51
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Dávila-Román VG, Checkley W. Lung Ultrasound in Cardiac Intensive Care: More Than Just LUCK? Circ Cardiovasc Imaging 2020; 13:e010909. [PMID: 32536198 DOI: 10.1161/circimaging.120.010909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Victor G Dávila-Román
- Cardiovascular Imaging and Clinical Research Core Laboratory, Cardiovascular Division, Department of Medicine, and Global Health Center, Institute of Public Health, Washington University School of Medicine, St. Louis, MO (V.G.D.-R.)
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine (W.C.), School of Medicine, Johns Hopkins University, Baltimore, MD.,Center for Global Non-Communicable Disease Research and Training (W.C.), School of Medicine, Johns Hopkins University, Baltimore, MD
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52
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Huang FY, Shah JP, Pu XB, Hagar A, Chen SJ. Influence of Gender on Clinical Characteristics and Outcomes in Chinese Patients With Hypertrophic Cardiomyopathy. Am J Med Sci 2020; 360:517-524. [PMID: 32540144 DOI: 10.1016/j.amjms.2020.05.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 03/12/2020] [Accepted: 05/13/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND Gender plays a crucial role in the prevalence, clinical presentation, management and outcomes of various cardiovascular diseases. The aim of this study was to evaluate the impact of gender on clinical manifestations and outcomes in the Chinese patients with hypertrophic cardiomyopathy (HCM). METHODS We evaluated 576 Chinese patients (316 males) who were diagnosed with HCM at West China Hospital from 2008 to 2016 and followed over 3.2 ± 2.3 years. RESULTS Compared to male patients, female patients were older (57.2 ± 16.7 years vs. 53.0 ± 15.7 years, P = 0.002) and more symptomatic [New York Heart Association class III-IV symptoms 46.9% vs. 30.7%, P < 0.001] at the time of diagnosis, and had higher left ventricular outflow tract gradient at rest [33 (12-58) mmHg vs. 24 (8-42) mmHg, P = 0.007]. During the follow-up period, survival analysis showed no significant differences in the incidences of all-cause mortality (P = 0.657) and cardiovascular mortality (P = 0.214) but the rate of rehospitalization due to heart failure was higher in females than in males (P = 0.015). Multivariable Cox analysis showed that left ventricular ejection fraction (hazard ratio [HR], 0.96 [95% confidence interval [CI], 0.94-0.99]; P = 0.003) and New York Heart Association class III-IV (HR, 2.86 [95% CI, 1.38-5.94]; P = 0.005) were independently associated with cardiovascular mortality. CONCLUSIONS Compared to males, females were older and more symptomatic at presentation, and had higher risk of progression to heart failure in Chinese HCM patients but there were no differences in cardiovascular mortality.
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Affiliation(s)
- Fang-Yang Huang
- Cardiology Department, Minda Hospital of Hubei Minzu University, 2 Wufengshan Road, Enshi, Hubei, China; Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jageshwar Prasad Shah
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xiao-Bo Pu
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Abdullah Hagar
- Cardiology Department, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shi-Jian Chen
- Cardiology Department, Minda Hospital of Hubei Minzu University, 2 Wufengshan Road, Enshi, Hubei, China.
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53
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Ramalli A, Rodriguez-Molares A, Avdal J, D'hooge J, Lovstakken L. High-Frame-Rate Color Doppler Echocardiography: A Quantitative Comparison of Different Approaches. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:923-933. [PMID: 31825865 DOI: 10.1109/tuffc.2019.2958031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Ultrasound color Doppler imaging (CDI) provides a map of the axial blood flow velocities in a 2-D/3-D region of interest. While CDI is clinically effective for a qualitative analysis of abnormal blood flows, e.g., for valvular disease in cardiology, it is in limited use for quantitative measures, mainly hampered by low frame rate and measurement bias. These limitations can be reduced by different approaches toward high-frame-rate (HFR) imaging at the expense of reduced image quality and penetration depth. The aim of this study was to compare the impact of different HFR sequences on CDI quantitatively. Different cardiac scan sequences, including diverging waves and multiline transmission, were designed, implemented on a research system, and compared in terms of patient safety parameters, image quality, and penetration depth. Furthermore, in vivo images were acquired and compared for healthy volunteers. Results showed that the HFR techniques spread artifacts on larger areas than the standard single-line scans (> +50%). In addition, due to patient safety limitations, they reduce the penetration depth up to -5 cm. On the other hand, the HFR techniques provide comparable velocity estimates (relative difference <6%) and enhance the time resolution of the color Doppler images, achieving frame rates up to 625 Hz in continuous acquisition.
