMI and with HF that reported HF morbidity were identified. Events (post-AMI: development of HF; HF: HF readmission) were compared between patients with and without RFP in both patient groups. Review Manager version 4.2.7 software was used for the analysis. Twelve post-AMI studies (1286 patients, 271 events) and 5 HF studies (647 patients, 176 events) were identified. RFP was associated with HF readmission in the HF patients (OR 2.96 [2.02-4.33] and development of HF post-AMI (OR 10.10 [7.02-14.51]). The event rate in the RFP group was the same regardless of disease category (49% post-AMI, 42% HF); however, RFP was less prevalent in the post-AMI group (22% versus 39%). CONCLUSIONS This literature-based meta-analysis confirms that RFP is a powerful predictor of HF hospitalization in patients with HF and especially the development of HF post-AMI. This is an important prognostic sign and should be incorporated into routine clinical practice.
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Affiliation(s)
- Jithendra B Somaratne
- Department of Medicine, School of Medicine, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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81
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Rovner A, Waggoner AD, Mathews SJ, Dávila-Román VG, de las Fuentes L. Role of Tissue Doppler and Color M-Mode Imaging for Evaluation of Diastolic Function in Ambulatory Patients with LV Systolic Dysfunction. Echocardiography 2007; 24:478-84. [PMID: 17456066 DOI: 10.1111/j.1540-8175.2007.00435.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION Tissue Doppler imaging (TDI) and color M-mode (CMM) indices provide assessment of left ventricular (LV) relaxation when combined with pulse-wave Doppler (PWD)-derived transmitral inflow, allows for estimation of LV filling pressures. However, use of these indices in patients with LV systolic dysfunction (LVSD) has not been well characterized. METHODS AND RESULTS The study included 115 patients (age 58 +/- 11 years, 67% male) with LVSD (LV ejection fraction [LVEF] < 55%). Patients were grouped according to the diastolic LV filling pressure assessed by E/Em(septal) ratio as follows: 1) Normal (NFP), E/Em(septal) < 8; 2) Intermediate (IFP), E/Em(septal): 8-15; and 3) High (HFP), E/Em(septal) >15. Age-, gender-, and LVEF-adjusted analyses were performed. LV volumes and LVEF were significantly different between the groups (P < 0.01). PWD-derived E-wave velocity showed a significant stepwise increase across the three groups and the Em(septal) velocity demonstrated a stepwise decrease (P < 0.01 for both). CMM-derived diastolic intra-ventricular pressure gradient (IVPG) was significantly lower in the HFP compared to the other 2 groups (P < 0.01 for both); Vp was increased in the HFP compared to the other 2 groups (P < 0.01 for both), and Vp exhibited a U-shape relationship to LVEF. CONCLUSION In patients with LVSD, abnormal LV relaxation is uniformly observed regardless of LV filling pressure. PWD-derived E-wave velocity and the TDI-derived Em velocity are important measurements to identify elevated LV filling pressures. CMM-derived Vp and IVPG were of limited incremental value for the evaluation of diastolic function in patients with LVSD.
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Affiliation(s)
- Aleksandr Rovner
- Cardiovascular Imaging and Clinical Research Core Laboratory, Washington University School of Medicine, Cardiovascular Division, St. Louis, Missouri 63110, USA
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82
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Poerner TC, Goebel B, Kralev S, Kaden JJ, Süselbeck T, Haase KK, Borggrefe M, Haghi D. Impact of mitral E/A ratio on the accuracy of different echocardiographic indices to estimate left ventricular end-diastolic pressure. ULTRASOUND IN MEDICINE & BIOLOGY 2007; 33:699-707. [PMID: 17383798 DOI: 10.1016/j.ultrasmedbio.2006.11.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 10/24/2006] [Accepted: 11/02/2006] [Indexed: 05/14/2023]
Abstract
The objective was to determine the influence of left ventricular (LV) inflow pattern on the accuracy of different echocardiographic indices for estimation of LV end-diastolic pressure (LVEDP). Echocardiography with color tissue Doppler imaging (TDI) and LVEDP measurements using fluid-filled catheters were performed in 176 consecutive patients on the same day. Mitral peak diastolic velocities (E, A) and the difference in duration between pulmonary venous retrograde velocity and mitral A-velocity (PV(R)-A) were recorded by pulsed Doppler. Propagation velocity of the early mitral inflow (V(P)) was assessed using color M-mode. Early diastolic longitudinal (E'(lat)) and radial (E'(radial)) velocities of mitral annulus were measured by TDI. Area under ROC curve (AUC) for prediction of elevated LVEDP (> or =15 mm Hg) was computed for each parameter. For E/A > or =1 (98 patients, 46 with elevated LVEDP), the AUC values were: PV(R)-A: 0.914; E/E'(lat): 0.780; E/E'(radial): 0.729; E/V(P): 0.712 (p < 0.001). When E/A <1 (78 patients, 26 with elevated LVEDP), only PV(R)-A reached statistical significance (AUC = 0.893, p < 0.001). The conclusions were: PV(R)-A enabled the most accurate noninvasive estimation of LVEDP irrespective of LV filling profile and combined indices E/V(P), E/E'(lat) and E/E'(radial) represent more feasible alternatives for patients with mitral E/A-1.
