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Garcia EL, Menezes MG, Stefani CDM, Danzmann LC, Torres MAR. Ergospirometry and echocardiography in early stage of heart failure with preserved ejection fraction and in healthy individuals. Arq Bras Cardiol 2015; 105:248-55. [PMID: 26247247 PMCID: PMC4592173 DOI: 10.5935/abc.20150085] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 02/26/2015] [Indexed: 12/17/2022] Open
Abstract
Background Heart failure with preserved ejection fraction is a syndrome characterized by
changes in diastolic function; it is more prevalent among the elderly, women, and
individuals with systemic hypertension (SH) and diabetes mellitus. However, in its
early stages, there are no signs of congestion and it is identified in tests by
adverse remodeling, decreased exercise capacity and diastolic dysfunction. Objective To compare doppler, echocardiographic (Echo), and cardiopulmonary exercise test
(CPET) variables - ergospirometry variables - between two population samples: one
of individuals in the early stage of this syndrome, and the other of healthy
individuals. Methods Twenty eight outpatients diagnosed with heart failure according to Framingham’s
criteria, ejection fraction > 50% and diastolic dysfunction according to the
european society of cardiology (ESC), and 24 healthy individuals underwent Echo
and CPET. Results The group of patients showed indexed atrial volume and left ventricular mass as
well as E/E’ and ILAV/A´ ratios significantly higher, in addition to a significant
reduction in peak oxygen consumption and increased VE/VCO2 slope, even
having similar left ventricular sizes in comparison to those of the sample of
healthy individuals. Conclusion There are significant differences between the structural and functional variables
analyzed by Echo and CPET when comparing two population samples: one of patients
in the early stage of heart failure with ejection fraction greater than or equal
to 50% and another of healthy individuals.
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Hashimoto I, Watanabe K. Z-Value of Mitral Annular Plane Systolic Excursion Is a Useful Indicator to Predict Left Ventricular Stroke Volume in Children: Comparing Longitudinal and Radial Contractions. Echocardiography 2015; 33:290-8. [DOI: 10.1111/echo.13016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Ikuo Hashimoto
- Department of Pediatrics; Toyama City Hospital; Toyama Japan
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Adel W, Roushdy AM, Nabil M. Mitral Annular Plane Systolic Excursion-Derived Ejection Fraction: A Simple and Valid Tool in Adult Males With Left Ventricular Systolic Dysfunction. Echocardiography 2015; 33:179-84. [PMID: 26178447 DOI: 10.1111/echo.13009] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Validation of a mitral annular plane systolic excursion (MAPSE)-derived formula to calculate the ejection fraction where EF = 4.8 × MAPSE (mm) + 5.8 in adult males with left ventricular (LV) dysfunction. BACKGROUND Echocardiographic assessment of LV function generally requires expert echocardiographer and is somewhat subjective and prone to reader discordance. MAPSE has been suggested as a surrogate measurement for LV function. METHODS Prospective analysis of 170 male patients with systolic dysfunction by two-dimensional transthoracic echocardiography was carried out. MAPSE and ejection fraction measured by qualitative visual inspection, M-mode, and biplane modified Simpson's rule were measured. MAPSE-derived EF was compared against other conventional methods to measure EF using Bland-Altman analysis and independent t-test. RESULTS There was a significant positive correlation between average MAPSE and EF measured by M-mode (r = 0.554, P < 0.001), Simpson's rule (r = 0.585, P < 0.001), and visual inspection (r = 0.611, P < 0.001). An average MAPSE cutoff value <= 5 provided the best balanced sensitivity (67.1%) and specificity (76.5%) to predict EF < 30%. The mean difference between MAPSE-derived EF and EF measured by visual inspection and by Simpson's method was 3.86 ± 5.24% and 3.57 ± 5.97%, respectively. The least mean difference of 0.5 ± 5.69% was present between MAPSE-derived EF and M-mode-measured EF (P value 0.2). CONCLUSION MAPSE-derived EF using the equation EF = 4.8 × MAPSE (mm) + 5.8 is a valid technique in adult males with severely impaired LV EF.