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54
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Kugamoorthy P, Spears DA. Management of tachyarrhythmias in pregnancy - A review. Obstet Med 2020; 13:159-173. [PMID: 33343692 DOI: 10.1177/1753495x20913448] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/16/2020] [Indexed: 11/16/2022] Open
Abstract
The most common arrhythmias detected during pregnancy include sinus tachycardia, sinus bradycardia, and sinus arrhythmia, identified in 0.1% of pregnancies. Isolated premature atrial or ventricular arrhythmias are observed in 0.03% of pregnancies. Arrhythmias may become more frequent during pregnancy or may manifest for the first time.
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Affiliation(s)
| | - Danna A Spears
- University Health Network - Toronto General Hospital, Toronto, Canada
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55
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Parbhudayal RY, Harms HJ, Michels M, van Rossum AC, Germans T, van der Velden J. Increased Myocardial Oxygen Consumption Precedes Contractile Dysfunction in Hypertrophic Cardiomyopathy Caused by Pathogenic TNNT2 Gene Variants. J Am Heart Assoc 2020; 9:e015316. [PMID: 32290750 PMCID: PMC7428531 DOI: 10.1161/jaha.119.015316] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Hypertrophic cardiomyopathy is caused by pathogenic sarcomere gene variants. Individuals with a thin‐filament variant present with milder hypertrophy than carriers of thick‐filament variants, although prognosis is poorer. Herein, we defined if decreased energetic status of the heart is an early pathomechanism in TNNT2 (troponin T gene) variant carriers. Methods and Results Fourteen individuals with TNNT2 variants (genotype positive), without left ventricular hypertrophy (G+/LVH−; n=6) and with LVH (G+/LVH+; n=8) and 14 healthy controls were included. All participants underwent cardiac magnetic resonance and [11C]‐acetate positron emission tomography imaging to assess LV myocardial oxygen consumption, contractile parameters and myocardial external efficiency. Cardiac efficiency was significantly reduced compared with controls in G+/LVH− and G+/LVH+. Lower myocardial external efficiency in G+/LVH− is explained by higher global and regional oxygen consumption compared with controls without changes in contractile parameters. Reduced myocardial external efficiency in G+/LVH+ is explained by the increase in LV mass and higher oxygen consumption. Septal oxygen consumption was significantly lower in G+/LVH+ compared with G+/LVH−. Although LV ejection fraction was higher in G+/LVH+, both systolic and diastolic strain parameters were lower compared with controls, which was most evident in the hypertrophied septal wall. Conclusions Using cardiac magnetic resonance and [11C]‐acetate positron emission tomography imaging, we show that G+/LVH− have an initial increase in oxygen consumption preceding contractile dysfunction and cardiac hypertrophy, followed by a decline in oxygen consumption in G+/LVH+. This suggests that high oxygen consumption and reduced myocardial external efficiency characterize the early gene variant–mediated disease mechanisms that may be used for early diagnosis and development of preventive treatments.
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Affiliation(s)
- Rahana Y Parbhudayal
- Department of Cardiology Amsterdam University Medical Center Amsterdam Cardiovascular Sciences Vrije Universiteit University Medical Center Amsterdam Amsterdam the Netherlands.,Department of Physiology Amsterdam University Medical Center Amsterdam Cardiovascular Sciences Vrije Universiteit University Medical Center Amsterdam Amsterdam the Netherlands.,The Netherlands Heart Institute Utrecht the Netherlands
| | - Hendrik J Harms
- Department of Nuclear Medicine and PET Center Aarhus University Aarhus Denmark
| | - Michelle Michels
- Department of Cardiology Erasmus Medical Center Rotterdam the Netherlands
| | - Albert C van Rossum
- Department of Cardiology Amsterdam University Medical Center Amsterdam Cardiovascular Sciences Vrije Universiteit University Medical Center Amsterdam Amsterdam the Netherlands
| | - Tjeerd Germans
- Department of Cardiology Amsterdam University Medical Center Amsterdam Cardiovascular Sciences Vrije Universiteit University Medical Center Amsterdam Amsterdam the Netherlands
| | - Jolanda van der Velden
- Department of Physiology Amsterdam University Medical Center Amsterdam Cardiovascular Sciences Vrije Universiteit University Medical Center Amsterdam Amsterdam the Netherlands.,The Netherlands Heart Institute Utrecht the Netherlands