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Affiliation(s)
- Tudor C Poerner
- Department of Medicine Jena, University of Jena, Jena, Germany.
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83
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Stein PK, Tereshchenko L, Domitrovich PP, Kleiger RE, Perez A, Deedwania P. Diastolic dysfunction and autonomic abnormalities in patients with systolic heart failure. Eur J Heart Fail 2007; 9:364-9. [PMID: 17123863 DOI: 10.1016/j.ejheart.2006.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2006] [Revised: 06/28/2006] [Accepted: 09/28/2006] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Patients with systolic heart failure (SHF) often have concomitant diastolic dysfunction (DD). SHF is associated with decreased heart rate variability (HRV), but the impact of degree of DD on HRV in SHF is unclear. METHODS AND RESULTS HRV was measured in 139 patients, aged 64+/-12 years, 74% male, LVEF 30+/-8%. Patients had stable NYHA class II-III CHF on ACE inhibitors or ATII receptor blockers, with LVEF<or=40% and BNP>or=200 pg/ml. Subjects underwent 2-D echocardiography with Doppler assessment and 24-h Holters. Patients were categorized as having impaired relaxation (E-deceleration time>2 SD above age-adjusted normal values (AANV), E/A<or=1, systolic/diastolic pulmonary vein flow>or=1; N=30), pseudonormal (E-deceleration time within 2 SD of AANV, E/A=1-2, systolic/diastolic pulmonary vein flow<1; N=25) or restrictive filling patterns (E-deceleration time>2 SD below AANV or/and E/A ratio>or=2; N=84) Differences were adjusted for clinical covariates using UNIANOVA, p<0.05. HRV was reduced and BNP higher in pseudonormal patients compared to impaired relaxation, but this difference was only significant for restrictive vs. impaired filling. Differences remained significant after adjustment for covariates. CONCLUSION Significantly more abnormal HRV, reflecting greater cardiac autonomic dysfunction, is associated with restrictive DD compared to impaired relaxation.
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Affiliation(s)
- Phyllis K Stein
- Washington University School of Medicine, St. Louis, MO 63108, USA.
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Ito H, Komura N, Iwakura K, Kawano S, Okamura A, Fujii K. Combination study of myocardial perfusion and left ventricular filling provides an excellent prediction of clinical outcomes in patients with reperfused myocardial infarction. Basic Res Cardiol 2007; 101:400-7. [PMID: 16915527 DOI: 10.1007/s00395-006-0619-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The no reflow phenomenon and left ventricular (LV) diastolic dysfunction are surrogate markers of poor outcomes in patients with myocardial infarction (MI). We studied the relationship between contrast perfusion defects and restrictive filling patterns for predicting prognosis after MI. Mitral inflow velocity and myocardial contrast perfusion were studied 2 weeks after reperfusion in 226 consecutive patients with acute MI. The cohort was divided into two groups according to the number of perfusion defect segments (PD); large-PD and small-PD. Mitral inflow was classified into two categories according to deceleration time; non-restrictive and restrictive. The patients were divided into 4 groups (small-PD/non-restrictive, n = 124; small-PD/restrictive, n = 29; large-PD/non-restrictive, n = 50; large-PD/restrictive, n = 23). LV end-diastolic volume index was the greatest and cardiac event rate was the highest in large-PD/restrictive, followed by large- PD/non-restrictive, small-PD/restrictive, and by small- PD/non-restrictive (81 +/- 19 vs. 74 +/- 17 vs. 66 +/- 19 vs. 59 +/- 15 ml/m2, events: 61 % vs. 16% vs. 14% vs. 8 %). Multivariate analysis revealed the large-PD is the most powerful predictive factor related to cardiac events (odds ratio = 5.5, P = 0.004) followed by the restrictive filing pattern (4.3, P = 0.005). Co-existence of large-PD and restrictive filling is a strong predictor of adverse outcomes in the patients with MI.
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Affiliation(s)
- H Ito
- Division of Cardiology, Sakurabashi Watanabe Hospital, 2-4-32 Umeda, Kita-ku, Osaka 530-0001, Japan.