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Affiliation(s)
- Walaa Adel
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | - Alaa M Roushdy
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
| | - Mohamed Nabil
- Cardiology Department, Ain Shams University Hospital, Cairo, Egypt
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Doesch C, Sperb A, Sudarski S, Lossnitzer D, Rudic B, Tülümen E, Heggemann F, Schimpf R, Schoenberg SO, Borggrefe M, Papavassiliu T. Mitral annular plane systolic excursion is an easy tool for fibrosis detection by late gadolinium enhancement cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Arch Cardiovasc Dis 2015; 108:356-66. [PMID: 25863428 DOI: 10.1016/j.acvd.2015.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/13/2014] [Accepted: 01/26/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) causes various degrees of fibrosis resulting in left ventricular function impairment, which can be measured using mitral annular plane systolic excursion (MAPSE). AIMS To determine the values for septal, lateral and average MAPSE using cardiovascular magnetic resonance (CMR) in healthy controls and patients with HCM; and to investigate whether MAPSE correlated with the extent of fibrosis. METHODS Patients with HCM and healthy controls underwent CMR. RESULTS In 50 healthy controls, septal and lateral MAPSE were comparable and showed excellent intra- and inter-observer reliability. Patients with HCM had significantly reduced septal, lateral and average MAPSE compared to healthy controls. Furthermore, in patients with HCM, septal MAPSE measurements were significantly reduced compared to lateral ones. Correspondingly, the septal myocardial segments showed significantly more late gadolinium enhancement (LGE) than lateral ones. No significant differences were found between echocardiographic and CMR MAPSE measurements in healthy controls and patients with HCM. Patients who suffered a major adverse cardiac event or stroke revealed a significantly reduced MAPSE and a significantly greater LGE extent compared to event-free patients with HCM. CONCLUSIONS MAPSE measurement using CMR is feasible, reproducible and comparable to echocardiography in healthy controls and patients with HCM. The asymmetric and mainly septal distribution of myocardial hypertrophy and fibrosis detected by LGE in patients with HCM was reflected by significantly reduced septal versus lateral MAPSE. Therefore, reduced MAPSE seems to be an easily determinable marker of fibrosis accumulation leading to left ventricular mechanical dysfunction and also seems to have a prognostic implication.
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Affiliation(s)
- Christina Doesch
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany.
| | - Amelie Sperb
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Sonja Sudarski
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dirk Lossnitzer
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Boris Rudic
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Felix Heggemann
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Rainer Schimpf
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
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Goto T, Wakami K, Fukuta H, Fujita H, Tani T, Ohte N. Patients with left ventricular ejection fraction greater than 58 % have fewer incidences of future acute decompensated heart failure admission and all-cause mortality. Heart Vessels 2015; 31:734-43. [PMID: 25771802 PMCID: PMC4850208 DOI: 10.1007/s00380-015-0657-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 02/27/2015] [Indexed: 01/24/2023]
Abstract
Based on our previous observation, inertia stress (IS) of late systolic aortic flow was often observed in left ventricles with relatively higher left ventricular (LV) ejection fraction (EF). Most left ventricles with relatively lower LVEF did not have IS. Accordingly, lack of IS may correlate with LV diastolic dysfunction through the loss of LV elastic recoil and may contribute to the pathogenesis of heart failure (HF) and reduced survival. We enrolled 144 consecutive patients that underwent cardiac catheterization for the diagnosis of coronary artery disease. Left ventricular ejection fraction (LVEF) was obtained from left ventriculography. The IS was calculated from the LV pressure (P)-dP/dt relation. The study endpoint of this retrospective outcome-observational study was combined subsequent acute decompensated heart failure (ADHF) and all-cause mortality. During the follow-up period (median 6.1 years), seven unscheduled hospitalizations for ADHF and nine all-cause deaths were observed. The event-free survival rate was significantly higher among patients with IS than among patients without IS (log-rank, p = 0.001). On a multivariate Cox regression analysis, lack of IS was a prime predictor of the endpoint during follow-up (hazard ratio: 6.98; 95 % confidence interval: 1.48-33.03; p = 0.01). An LVEF ≥ 58 % was a surrogate indicator for the presence of IS, and patients with LVEF ≥ 58 % had fewer incidences of the endpoint than patients with LVEF < 58 %. In conclusion, lack of IS or LVEF < 58 % should be a predictor of future ADHF and all-cause mortality.
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Affiliation(s)
- Toshihiko Goto
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Kazuaki Wakami
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hidekatsu Fukuta
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Hiroshi Fujita
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Tomomitsu Tani
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan
| | - Nobuyuki Ohte
- Department of Cardio-Renal Medicine and Hypertension, Nagoya City University Graduate School of Medical Sciences, 1 Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, 467-8601, Japan.
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Meluzin J, Gregorova Z, Spinarova M, Panovsky R. Can we diagnose isolated, exercise-induced heart failure with normal ejection fraction? Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2015; 159:513-8. [PMID: 25690524 DOI: 10.5507/bp.2014.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/19/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND A significant proportion of patients with exertional dyspnea require exercise to diagnose heart failure with normal ejection fraction (HFNEF). METHODS AND RESULTS In this review article, we evaluate current data on the prevalence, clinical significance and specifically the establishment of a diagnosis of isolated, exercise-induced HFNEF. Despite the unquestioned clinical importance and high prevalence of exercise-induced HFNEF, there are limited and conflicting data on making a diagnosis of exercise-induced HFNEF. This mostly relies on the evidence of exercise-induced elevation in left ventricular filling pressure (LVFP). At present, there is no agreement on the ability of exercise echocardiographic parameteres to predict exercise-induced LVFP elevation. In addition, even invasively measured exercise LVFP faces the problem of defining normal exercise LVFP values. More data and probably new diagnostic approaches are necessary to reliably diagnose exercise HFNEF. CONCLUSIONS There are conflicting results and significant problems associated with the diagnosis of exercise HFNEF. This review hopefully will encourage further research in this difficult but clinically important area of heart failure.