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56
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miR-21 and NT-proBNP Correlate with Echocardiographic Parameters of Atrial Dysfunction and Predict Atrial Fibrillation. J Clin Med 2020; 9:jcm9041118. [PMID: 32295105 PMCID: PMC7230176 DOI: 10.3390/jcm9041118] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 12/21/2022] Open
Abstract
This study aimed to investigate the association of circulating biomarkers with echocardiographic parameters of atrial remodelling and their potential for predicting atrial fibrillation (AF). In patients with and without AF (n = 21 and n = 60) the following serum biomarkers were determined: soluble ST2 (sST2), Galectin-3 (Gal-3), N-terminal pro-brain natriuretic peptide (NT-proBNP), microRNA (miR)-21, -29a, -133a, -146b and -328. Comprehensive transthoracic echocardiography was performed in all participants. Biomarkers were significantly altered in patients with AF. The echocardiographic parameter septal PA-TDI, indicating left atrial (LA) remodelling, correlated with concentrations of sST2 (r = 0.249, p = 0.048), miR-21 (r = -0.277, p = 0.012), miR-29a (r = -0.269, p = 0.015), miR-146b (r = -0.319, p = 0.004) and miR-328 (r = -0.296, p = 0.008). In particular, NT-proBNP showed a strong correlation with echocardiographic markers of LA remodelling and dysfunction (septal PA-TDI: r = 0.444, p < 0.001, LAVI/a': r = 0.457, p = 0.001, SRa: r = 0.581, p < 0.001). Multivariate Cox regressions analysis highlighted miR-21 and NT-proBNP as predictive markers for AF (miR-21: hazard ratio (HR) 0.16; 95% confidence interval (CI) 0.04-0.7, p = 0.009; NT-proBNP: HR 1.002 95%CI 1.001-1.004, p = 0.006). Combination of NT-proBNP and miR-21 had the best accuracy to discriminate patients with AF from those without AF (area under the curve (AUC)= 0.843). Our findings indicate that miR-21 and NT-proBNP correlate with echocardiographic parameters of atrial remodeling and predict AF, in particular if combined.
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57
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Aguiar MO, Tavares BG, Tsutsui JM, Fava AM, Borges BC, Oliveira MT, Soeiro A, Nicolau JC, Ribeiro HB, Chiang HP, Sbano JC, Goldsweig A, Rochitte CE, Lopes BB, Ramirez JA, Kalil Filho R, Porter TR, Mathias W. Sonothrombolysis Improves Myocardial Dynamics and Microvascular Obstruction Preventing Left Ventricular Remodeling in Patients With ST Elevation Myocardial Infarction. Circ Cardiovasc Imaging 2020; 13:e009536. [DOI: 10.1161/circimaging.119.009536] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Background:
It has recently been demonstrated that high-energy diagnostic transthoracic ultrasound and intravenous microbubbles dissolve thrombi (sonothrombolysis) and increase angiographic recanalization rates in patients with ST-segment–elevation myocardial infarction. We aimed to study the effect of sonothrombolysis on the myocardial dynamics and infarct size obtained by real-time myocardial perfusion echocardiography and their value in preventing left ventricular remodeling.
Methods:
One hundred patients with ST-segment–elevation myocardial infarction were randomized to therapy (50 patients treated with sonothrombolysis and percutaneous coronary intervention) or control (50 patients treated with percutaneous coronary intervention only). Left ventricular volumes, ejection fraction, risk area (before treatment), myocardial perfusion defect over time (infarct size), and global longitudinal strain were determined by quantitative real-time myocardial perfusion echocardiography and speckle tracking echocardiography imaging.
Results:
Risk area was similar in the control and therapy groups (19.2±10.1% versus 20.7±8.9%;
P
=0.56) before treatment. The therapy group presented a behavior significantly different than control group over time (
P
<0.001). The perfusion defect was smaller in the therapy at 48 to 72 hours even in the subgroup of patients with no recanalization at first angiography (12.9±6.5% therapy versus 18.8±9.9% control;
P
=0.015). The left ventricular global longitudinal strain was higher in the therapy than control immediately after percutaneous coronary intervention (14.1±4.1% versus 12.0±3.3%;
P
=0.012), and this difference was maintained until 6 months (17.1±3.5% versus 13.6±3.6%;
P
<0.001). The only predictor of left ventricular remodeling was treatment with sonothrombolysis: the control group was more likely to exhibit left ventricular remodeling with an odds ratio of 2.79 ([95% CI, 0.13–6.86];
P
=0.026).