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85
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Sinagra G, Bussani R, Abbate A, Piro M, Biondi-Zoccai GGL, Kontos MC, Sabbadini G, Barresi E, Crea F, Biasucci LM, Aleksova A, Pinamonti B, Silvestri F, Vetrovec GW, Baldi A. Left ventricular diastolic filling pattern at Doppler echocardiography and apoptotic rate in fatal acute myocardial infarction. Am J Cardiol 2007; 99:307-9. [PMID: 17261387 DOI: 10.1016/j.amjcard.2006.08.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 08/08/2006] [Accepted: 08/08/2006] [Indexed: 02/05/2023]
Abstract
Heart failure is a complex syndrome characterized by impaired emptying and/or impaired filling of the heart chambers. The use of parameters of diastolic function has provided novel tools for risk stratification and management of patients with heart failure. This study evaluated the potential correlation between apoptosis at time of death and left ventricular (LV) diastolic function after acute myocardial infarction. We selected, at routine postmortem examination, 14 subjects who died 10 to 62 days after an acute myocardial infarction and had an available echocardiographic report from the most recent hospital admission. The apoptotic rate was calculated at the region bordering the infarct, using co-localization of in situ end-labeling for deoxyribonucleic acid fragmentation and immunohistochemistry for caspase-3. Transthoracic echocardiographic studies were retrospectively reevaluated and pulse-wave Doppler spectra of mitral inflow were analyzed. LV diastolic function was assessed by measuring the ratio of E peak velocity to A peak velocity and E-wave deceleration time; a ratio of E peak velocity to A peak velocity >or=2 and deceleration time <115 ms were considered a restrictive filling pattern. A restrictive pattern was found in 4 cases (29%). All subjects with a restrictive pattern were symptomatic for New York Heart Association class IV heart failure (100% vs 20%, p = 0.015) and had larger transverse heart diameters at pathology (p = 0.014). The apoptotic rate in the peri-infarct region was significantly higher in patients with a restrictive versus nonrestrictive diastolic pattern (13%, 10 to 14, vs 3%, 1 to 6, p = 0.014). At multivariable analysis that included the restrictive pattern, class IV heart failure, and cardiac diameters, the restrictive pattern remained an independent predictor of increased apoptosis (p = 0.030). In conclusion, patients with severe postinfarction LV diastolic dysfunction had significantly higher rates of cardiomyocyte loss by apoptosis, which may partly explain their unfavorable outcome.
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Affiliation(s)
- Gianfranco Sinagra
- Institutes of Cardiology, Anatomic Pathology, and Internal Medicine, University of Trieste, Trieste, Italy
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Fox ER, Taylor J, Taylor H, Han H, Samdarshi T, Arnett D, Myerson M. Left ventricular geometric patterns in the Jackson cohort of the Atherosclerotic Risk in Communities (ARIC) Study: clinical correlates and influences on systolic and diastolic dysfunction. Am Heart J 2007; 153:238-44. [PMID: 17239683 DOI: 10.1016/j.ahj.2006.09.013] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2005] [Accepted: 09/16/2006] [Indexed: 01/19/2023]
Abstract
BACKGROUND The distribution and determinants of left ventricular (LV) geometric patterns and their relation to LV function in African Americans is not well described despite higher rates of LV hypertrophy and cardiovascular mortality reported in this group. PURPOSE This study investigates the distribution and clinical correlates of LV geometric patterns and how these patterns relate to function in a population-based African American cohort. METHODS The study population included participants in the Jackson cohort of ARIC, who underwent echocardiograms between 1993 and 1995. We defined 4 geometric patterns (normal geometry, concentric remodeling [CR], eccentric hypertrophy [EH], and concentric hypertrophy [CH]) according to LV mass index and relative wall thickness. Multiple logistic regression was used to assess the association of geometric patterns to systolic dysfunction and diastolic dysfunction, adjusting for traditional coronary risk factors. RESULTS There were 1849 participants in the study population (mean age 59 years, 65% women). Concentric remodeling and CH were highly prevalent. Concentric hypertrophy and EH groups had the highest rates of hypertension, obesity, and diabetes mellitus. Compared to the normal geometric pattern, EH was related to systolic dysfunction (OR 24.27, CI 6.71-87.80), and CH was related to diastolic dysfunction 1.58 (1.04-2.39). Concentric remodeling was not related to systolic or diastolic dysfunction. CONCLUSION In this large middle-aged African American cohort, CR and CH are prevalent. Hypertension, diabetes mellitus, and obesity are associated with both CH and EH. Concentric hypertrophy is strongly associated with diastolic dysfunction; EH is strongly associated with systolic dysfunction. Concentric remodeling, however, is not related to either systolic or diastolic dysfunction.