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Affiliation(s)
- Jaroslav Meluzin
- Department of Cardiovascular Diseases, St. Anne´s University Hospital, ICRC, Brno, Czech Republic.,Department of Cardiovascular Diseases, Masaryk University, Brno, Czech Republic
| | - Zdenka Gregorova
- Department of Cardiovascular Diseases, St. Anne´s University Hospital, ICRC, Brno, Czech Republic.,Department of Cardiovascular Diseases, Masaryk University, Brno, Czech Republic
| | - Monika Spinarova
- Department of Cardiovascular Diseases, St. Anne´s University Hospital, ICRC, Brno, Czech Republic.,Department of Cardiovascular Diseases, Masaryk University, Brno, Czech Republic
| | - Roman Panovsky
- Department of Cardiovascular Diseases, St. Anne´s University Hospital, ICRC, Brno, Czech Republic.,Department of Cardiovascular Diseases, Masaryk University, Brno, Czech Republic
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Gromadziński L, Pruszczyk P. Echocardiographic changes in patients with stage 3-5 chronic kidney disease and left ventricular diastolic dysfunction. Cardiorenal Med 2014; 4:234-43. [PMID: 25737688 DOI: 10.1159/000369106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2014] [Accepted: 10/07/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction in chronic kidney disease (CKD) patients frequently leads to the development of congestive heart failure. We evaluated changes in echocardiographic parameters among CKD patients with LV diastolic dysfunction. METHODS We examined 70 ambulatory patients with CKD at stages 3-5 and 26 patients without CKD as a control group. Standard echocardiography and tissue Doppler imaging were performed on all patients. Patients with CKD were divided into two groups according to the results of lateral mitral early diastolic velocity (EmLVlat): a group with diastolic dysfunction (DD group; EmLVlat <8 cm/s) and a group without diastolic dysfunction (WDD group; EmLVlat ≥8 cm/s). RESULTS Compared to the patients in the WDD group, those in the DD group were characterized by lower values of mitral annular plane systolic excursion [MAPSE; 13 (11-17) vs. 14 (11-16) mm, p < 0.0001] and lateral mitral annular systolic velocity [SmLVlat; 7 (5-14) vs. 8 (5-13) cm/s, p = 0.006]. The area under the receiver operating characteristic (ROC) curve of the MAPSE level for the detection of LV diastolic dysfunction was 0.801 [95% CI 0.684-0.890, p < 0.0001], whereas a ROC-derived MAPSE value of ≤13 mm was characterized by a sensitivity of 84.4% and a specificity of 75.8% for diagnosing LV diastolic dysfunction. The only independent variable predicting LV diastolic dysfunction was MAPSE [OR = 0.39; 95% CI 0.21-0.74, p = 0.003]. CONCLUSION We showed that reduced MAPSE, but not SmLVlat, is an independent predictive factor for LV diastolic dysfunction in CKD patients.
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Affiliation(s)
- Leszek Gromadziński
- Department of Internal Diseases, Gastroenterology and Hepatology, University Clinical Hospital in Olsztyn, Olsztyn, Poland ; Department of Internal Diseases, Gastroenterology, Cardiology and Infectiology, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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Dori G, Rajab I, David K, Naama S, Moshe V. Ejection fraction in patients with heart failure and preserved ejection fraction is greater than in healthy controls: a meta-analysis. Eur J Intern Med 2014; 25:831-6. [PMID: 25303783 DOI: 10.1016/j.ejim.2014.09.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 08/26/2014] [Accepted: 09/23/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ejection fraction (EF) slightly declines with age in healthy control (HC) subjects. Yet, studies of heart failure with preserved ejection fraction (HFPEF) often report EF values which are surprisingly greater than those reported for HC of the same age. The goals of this study were to: (1) compare the EF, at rest, in subjects with HFPEF versus HC, and (2) compare how EF varies with age in HFPEF and HC. METHODS A systematic review and meta-analysis of the literature was performed. Studies were identified in the PUBMED and EMBASE databases until August 2013. A study reporting EF at rest in HFPEF and HC was included regardless of the aim of the primary study. In most of the primary studies (25 of 28 studies, 89%) EF was not a primary endpoint. A summary measure was the standardized mean difference (SMD) of the EF in HFPEF vs. HC RESULTS Twenty eight studies (1529 HFPEF and 1068 HC subjects) were included. SMD was 0.71 (95% CI: 0.31, 1.12, P<0.001) demonstrating a greater EF in HFPEF. Effect size of HFPEF on EF was moderate. A meta-regression showed a statistically non-significant trend of increased SMD with older age. CONCLUSIONS This analysis showed that EF in HFPEF is on average "greater-than-normal". This phenomenon may be related to an underlying adaptive mechanism occurring in HFPEF. Further research is needed.