Conclusions:
Sonothrombolysis reduces microvascular obstruction and improves myocardial dynamics in patients with ST-segment–elevation myocardial infarction and is an independent predictor of left ventricular remodeling over time.
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Affiliation(s)
- Miguel O.D. Aguiar
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Bruno G. Tavares
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Jeane M. Tsutsui
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Agostina M. Fava
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Bruno C. Borges
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Mucio T. Oliveira
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Alexandre Soeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Jose C. Nicolau
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Henrique B. Ribeiro
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Hsu P. Chiang
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - João C.N. Sbano
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
| | - Andrew Goldsweig
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Carlos E. Rochitte
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Bernardo B.C. Lopes
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - José A.F. Ramirez
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Roberto Kalil Filho
- Heart Institute (InCor)- University of São Paulo Medical School, Brazil (B.C.B., M.T.O., A.S., J.C.N., H.B.R., C.E.R., B.B.C.L., J.A.F.R., R.K.F.)
| | - Thomas R. Porter
- University of Nebraska Medical Center, Omaha (A.M.F., A.G., T.R.P.)
| | - Wilson Mathias
- Heart Institute (InCor), University of São Paulo Medical School and Fleury Group, Brazil (M.O.D.A., B.G.T., J.M.T., H.P.C., J.C.N.S., W.M.)
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58
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Wang Y, Zhou T, Zhang Q, Fei Y, Li Z, Li S, He L, Zhang Q, Dong Y, Fan Y, Wang N. Poor Renal and Cardiovascular Outcomes in Patients with Biopsy-Proven Diabetic Nephropathy. Kidney Blood Press Res 2020; 45:378-390. [PMID: 32209792 DOI: 10.1159/000505919] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 01/13/2020] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Despite the high mortality of cardiovascular disease (CVD) in diabetic patients with renal injury, few studies have compared cardiovascular characteristics and outcomes between patients with diabetic nephropathy (DN) and non-diabetic renal disease (NDRD). METHODS A total of 326 type 2 diabetes mellitus patients with renal biopsy were assigned to DN and NDRD groups. Echocardiography and Doppler ultrasound were performed to evaluate left ventricular hypertrophy (LVH) and peripheral atherosclerosis disease (PAD). Renal and cardiovascular survival rates were compared between the DN and NDRD groups by Kaplan-Meier analysis. Risk factors for renal and cardiovascular events in DN patients were identified by a Cox proportional hazards model. RESULTS In total, 179 patients entered the DN group (54.9%) and 147 made up the NDRD group (45.1%). The presence of diabetic retinopathy, family history of diabetes, and dependence on insulin therapy were associated with the presence of DN. DN patients had more CVD with more severe LVH and PAD. Poorer renal (log-rank χ2 = 26.534, p < 0.001) and cardiovascular (log-rank χ2 = 16.257, p < 0.001) prognoses were seen in the DN group. DR (HR 1.539, 95% CI 1.332-1.842), eGFR (HR 0.943, 95% CI 0.919-0.961), and 24-h proteinuria (HR 1.211, 95% CI 1.132-1.387) were identified as risk factors for renal endpoints. Age (HR 1.672, 95% CI 1.487-1.821), HbA1C (HR 1.398, 95% CI 1.197-1.876), and 24-h proteinuria (HR 1.453, 95% CI 1.289-1.672) were associated with cardiovascular endpoints. CONCLUSION Patients with DN had more severe CVD along with poorer renal and cardiovascular prognoses than those with NDRD.
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Affiliation(s)
- Yiyun Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ting Zhou
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qiming Zhang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yang Fei
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ze Li
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Shiqi Li
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Li He
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Qunzi Zhang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yang Dong
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Ying Fan
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China,
| | - Niansong Wang
- Department of Nephrology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Tongers J, Sieweke JT, Kühn C, Napp LC, Flierl U, Röntgen P, Schmitto JD, Sedding DG, Haverich A, Bauersachs J, Schäfer A. Early Escalation of Mechanical Circulatory Support Stabilizes and Potentially Rescues Patients in Refractory Cardiogenic Shock. Circ Heart Fail 2020; 13:e005853. [DOI: 10.1161/circheartfailure.118.005853] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Limited progress has been made in the management of cardiogenic shock (CS). Morbidity and mortality of refractory CS remain high. The effects of mechanical circulatory support (MCS) are promising, although many aspects are elusive. We evaluated efficacy and safety of early combined MCS (Impella microaxial pump + venoarterial extracorporeal membrane oxygenation [VA-ECMO]) in refractory CS and aimed to determine factors for decision-making in combined MCS.