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Affiliation(s)
- Ervin R Fox
- The NHLBI's Jackson Heart Study, Jackson, MS 39216, USA.
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87
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Stainback RF. Introduction to Echocardiography. CARDIOVASCULAR MEDICINE 2007. [DOI: 10.1007/978-1-84628-715-2_5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ahn SG, Shin JH, Koh BR, Choi JH, Kang SJ, Choi BJ, Choi SY, Yoon MH, Hwang GS, Tahk SJ. Impact of myocardial perfusion on left atrial remodeling following primary angioplasty for acute myocardial infarction. Coron Artery Dis 2006; 17:597-603. [PMID: 17047443 DOI: 10.1097/01.mca.0000236281.74361.d4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To investigate the impact of myocardial perfusion on left atrial remodeling and its determinants after primary percutaneous coronary intervention for acute myocardial infarction. BACKGROUND Left atrial volume is an important predictor of morbidity and mortality in acute myocardial infarction, while thrombolysis in myocardial infarction (TIMI) myocardial perfusion (TMP) grade is an angiographic index associated with infarct size and mortality. As yet, however, the relationship between TMP grade and left atrial remodeling has not been investigated. METHODS Conventional transthoracic echocardiography was performed in 105 patients (55+/-13 years old, 92 men) with acute myocardial infarction within 24 h and after 6 months (mean 9+/-4, range 6-29 months) following successful primary percutaneous coronary intervention. Absolute left atrial volume was calculated using an elliptical model. Myocardial perfusion was evaluated, using TMP grade, by visual assessment on the coronary angiogram. Patients were divided into three groups on the basis of myocardial perfusion status, as TMP 0/1 (n=36), TMP 2 (n=36) and TMP 3 (n=33). RESULTS No difference was observed between baseline and follow-up left atrial volumes in the overall study population (42.5+/-16.1 vs. 43.5+/-17.4 ml, P=0.519). As regards TMP grade, follow-up left atrial volume significantly increased in the TMP 0/1 group (43+/-17 vs. 54.6+/-1.1 ml, P<0.001) and significantly decreased in the TMP 3 group (42.9+/-15.7 vs. 35.5+/-12.2 ml, P=0.001) compared with initial values. No change was observed in left atrial volume in the TMP 2 group. Multivariate analysis showed that TMP grade (P<0.001) and anterior location of myocardial infarction (P<0.001) were independent determinants of left atrial remodeling. CONCLUSIONS These results suggest that poor myocardial perfusion and anterior location of myocardial infarction can affect left atrial remodeling in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention. It appears that adequate myocardial perfusion is crucial to prevent left atrial remodeling, a poor prognostic factor in acute myocardial infarction.
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Affiliation(s)
- Sung-Gyun Ahn
- Department of Cardiology, Ajou University Medical Center, Suwon, Republic of Korea
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89
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Fox ER, Han H, Taylor HA, Walls UC, Samdarshi T, Skelton TN, Pan J, Arnett D. The prognostic value of the mitral diastolic filling velocity ratio for all-cause mortality and cardiovascular morbidity in African Americans: the Atherosclerotic Risks in Communities (ARIC) study. Am Heart J 2006; 152:749-55. [PMID: 16996852 DOI: 10.1016/j.ahj.2006.04.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Accepted: 04/13/2006] [Indexed: 01/19/2023]
Abstract
BACKGROUND Although recent data suggest that the mitral diastolic early-to-late (E/A) ratio may be prognostic in selected population-based cohorts, its predictive value for morbidity and mortality in African Americans has not yet been well studied. METHODS The study population consisted of African American participants from the Jackson cohort of the Atherosclerotic Risks in Community Study. Three subgroups of E/A ratios were defined: E/A <0.7, E/A 0.7-1.5, and E/A >1.5, using the middle group as reference. Cox proportional hazard models were used to assess the association between the E/A ratio and both all-cause mortality and incident cardiovascular disease (CVD). The mean follow-up period was 6.8 +/- 1.3 years. RESULTS Of the 2211 participants in the study population (mean age 62 years, 65.1% women), 8.2% had an E/A ratio <0.7, 84.7% had an E/A 0.7-1.5, and 7.1% had an E/A >1.5. An E/A >1.5 was independently associated with all-cause mortality (hazard ratio [HR] 2.18, 95% confidence interval [CI] 1.20-4.03) in the multivariable model. An E/A <0.7 was associated with higher all-cause mortality (HR 1.79, 95% CI 1.17-2.73) and incident CVD (HR 1.91, 95% CI 1.29-2.83) compared with a normal E/A in the age and sex adjusted model but was not independently predictive in the multivariable model (P > .05). CONCLUSIONS In a population-based cohort of middle-aged African Americans, an E/A >1.5 independently predicts all-cause mortality. An E/A >1.5 and an E/A <0.7 were both associated with incident CVD when adjusted for age and sex alone but were not independently predictive in the multivariable analysis.