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Affiliation(s)
- Guy Dori
- HaEmek Medical Center, Rabin Blvd., Afula 18101, Israel; Rappaport School of Medicine, Technion- Israel Institute of Technology, Efron St., P.O.B. 9649, Bat Galim, Haifa 31096, Israel.
| | - Idriss Rajab
- Carmel Medical Center, 7 Michal St., Haifa 34362, Israel
| | - Kestenbaum David
- Rappaport School of Medicine, Technion- Israel Institute of Technology, Efron St., P.O.B. 9649, Bat Galim, Haifa 31096, Israel
| | | | - Vardi Moshe
- Harvard Clinical Research Institute, 930 Commonwealth Ave., Boston, MA 02215, USA
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Wang J, Fang F, Wai-Kwok Yip G, Sanderson JE, Feng W, Xie JM, Luo XX, Lee APW, Lam YY. Left ventricular long-axis performance during exercise is an important prognosticator in patients with heart failure and preserved ejection fraction. Int J Cardiol 2014; 178:131-5. [PMID: 25464236 DOI: 10.1016/j.ijcard.2014.10.130] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 10/21/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although many prognostic variables have been reported, the risk stratification of patients with heart failure and preserved ejection fraction (HFPEF) has long been controversial due to considerable discordance. Ergometry stress echocardiography may provide a more clinical relevant evaluation in HFPEF. We aimed at evaluating the prognostic value of echocardiographic parameters during exercise in HFPEF patients. METHODS Comprehensive echocardiographic examination with symptom-limited exercise testing on a semi-recumbent and tilting bicycle Ergometer (Lode BV, Groningen, the Netherlands) was performed on 80 consecutive HFPEF patients (aged 66±8years; 64% male). The exercise images for two-dimensional (2D) speckle tracking analysis were acquired with heart rate of 90-100bpm, while exercise images for tissue Doppler imaging (TDI) and M-mode echocardiography were stored with attainment of >85% of maximal age-predicted heart rate. All patients were followed up for 3years after stress echocardiography for all-cause mortality and/or heart failure (HF) hospitalization. RESULTS During the follow-up, 43 (54%) patients reached the combined end point: 5 (6%) patients died, and another 38 (48%) patients experienced HF hospitalizations. Univariate predictors were: decreased resting left atrial ejection fraction (LAEF), lower peak heart rate, elevated E/e' ratio, reduced TDI myocardial velocities, and impaired 2D global longitudinal strain (GLS) during exercise. Only impaired GLS (hazard ratio [HR] 0.79, 95% confidence interval [CI] 0.67 to 0.91) remained independent after multivariate analysis (p=0.008). CONCLUSIONS More than half of the HFPEF patients died or were hospitalized for HF at 3-year follow-up and this was significantly related to impaired left ventricular long-axis function during exercise.
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Affiliation(s)
- Jing Wang
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Fang Fang
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | | | - John E Sanderson
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Wei Feng
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Jun-Min Xie
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Xiu-Xia Luo
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Alex Pui-Wai Lee
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong
| | - Yat-Yin Lam
- Institute of Vascular Medicine, Li Ka Shing Institute of Health Science, S.H. Ho Cardiovascular Disease and Stroke Centre, Division of Cardiology, Department of Medicine and Therapeutics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong.