Methods and Results:
We analyzed 69 consecutive patients with refractory CS from our registry requiring combined MCS. In 12 cases, therapy was actively withdrawn according to patient’s will. Patients were severely sick (Survival After Venoarterial ECMO score mean±SD, –8.9±4.4) predicting 30% in-hospital survival; ventilation 94%, dialysis 56%. Impella pumps and VA-ECMO were combined early (duration of combined MCS: median 94 hours; interquartile range, 49–150 hours). Early MCS escalation stabilized patients rapidly, reducing number and doses of catecholamines (
P
<0.05 versus baseline) while hemodynamics improved. Reflecting an improved microcirculation, lactate levels normalized within 24 hours (
P
<0.05 versus baseline). Despite refractory CS and disease severity, survival was favorable (on MCS 61%, 30 days 49%, 6 months 40%). In multivariate Cox-regression, duration of shock-to-first device (hours, hazard ratio, 1.05 [95% CI, 1.01–1.08];
P
=0.007) and lactate levels after 12 hours of MCS (hazard ratio, 1.28 [95% CI, 1.09–1.51];
P
=0.002) independently predicted survival. Additional right ventricular failure predisposed to futility (hazard ratio, 8.48 [95% CI, 1.85–38.91];
P
=0.006).
Conclusions:
The early and consequent combination of MCS by Impella microaxial pumps and VA-ECMO enables stabilization and may rescue high-risk patients with refractory CS at low overall risk. Independent predictors of survival may guide prognostication, decision-making, and allocation of medical resources.
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Affiliation(s)
- Jörn Tongers
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Jan-Thorben Sieweke
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Christian Kühn
- Cardiothoracic, Transplantation and Vascular Surgery (C.K., J.D.S., A.H.), Hannover Medical School, Germany
| | - L. Christian Napp
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Ulrike Flierl
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Philipp Röntgen
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Jan D. Schmitto
- Cardiothoracic, Transplantation and Vascular Surgery (C.K., J.D.S., A.H.), Hannover Medical School, Germany
| | - Daniel G. Sedding
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany (D.G.S.)
| | - Axel Haverich
- Cardiothoracic, Transplantation and Vascular Surgery (C.K., J.D.S., A.H.), Hannover Medical School, Germany
| | - Johann Bauersachs
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
| | - Andreas Schäfer
- Departments of Cardiology and Angiology (J.T., J.-T.S., L.C.N., U.F., P.R., J.B., A.S.), Hannover Medical School, Germany
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60
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Succurro E, Pedace E, Andreozzi F, Papa A, Vizza P, Fiorentino TV, Perticone F, Veltri P, Cascini GL, Sesti G. Reduction in Global Myocardial Glucose Metabolism in Subjects With 1-Hour Postload Hyperglycemia and Impaired Glucose Tolerance. Diabetes Care 2020; 43:669-676. [PMID: 31974102 DOI: 10.2337/dc19-1975] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Impaired insulin-stimulated myocardial glucose uptake has occurred in patients with type 2 diabetes with or without coronary artery disease. Whether cardiac insulin resistance is present remains uncertain in subjects at risk for type 2 diabetes, such as individuals with impaired glucose tolerance (IGT) or those with normal glucose tolerance (NGT) and 1-h postload glucose ≥155 mg/dL during an oral glucose tolerance test (NGT 1-h high). This issue was examined in this study. RESEARCH DESIGN AND METHODS The myocardial metabolic rate of glucose (MRGlu) was measured by using dynamic 18F-fluorodeoxyglucose positron emission tomography combined with a euglycemic-hyperinsulinemic clamp in 30 volunteers without coronary artery disease. Three groups were studied: 1) those with 1-h postload glucose <155 mg/dL (NGT 1-h low) (n = 10), 2) those with NGT 1-h high (n = 10), 3) and those with IGT (n = 10). RESULTS After adjusting for age, sex, and BMI, both subjects with NGT 1-h high (23.7 ± 6.4 mmol/min/100 mg; P = 0.024) and those with IGT (16.4 ± 6.0 mmol/min/100 mg; P < 0.0001) exhibited a significant reduction in global myocardial MRGlu; this value was 32.8 ± 9.7 mmol/min/100 mg in subjects with NGT 1-h low. Univariate correlations showed that MRGlu was positively correlated with insulin-stimulated whole-body glucose disposal (r = 0.441; P = 0.019) and negatively correlated with 1-h (r = -0.422; P = 0.025) and 2-h (r = -0.374; P = 0.05) postload glucose levels, but not with fasting glucose. CONCLUSIONS This study shows that myocardial insulin resistance is an early defect that is already detectable in individuals with dysglycemic conditions associated with an increased risk of type 2 diabetes, such as IGT and NGT 1-h high.