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Affiliation(s)
- Ervin R Fox
- NHLBI's Atherosclerotic Risk in Communities Study, Jackson, MS, USA.
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90
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Wierzbowska-Drabik KA, Krzemińska-Pakuła M, Kasprzak JD. Propagation velocity, contractility and prognosis in patients with delayed relaxation. Int J Cardiol 2006; 113:111-2. [PMID: 16266758 DOI: 10.1016/j.ijcard.2005.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2005] [Accepted: 08/06/2005] [Indexed: 11/30/2022]
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91
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Ogunyankin KO, Burggraf GW, Abiose AK, Malik PG. Validity of Revised Doppler Echocardiographic Algorithms and Composite Clinical and Angiographic Data in Diagnosis of Diastolic Dysfunction. Echocardiography 2006; 23:817-28. [PMID: 17069599 DOI: 10.1111/j.1540-8175.2006.00329.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Commonly used echocardiographic indices for grading diastolic function predicated on mitral inflow Doppler analysis have a poor diagnostic concordance and discriminatory value. Even when combined with other indices, significant overlap prevents a single group assignment for many subjects. We tested the relative validity of echocardiographic and clinical algorithms for grading diastolic function in patients undergoing cardiac catheterization. METHOD Patients (n = 115), had echocardiograms immediately prior to measuring left ventricular (LV) diastolic (pre-A, mean, end-diastolic) pressures. Diastolic function was classified into the traditional four stages, and into three stages using a new classification that obviates the pseudonormal class. Summative clinical and angiographic data were used in a standardized fashion to classify each patient according to the probability for abnormal diastolic function. Measured LV diastolic pressure in each patient was compared with expected diastolic pressures based on the clinical and echocardiographic classifications. RESULT The group means of the diastolic pressures were identical in patients stratified by four-stage or three-stage echocardiographic classifications, indicating that both classifications schemes are interchangeable. When severe diastolic dysfunction is diagnosed by the three-stage classification, 88% and 12%, respectively, were clinically classified as high and intermediate probability, and the mean LV pre-A pressures was >12 mmHg (P < 0.005). Conversely, the mean LV pre-A pressure in the clinical low probability or echocardiographic normal groups was <11 mmHg. CONCLUSION Use of a standardized clinical algorithm to define the probability of diastolic function identifies patients with elevated LV filing pressure to the same extent as echocardiographic methods.
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Affiliation(s)
- Kofo O Ogunyankin
- Division of Cardiology, Queens University, Kingston General Hospital, Kingston, Ontario, Canada.
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92
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Møller JE, Pellikka PA, Hillis GS, Oh JK. Prognostic importance of diastolic function and filling pressure in patients with acute myocardial infarction. Circulation 2006; 114:438-44. [PMID: 16880341 DOI: 10.1161/circulationaha.105.601005] [Citation(s) in RCA: 129] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Jacob E Møller
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
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93
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Ikonomidis I, Aznaouridis K, Protogerou A, Stamatelopoulos K, Markomihelakis N, Papamichael C, Kaklamanis P, Mavrikakis M, Lekakis J. Arterial Wave Reflections Are Associated With Left Ventricular Diastolic Dysfunction in Adamantiades-Behçet's Disease. J Card Fail 2006; 12:458-63. [PMID: 16911913 DOI: 10.1016/j.cardfail.2006.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2006] [Revised: 04/01/2006] [Accepted: 04/14/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Adamantiades-Behçet's disease (ABD) is characterized by systemic vasculitis. We investigated whether aortic distensibility and arterial wave reflections are linked to left ventricular (LV) diastolic dysfunction in ABD. METHODS AND RESULTS Eighty-two patients and 40 controls with similar atherosclerotic risk factors were examined by applanation tonometry of the radial artery (SphygmoCor) and echocardiography. Augmentation index (AI%) and arrival time (Deltat, ms) of reflected arterial waves as well as aortic distensibility (AoD) assessed by echocardiography were estimated. Doppler diastolic abnormalities were defined as proposed by the European Study Group on Diastolic Heart Failure by measurement of E/A ratio, isovolumic relaxation time, deceleration time, and flow propagation velocity. Patients had impaired central augmentation index (CAI), Deltat, and AoD compared with controls (P > .05). After adjusting for age, atherosclerotic risk factors, left ventricular mass, and medication the odds-ratio of AoD and CAI for left ventricular diastolic dysfunction was 0.664 (95%CI 0.449-0.982), P = .04, and 1.073 (95% CI 1.014-1.140), P = .001, respectively. The addition of CAI to the multivariable model including AoD significantly increased the power of the model for prediction of left ventricular diastolic dysfunction (-2 Log likelihood change = 18.8, P for change > .01). CONCLUSION Augmentation index has a complementary value to aortic distensibility in the assessment of left ventricular diastolic dysfunction in ABD.