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Taşolar H, Mete T, Çetin M, Altun B, Ballı M, Bayramoğlu A, Otlu YÖ. Mitral annular plane systolic excursion in the assessment of left ventricular diastolic dysfunction in obese adults. Anatol J Cardiol 2014; 15:558-64. [PMID: 25537997 PMCID: PMC5337036 DOI: 10.5152/akd.2014.5561] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Objective: Mitral annular plane systolic excursion (MAPSE) is a simple way to assess left ventricle (LV) function. MAPSE is also correlated to parameters, illustrating the close relation between systolic and diastolic function of LV. In this study, we evaluated whether MAPSE could help us in the determination the LV diastolic dysfunction (DD) in obese adults. Methods: Our study was a prospective cross-sectional study. Obese patients who were referred from the endocrinology clinic were enrolled into this study. The participants included 40 obese patients with early-stage DD (grade I and II) and 40 obese patients with normal diastolic function, with an equal number of males and females. The patients with DD were further divided into Obese DD+I, who had grade I DD, and Obese DD+II, who had grade II DD. Student t-test, Mann-Whitney U test, one-way analysis of variance, ROC curve analysis, and pairwise comparisons of the ROC curves were used for statistical analysis. Results: MAPSE was different in all groups, with the lowest value in the Obese DD+II group (p<0.001). E/Em ratio was also different among all groups and was highest in the Obese DD+II group (p<0.001). Furthermore, MAPSE was negatively correlated with E/Em ratio (r=-0.368, p=0.020). The optimal threshold point of MAPSE in the diagnosis of left ventricle diastolic dysfunction (LVDD) was ≥1.45 cm, with 92.5% sensitivity (95% CI 79.6-98.4) and 77.5% specificity (95% CI 61.5-89.2) in the ROC curve analysis. There was no difference in the pairwise comparisons of the ROC curves of MAPSE and E/Em ratio in the diagnosis of DD [area under the ROC curve 0.902 (0.033) vs. 0.927 (0.027); p=0.54]. Conclusion: Consequently, we found significantly a close relationship between MAPSE with conventional echocardiographic parameters, especially with E/Em, in the detection of left ventricle diastolic dysfunction (LVDD) in obese adults with normal LV ejection fraction. We think that MAPSE is a simple, easily acquired and less time consuming measurement and may help us in the stratification of LVDD in obese adults.
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Affiliation(s)
- Hakan Taşolar
- Department of Cardiology, Adıyaman University, Training and Research Hospital; Adıyaman-Turkey.
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Koestenberger M, Nagel B, Ravekes W, Avian A, Cvirn G, Rehak T, Gamillscheg A. Reference values of the mitral annular peak systolic velocity (Sm) in 690 healthy pediatric patients, calculation of Z-score values, and comparison to the mitral annular Plane systolic excursion (MAPSE). Echocardiography 2014; 31:1122-30. [PMID: 25271547 DOI: 10.1111/echo.12541] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The mitral annular peak systolic velocity (Sm) is an echocardiographic measurement using tissue Doppler imaging to assess longitudinal left ventricular (LV) systolic function in children and adults. We determined growth-related changes in Sm to establish reference values for the entire pediatric age group. METHODS AND RESULTS A prospective study was conducted in a group of 690 healthy pediatric patients (age: 1 day-18 years). We determined the effects of age, sex, and body surface area (BSA) on the Sm values. Regression analysis was used to estimate Sm from age, BSA, and sex. In addition, a correlation of normal Sm with normal age-matched values of the M-mode parameter mitral annular plane systolic excursion (MAPSE) was measured. The Sm ranged from a mean of 5.8 cm/sec (Z-score ±2: 3.6-8.0 cm/sec) in the newborn to 11.8 cm/sec (Z-score ±2: 8.5-15.1 cm/sec) in the 18-year-old adolescent. The Sm values showed a positive correlation with age and BSA with a nonlinear course. There was no significant difference in Sm values between females and males. A significant correlation was found between Sm and MAPSE values. CONCLUSION Z-scores of Sm values were calculated and percentile charts were established to serve as reference data in patients with congenital heart diseases.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria
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Effect of antiepilepsy drug therapy on ventricular function in children with epilepsy: a tissue Doppler imaging study. Pediatr Cardiol 2014; 35:280-8. [PMID: 23942784 DOI: 10.1007/s00246-013-0771-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/24/2013] [Indexed: 01/14/2023]
Abstract
Impaired cardiac myocardial function may contribute to the risk for sudden unexpected death of a patient with epilepsy. This study aimed to investigate the effect of antiepilepsy drugs (AEDs) on cardiac function in pediatric epileptic patients using standard and tissue Doppler imaging (TDI) echocardiography. This hospital-based, prospective cross-sectional study investigated 52 epileptic children (mean age 9.3 ± 3.1 years) treated with AEDs (duration 2.4-10.0 years) and 36 healthy children (mean age 9.5 ± 4.0 years). In the epilepsy group, standard echocardiography showed increased left ventricular (LV) end-diastolic and end-systolic diameters, an increased LV mass index, and preserved ejection fraction. The patients also exhibited increased mitral peak A-wave velocity and mitral E-wave deceleration time as well as a decreased mitral E/A ratio. The E/Em ratio was significantly higher in the epilepsy group (5.6 ± 1.2) than in the control group (5.2 ± 1.1) (p = 0.016). In the epilepsy group, TDI showed an increased isovolumetric relaxation time and myocardial performance index (MPI). It also exhibited decreased early diastolic velocity (Em) and a decreased mitral annular displacement index in these patients. There were positive correlations between the LV lateral wall MPI (r = 0.231), septal MPI (r = 0.223), and LV mass index (p < 0.05) but no correlation with the duration of AED treatment. The authors detected subclinical ventricular dysfunction associated with AEDs at a preclinical stage. They suggest that TDI can be useful for determining the short- and long-term cardiac effects of AEDs.
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Luszczak J, Olszowska M, Drapisz S, Plazak W, Kaznica-Wiatr M, Karch I, Podolec P. Assessment of left ventricle function in aortic stenosis: mitral annular plane systolic excursion is not inferior to speckle tracking echocardiography derived global longitudinal peak strain. Cardiovasc Ultrasound 2013; 11:45. [PMID: 24373119 PMCID: PMC3878794 DOI: 10.1186/1476-7120-11-45] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/20/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Early detection of left ventricle (LV) systolic dysfunction is essential for management of patients with aortic stenosis (AS). Two- dimensional speckle tracking derived global longitudinal peak strain (GLPS) is more sensitive than ejection fraction (EF) but requires good image quality and is not easily accessible. The aim of the study was to compare GLPS with traditional echocardiographic parameter- mitral annular plane systolic excursion (MAPSE) in AS. MATERIAL AND METHODS In consecutive patients with moderate to severe AS and LV ejection fraction ≥ 50% standard echocardiography and two-dimensional speckle tracking echocardiography were performed. Mitral annular plane systolic excursion and global longitudinal peak strain were obtained from apical echocardiographic views. RESULTS A total of 82 patients were examined, median age was 68 (60-78), 56% of them were men. There was a positive correlation between aortic valve area index (AVAI) and: MAPSE (r = 0.334, p = 0.002), MAPSE indexed for body surface area- MAPSEI (r = 0.349, p = 0.001) and GLPS (r = 0.342, p = 0.002) but not EF (r = 0.031, p = 0.782). A positive correlation was found between GLPS and MAPSE (r = 0.558, p < 0.001) and between GLPS and MAPSEI (r = 0.543, p < 0.001). All above parameters were significantly lower in symptomatic patients compared to asymptomatic subjects (GLPS: -13.82 ± 3.56 vs. -16.39 ± 3.16%, p = 0.002, MAPSE: 10.49 ± 1.91 vs. 11.95 ± 1.82 mm, p = 0.001 and MAPSEI: 5.66 (4.83-6.6) vs. 6.46 ± 0.97 mm/m2, p = 0.005). CONCLUSION Despite the development of the modern echocardiographic techniques, mitral annular plane systolic excursion can still be used as a sensitive tool to detect early longitudinal LV systolic dysfunction.
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Affiliation(s)
- Joanna Luszczak
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland
| | - Maria Olszowska
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland
| | - Sylwia Drapisz
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland
| | - Wojciech Plazak
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland
| | - Magdalena Kaznica-Wiatr
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland
| | - Izabela Karch
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland
| | - Piotr Podolec
- Department of Cardiac and Vascular Diseases, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80, 31-202 Krakow, Poland
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Role of Echocardiography in the Diagnosis of Heart Failure with Preserved Left Ventricular Systolic Function: Update 2013. CURRENT CARDIOVASCULAR IMAGING REPORTS 2013. [DOI: 10.1007/s12410-013-9223-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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65
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Maras D, Chung R, Duncan A, Li W, Thorp C, Mörner S, Lindqvist P, Henein MY. Patterns of cardiac dysfunction coinciding with exertional breathlessness in hypertrophic cardiomyopathy. Int J Cardiol 2013; 170:233-8. [DOI: 10.1016/j.ijcard.2013.10.059] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 08/02/2013] [Accepted: 10/19/2013] [Indexed: 10/26/2022]
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66
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Abnormal left ventricular longitudinal function assessed by echocardiographic and tissue Doppler imaging is a powerful predictor of diastolic dysfunction in hypertensive patients: The SPHERE study. Int J Cardiol 2013; 168:3351-8. [DOI: 10.1016/j.ijcard.2013.04.122] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/13/2012] [Accepted: 04/11/2013] [Indexed: 11/30/2022]
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67
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Cruz-Lemini M, Crispi F, Valenzuela-Alcaraz B, Figueras F, Sitges M, Gómez O, Bijnens B, Gratacós E. Value of annular M-mode displacement vs tissue Doppler velocities to assess cardiac function in intrauterine growth restriction. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2013; 42:175-181. [PMID: 23280816 DOI: 10.1002/uog.12374] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/10/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To compare the ability of two different methods for longitudinal annular motion measurement, M-mode and tissue Doppler imaging (TDI), to demonstrate cardiac dysfunction in intrauterine-growth-restricted (IUGR) fetuses. METHODS Cardiac longitudinal annular motion in the basal free wall of the left ventricle (mitral annulus), interventricular septum and tricuspid annulus was assessed in 23 early-onset IUGR cases and 43 controls by TDI (annular peak velocities) and M-mode (displacement). RESULTS All annular parameters were significantly decreased in the IUGR group with respect to controls using both methods. M-mode showed a trend towards equal performance as classifier between cases and controls, as compared to TDI, mainly in the tricuspid annulus. CONCLUSIONS Both M-mode and TDI demonstrate annular motion changes and consequently cardiac dysfunction in IUGR fetuses. M-mode imaging is simpler to perform and could be as sensitive as TDI for detecting subtle changes.