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Affiliation(s)
- Ignatios Ikonomidis
- Department of Clinical Therapeutics, University of Athens, Alexandra Hospital, Athens, Greece
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94
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Whalley GA, Gamble GD, Doughty RN. Restrictive diastolic filling predicts death after acute myocardial infarction: systematic review and meta-analysis of prospective studies. Heart 2006; 92:1588-94. [PMID: 16740920 PMCID: PMC1861228 DOI: 10.1136/hrt.2005.083055] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To determine, through a systematic review and meta-analysis, the magnitude of the survival deficit associated with a restrictive filling pattern after acute myocardial infarction (AMI). METHODS Online databases were searched for prospective echocardiography outcome studies of patients after AMI. All authors were contacted to seek confirmation of their data. Restrictive filling was compared with all non-restrictive filling patterns. Review Manager Version 4.2.7 software was used for analysis. RESULTS 3855 patients in 16 studies were identified. Follow up varied from two weeks to five years (> 1 year, 10 studies; and > 4 years, four studies). 776 (20%) of patients had a restrictive filling pattern at baseline. 580 patients died (247 in the restrictive group), and the overall odds ratio for death (restrictive filling worse) was 4.10 (95% confidence interval 3.38 to 4.99). CONCLUSIONS Mortality is about four times higher in patients with a restrictive filling pattern than in those with non-restrictive filling patterns after AMI. Echocardiographic assessment of diastolic filling pattern is an important part of the echocardiographic assessment of patients after myocardial infarction and provides important prognostic information about such patients.
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Affiliation(s)
- G A Whalley
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Auckland, Auckland, New Zealand.
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95
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Hillis GS, Ujino K, Mulvagh SL, Hagen ME, Oh JK. Echocardiographic Indices of Increased Left Ventricular Filling Pressure and Dilation After Acute Myocardial Infarction. J Am Soc Echocardiogr 2006; 19:450-6. [PMID: 16581486 DOI: 10.1016/j.echo.2005.11.007] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2005] [Indexed: 11/21/2022]
Abstract
The relationship between echocardiographic indicators of acute and chronic left ventricular (LV) filling pressure and LV dilation after acute myocardial infarction was assessed in 47 patients. The ratio of early transmitral flow velocity to early mitral annulus velocity (E/e') reflects acute LV filling pressure and the indexed volume of the left atrium is an indicator of chronic LV filling pressure. E/e' was higher (19 vs 10, P = .001) among patients who experienced a greater than 15% increase in indexed LV end-diastolic volume (remodeling group, n = 10). Receiver operating characteristic curve analysis confirmed that E/e' was a predictor of remodeling (area under the curve 0.83, P = .002). Patients with E/e' greater than 15 had a mean increase in indexed LV end-diastolic volume of 9.3 versus 1.7 mL/m2 in patients with E/e' 15 or less (P = .01). Multivariable regression analyses confirmed that E/e' was the strongest independent predictor of remodeling in this cohort (odds ratio 1.39, P = .01). There was no relationship between indexed volume of the left atrium and LV dilation. These data suggest that the E/e' ratio may be a useful predictor of LV dilation after acute myocardial infarction. In particular, an E/e' ratio greater than 15 identifies patients at increased risk.
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Affiliation(s)
- Graham S Hillis
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA.
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96
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Reynolds HR, Anand SK, Fox JM, Harkness S, Dzavik V, White HD, Webb JG, Gin K, Hochman JS, Picard MH. Restrictive physiology in cardiogenic shock: observations from echocardiography. Am Heart J 2006; 151:890.e9-15. [PMID: 16569556 DOI: 10.1016/j.ahj.2005.08.020] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2005] [Accepted: 08/27/2005] [Indexed: 01/23/2023]
Abstract
BACKGROUND Left ventricular diastolic abnormalities are associated with adverse outcome in myocardial infarction. Intra-aortic balloon pump (IABP) support is associated with improved diastolic filling. In the SHOCK trial and registry, average left ventricular ejection fraction (LVEF) was approximately 30%, higher than expected based on the classic paradigm. We hypothesized that restrictive physiology plays a role in cardiogenic shock (CS). METHODS Echocardiograms obtained during the SHOCK trial within 24 hours of randomization were centrally interpreted. Patients with quantifiable mitral E-wave deceleration time were included (n = 64). The restrictive filling pattern was defined as deceleration time < 140 milliseconds. RESULTS The restrictive pattern was seen in 60.9% of patients studied. Patients with this pattern had lower LVEF (31.1% vs 39.0%, P = .02) and higher wall motion score index (2.1 vs 1.8, P = .05). Patients with restriction were more likely to have IABP support during echocardiography (73.7% vs 43.5%, P = .03). There was no difference with and without restriction in demographic and hemodynamic variables or in mitral regurgitation degree or extent of coronary disease. The restrictive pattern had positive predictive value of 80% for pulmonary capillary wedge pressure > or = 20 mm Hg. Thirty-day survival was 53.9% with restriction versus 68.0% without restriction, P = .31. There was no difference in New York Heart Association class at 1 year between groups. CONCLUSIONS The restrictive filling pattern is common in patients with CS, which may suggest that diastolic dysfunction contributes to CS pathogenesis. Patients with the restrictive pattern had lower LVEF despite IABP support. An association between the restrictive pattern and mortality was not demonstrated; power was limited by sample size.