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Affiliation(s)
- M Cruz-Lemini
- Department of Maternal-Fetal Medicine, Fetal and Perinatal Medicine Research Group Institut Clínic de Ginecologia, Obstetrícia i Neonatologia, Barcelona, Spain
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Bergenzaun L, Ohlin H, Gudmundsson P, Willenheimer R, Chew MS. Mitral annular plane systolic excursion (MAPSE) in shock: a valuable echocardiographic parameter in intensive care patients. Cardiovasc Ultrasound 2013; 11:16. [PMID: 23718803 PMCID: PMC3679845 DOI: 10.1186/1476-7120-11-16] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 05/24/2013] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Assessing left ventricular (LV) dysfunction by echocardiography in ICU patients is common. The aim of this study was to investigate mitral annular plane systolic excursion (MAPSE) in critically ill patients with shock and its relation to LV systolic and diastolic function, myocardial injury and to outcome. METHODS In a prospective, observational, cohort study we enrolled 50 patients with SIRS and shock despite fluid resuscitation. Transthoracic echocardiography (TTE) measuring LV function was performed within 12 hours after admission and daily for a 7-day observation period. TTE and laboratory measurements were related to 28-day mortality. RESULTS MAPSE on day 1 correlated significantly with LV ejection fraction (LVEF), tissue Doppler indices of LV diastolic function (é, E/é) and high-sensitive troponin T (hsTNT) (p< 0.001, p= 0.039, p= 0.009, p= 0.003 respectively) whereas LVEF did not correlate significantly with any marker of LV diastolic function or myocardial injury. Compared to survivors, non-survivors had a significantly lower MAPSE (8 [IQR 7.5-11] versus 11 [IQR 8.9-13] mm; p= 0.028). Other univariate predictors were age (p=0.033), hsTNT (p=0.014) and Sequential Organ Failure Assessment (SOFA) scores (p=0.007). By multivariate analysis MAPSE (OR 0.6 (95% CI 0.5- 0.9), p= 0.015) and SOFA score (OR 1.6 (95% CI 1.1- 2.3), p= 0.018) were identified as independent predictors of mortality. Daily measurements showed that MAPSE, as sole echocardiographic marker, was significantly lower in most days in non-survivors (p<0.05 at day 1-2, 4-6). CONCLUSIONS MAPSE seemed to reflect LV systolic and diastolic function as well as myocardial injury in critically ill patients with shock. The combination of MAPSE and SOFA added to the predictive value for 28-day mortality.
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Affiliation(s)
- Lill Bergenzaun
- Department of Anaesthesiology and Intensive Care, Skåne University Hospital, Institute for Clinical Sciences Malmö, Lund University, Malmö, Sweden.
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McIntosh RA, Silberbauer J, Veasey RA, Raju P, Baumann O, Kelly S, Beale L, Brickley G, Sulke N, Lloyd GW. Tissue Doppler-Derived Contractile Reserve Is a Simple and Strong Predictor of Cardiopulmonary Exercise Performance across a Range of Cardiac Diseases. Echocardiography 2013; 30:527-33. [DOI: 10.1111/echo.12084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Robert A. McIntosh
- Cardiology Department; Eastbourne Hospital; East Sussex Hospitals NHS Trust; Eastbourne; United Kingdom
| | - John Silberbauer
- Cardiology Department; Eastbourne Hospital; East Sussex Hospitals NHS Trust; Eastbourne; United Kingdom
| | - Rick A. Veasey
- Cardiology Department; Eastbourne Hospital; East Sussex Hospitals NHS Trust; Eastbourne; United Kingdom
| | - Prashanth Raju
- Cardiology Department; Eastbourne Hospital; East Sussex Hospitals NHS Trust; Eastbourne; United Kingdom
| | - Oliver Baumann
- Institute of Sound and Vibration Research; Southampton University; Southampton; United Kingdom
| | - Sarah Kelly
- Chelsea School; University of Brighton; Eastbourne; United Kingdom
| | - Louisa Beale
- Chelsea School; University of Brighton; Eastbourne; United Kingdom
| | - Gary Brickley
- Chelsea School; University of Brighton; Eastbourne; United Kingdom
| | - Neil Sulke
- Cardiology Department; Eastbourne Hospital; East Sussex Hospitals NHS Trust; Eastbourne; United Kingdom
| | - Guy W. Lloyd
- Cardiology Department; Eastbourne Hospital; East Sussex Hospitals NHS Trust; Eastbourne; United Kingdom
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Hu K, Liu D, Herrmann S, Niemann M, Gaudron PD, Voelker W, Ertl G, Bijnens B, Weidemann F. Clinical implication of mitral annular plane systolic excursion for patients with cardiovascular disease. Eur Heart J Cardiovasc Imaging 2012; 14:205-12. [DOI: 10.1093/ehjci/jes240] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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71
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Matos J, Kronzon I, Panagopoulos G, Perk G. Mitral Annular Plane Systolic Excursion as a Surrogate for Left Ventricular Ejection Fraction. J Am Soc Echocardiogr 2012; 25:969-74. [DOI: 10.1016/j.echo.2012.06.011] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Indexed: 11/27/2022]
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72
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Cacciapuoti F. Mitral annulus posterior systolic excursion instead of left ventricular ejection fraction to evaluate left ventricular systolic function both during urgent hypertensive crisis and after blood pressure normalization. J Clin Hypertens (Greenwich) 2012; 14:480. [PMID: 22747624 DOI: 10.1111/j.1751-7176.2012.00612.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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73
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Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fritsch P, Fandl A, Rehak T, Gamillscheg A. Left ventricular long-axis function: reference values of the mitral annular plane systolic excursion in 558 healthy children and calculation of z-score values. Am Heart J 2012; 164:125-31. [PMID: 22795292 DOI: 10.1016/j.ahj.2012.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/10/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Longitudinal myocardial function has gained more interest in the last years. The mitral annular plane systolic excursion (MAPSE) is an echocardiographic measurement to assess left ventricular (LV) long-axis function in adults. The aim of this study was to evaluate MAPSE values in a healthy pediatric population and to propose reference values. METHODS A prospective study was conducted in a group of 558 healthy children and adolescents (age day 1 to 18 years) (body surface area [BSA] 0.18-2.21 m(2)). We determined the effects of age and BSA on MAPSE values and a possible correlation of MAPSE values with LV ejection fraction values. RESULTS The MAPSE ranged from a mean of 0.57 cm (z-score ±2: 0.38-0.76 cm) in neonates to 1.63 cm (z-score ±2: 1.31-1.95 cm) in 18-year-old adolescents. The MAPSE values showed a positive correlation with age (r = 0.87, P < .001) and BSA (r = 0.89, P < .001) with a nonlinear course. There was no significant difference in MAPSE values between females or males. A positive correlation was found between MAPSE values and LV ejection fraction values (r = 0.28, P < .001). CONCLUSIONS Z-scores of MAPSE values were calculated, and percentile charts were established to serve as reference data in patients with congenital heart disease or heart failure in the future.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.
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MacIver DH, Dayer MJ, Harrison AJI. A general theory of acute and chronic heart failure. Int J Cardiol 2012; 165:25-34. [PMID: 22483252 DOI: 10.1016/j.ijcard.2012.03.093] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2012] [Revised: 03/07/2012] [Accepted: 03/08/2012] [Indexed: 12/13/2022]
Abstract
Current concepts of heart failure propose multiple heterogeneous pathophysiological mechanisms. Recently a theoretical framework for understanding chronic heart failure was suggested. This paper develops this framework to include acute heart failure syndromes. We propose that all acute heart failure syndromes may be understood in terms of a relative fall in left ventricular stroke volume. The initial compensatory mechanism is frequently a tachycardia often resulting in a near normal cardiac output. In more severe forms a fall in cardiac output causes hypotension or cardiogenic shock. In chronic heart failure the stroke volume and cardiac output is returned to normal predominantly through ventricular remodeling or dilatation. Ejection fraction is simply the ratio of stroke volume and end-diastolic volume. The resting stroke volume is predetermined by the tissue's needs; therefore, if the ejection fraction changes, the end-diastolic volume must change in a reciprocal manner. The potential role of the right heart in influencing the presentation of left heart disease is examined. We propose that acute pulmonary edema occurs when the right ventricular stroke volume exceeds left ventricular stroke volume leading to fluid accumulation in the alveoli. The possible role of the right heart in determining pulmonary hypertension and raised filling pressures in left-sided heart disease are discussed. Different clinical scenarios are presented to help clarify these proposed mechanisms and the clinical implications of these theories are discussed. Finally an alternative definition of heart failure is proposed.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton & Somerset Hospital, Musgrove Park, Taunton TA1 5DA, UK.
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