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Affiliation(s)
- Harmony R Reynolds
- Department of Medicine, New York University School of Medicine, New York, NY, USA.
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97
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Zacharoulis A, Kotseroglou V, Lerakis S, Karavidas A, Arapi S, Zacharoulis A. Predictive Value of C-Reactive Protein and Left Ventricular Diastolic Filling Pattern after a Non-ST Elevation Myocardial Infarction. Am J Med Sci 2006; 331:113-8. [PMID: 16538070 DOI: 10.1097/00000441-200603000-00001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent studies have shown that the odds ratio for high-sensitivity C-reactive protein (CRP) in predicting a coronary events in healthy subjects is 1.4, a value substantially less than previously reported. It is unclear whether this extends to acute coronary syndrome patients or if CRP would predict long-term events in this population. We evaluated the predictive value of CRP in patients with non-ST segment elevation myocardial infarction (NSTEMI) as their first manifestation of coronary artery disease and compared it with that of left ventricle diastolic function. METHODS Serum CRP concentration measurement and left ventricle diastolic function evaluation were performed in 51 consecutive patients with NSTEMI 48 hours, 3 months, and 6 months after infarction. Patients were followed for 1 year and events comprising the endpoints of death, new myocardial infarction, percutaneous coronary intervention, and coronary artery bypass grafting were reported. RESULTS Thirty of 51 patients developed the endpoints. Mean CRP concentration in patients who developed any endpoint and those who did not was similar at 48 hours, 3 months, and 6 months. A strong correlation between the presence of impaired relaxation 6 months after the infarction and development of the combined endpoints was noted (P < 0.001). CONCLUSION CRP has limited value in predicting future cardiovascular events in subjects with NSTEMI. Other biomarkers or a combination of other biomarkers may be needed to identify patients at high risk. Evaluation of diastolic left ventricular function not during the acute phase but 6 months later could predict adverse outcome in our series.
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98
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Naqvi TZ, Padmanabhan S, Rafii F, Hyuhn HK, Mirocha J. Comparison of usefulness of left ventricular diastolic versus systolic function as a predictor of outcome following primary percutaneous coronary angioplasty for acute myocardial infarction. Am J Cardiol 2006; 97:160-6. [PMID: 16442355 DOI: 10.1016/j.amjcard.2005.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Revised: 08/12/2005] [Accepted: 08/12/2005] [Indexed: 10/25/2022]
Abstract
Left ventricular (LV) diastolic function is an important predictor of morbidity and mortality after acute myocardial infarction (AMI). We evaluated the role of diastolic function in predicting in-hospital events and LV ejection fraction (EF) 6 months after a first AMI that was treated with primary percutaneous coronary intervention (PCI). We prospectively enrolled 59 consecutive patients who were 60 +/- 15 years of age (48 men), presented at our institution with their first AMI, and were treated with primary PCI. Patients underwent 2-dimensional and Doppler echocardiography, including tissue Doppler imaging of 6 basal mitral annular regions within 24 hours after primary PCI and were followed until discharge. Clinical and echocardiographic variables at index AMI were compared with a combined end point of cardiac death, ventricular tachycardia, congestive heart failure, or emergency in-hospital surgical revascularization. Follow-up echocardiographic assessment was performed at 6 months in 24 patients. During hospitalization, 3 patients died, 7 developed congestive heart failure, 4 had ventricular tachycardia, and 1 required emergency surgical revascularization. Stepwise logistic regression analysis showed the ratio of early mitral inflow diastolic filling wave (E) to peak early diastolic velocity of non-infarct-related mitral annulus (p < 0.01) (E') and mitral inflow E-wave deceleration time (p < 0.02) to be independent predictors of in-hospital cardiac events (generalized R2 = 0.66). In a stepwise multiple linear regression model, independent predictors of follow-up LVEF were mitral inflow deceleration time (R2 = 0.39, p = 0.002), baseline LVEF (R2 = 0.54, p < 0.02), and mitral inflow peak early velocity/mitral annular peak early velocity (or E/E') of infarct annulus (R2 = 0.66, p = 0.02). In conclusion, in patients who are treated with primary PCI for a first AMI, E/E' velocity ratio and mitral inflow E-wave deceleration time are strong predictors of in-hospital cardiac events and of LVEF at 6-month follow-up.
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Affiliation(s)
- Tasneem Z Naqvi
- The Cedars-Sinai Medical Center, University of California Los Angeles School of Medicine, Los Angeles, California, USA.
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99
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Nørager B, Husic M, Møller JE, Bo Hansen A, Pellikka PA, Egstrup K. Changes in the Doppler myocardial performance index during dobutamine echocardiography: association with neurohormonal activation and prognosis after acute myocardial infarction. Heart 2005; 92:1071-6. [PMID: 16387817 PMCID: PMC1861079 DOI: 10.1136/hrt.2005.066225] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To test whether an increase in Doppler myocardial performance index (MPI) during dobutamine stress echocardiography, reflecting deterioration of overall left ventricular function, is associated with increased N-terminal pro-brain natriuretic peptide (NT-pro-BNP) concentration and provides prognostic information beyond conventional systolic wall motion analysis after acute myocardial infarction (AMI). DESIGN Prospective, observational study. METHODS Dobutamine-atropine stress echocardiography (DASE) and NT-pro-BNP were assessed five days after AMI in 109 consecutive patients. MPI was measured at rest and at low-dose (10 microg/kg/min) and peak dobutamine infusion (<or= 40 microg/kg/min with or without atropine). MAIN OUTCOME MEASURES End point was a composite of cardiac death or readmission for heart failure or reinfarction. RESULTS In 35 patients (32%), MPI increased at low-dose DASE. This was associated with higher NT-pro-BNP concentrations (beta = 0.30, p = 0.004). During a mean follow up of 27 (SD 7) months, 8 patients died of cardiac causes and 15 patients were readmitted for heart failure or reinfarction. On Cox regression analysis, an increase in MPI at low-dose DASE (p = 0.02) was an independent predictor of cardiac events. In contrast, traditional wall motion analysis during DASE provided no additional prognostic information. CONCLUSIONS An increase in MPI at low-dose DASE, reflecting early deterioration of overall left ventricular function, is associated with raised NT-pro-BNP concentration and provides prognostic information beyond conventional stress echocardiographic data after AMI.
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Affiliation(s)
- B Nørager
- Department of Medical Research, Svendborg Hospital, Svendborg, Denmark.
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100
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García-Rubira JC, Cobos MA, Fernández-Ortiz A, Macaya C. Acute pulmonary edema complicating myocardial infarction: Is colour M-mode Doppler of the mitral valve a valuable tool? Int J Cardiol 2005; 105:174-7. [PMID: 16243109 DOI: 10.1016/j.ijcard.2004.12.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 12/11/2004] [Accepted: 12/19/2004] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To assess the value of colour M-mode Doppler of the mitral valve in patients with acute myocardial infarction complicated by pulmonary edema. DESIGN Case-control, clinical. SETTING Coronary care unit in a university hospital. PATIENTS/SUBJECTS 28 patients admitted because of acute myocardial infarction, and who developed pulmonary edema (group P, cases); 39 patients with uncomplicated myocardial infarction (group C, controls). RESULTS Patients in group P showed higher E wave (77+/-20 vs. 64+/-16 cm/s, p=0.007), E/A ratio (1.5+/-1.0 vs. 1.0+/-0.4, p=0.014), lower time of deceleration of the E wave (153+/-40 vs. 196+/-53 ms, p=0.001) and lower Ejection Fraction (35+/-10 vs. 49+/-11, p<0.001). There were no differences in the velocity of the colour M-mode Doppler of the mitral valve (Vp: 36.2+/-11 vs. 34.0+/-12 cm/s). Excluding patients with abnormal relaxation or restrictive pattern of the pulsed Doppler, Vp was identical (group P 34+/-10, group C 34+/-12). CONCLUSIONS M-mode colour Doppler of the mitral valve was not useful to differentiate patients with acute pulmonary edema complicating myocardial infarction. Measurement of Vp is not warranted as a routine in these patients.
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Affiliation(s)
- Juan C García-Rubira
- Unidad Coronaria, Instituto Cardiovascular, Hospital Clínico San Carlos, 2(a) planta, Avenida Prof Martin Lagos, sn, 28040 Madrid, Spain.
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