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Affiliation(s)
- Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elisabetta Pedace
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Annalisa Papa
- Nuclear Medicine Unit, AOU Mater Domini, Catanzaro, Italy
| | - Patrizia Vizza
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Teresa Vanessa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Pierangelo Veltri
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Lucio Cascini
- Department of Experimental and Clinical Medicine, Magna Graecia University of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University of Rome-Sapienza, Rome, Italy
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Szabó Z, Ujvárosy D, Ötvös T, Sebestyén V, Nánási PP. Handling of Ventricular Fibrillation in the Emergency Setting. Front Pharmacol 2020; 10:1640. [PMID: 32140103 PMCID: PMC7043313 DOI: 10.3389/fphar.2019.01640] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/16/2019] [Indexed: 12/11/2022] Open
Abstract
Ventricular fibrillation (VF) and sudden cardiac death (SCD) are predominantly caused by channelopathies and cardiomyopathies in youngsters and coronary heart disease in the elderly. Temporary factors, e.g., electrolyte imbalance, drug interactions, and substance abuses may play an additive role in arrhythmogenesis. Ectopic automaticity, triggered activity, and reentry mechanisms are known as important electrophysiological substrates for VF determining the antiarrhythmic therapies at the same time. Emergency need for electrical cardioversion is supported by the fact that every minute without defibrillation decreases survival rates by approximately 7%–10%. Thus, early defibrillation is an essential part of antiarrhythmic emergency management. Drug therapy has its relevance rather in the prevention of sudden cardiac death, where early recognition and treatment of the underlying disease has significant importance. Cardioprotective and antiarrhythmic effects of beta blockers in patients predisposed to sudden cardiac death were highlighted in numerous studies, hence nowadays these drugs are considered to be the cornerstones of the prevention and treatment of life-threatening ventricular arrhythmias. Nevertheless, other medical therapies have not been proven to be useful in the prevention of VF. Although amiodarone has shown positive results occasionally, this was not demonstrated to be consistent. Furthermore, the potential proarrhythmic effects of drugs may also limit their applicability. Based on these unfavorable observations we highlight the importance of arrhythmia prevention, where echocardiography, electrocardiography and laboratory testing play a significant role even in the emergency setting. In the following we provide a summary on the latest developments on cardiopulmonary resuscitation, and the evaluation and preventive treatment possibilities of patients with increased susceptibility to VF and SCD.
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Affiliation(s)
- Zoltán Szabó
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Dóra Ujvárosy
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Tamás Ötvös
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Veronika Sebestyén
- Department of Emergency Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Doctoral School of Health Sciences, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Péter P Nánási
- Department of Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.,Department of Dental Physiology, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
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63
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Zhu R, Li W, Xia L, Yang X, Zhang B, Liu F, Ma J, Hu Z, Li Y, Li D, Jiang J, He Y, Shan G. Hand grip strength is associated with cardiopulmonary function in Chinese adults: Results from a cross-sectional study. J Exerc Sci Fit 2019; 18:57-61. [PMID: 31889964 PMCID: PMC6933200 DOI: 10.1016/j.jesf.2019.12.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 12/08/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022] Open
Abstract
Background The objective of this population-based study was to examine whether there was association of hand grip strength (HGS) with cardiopulmonary function in population without cardiopulmonary disease. Methods Data were derived from an ongoing cross-sectional survey of the National Physique and Health in Shanxi Province. There were 908 participants with the cardiac function tests and 380 participants with the pulmonary function tests. Multiple linear regression analysis was used to assess the association of HGS with cardiopulmonary function. Results Among participants with the cardiac function tests, HGS was positively associated with left ventricular end diastolic diameter in both genders (male: b = 0.010 (0.005, 0.015), P < 0.001; female: b = 0.008 (0.002, 0.014), P = 0.01) and left ventricular ejection fraction in males (b = 0.114 (0.027, 0.201), P = 0.01). Among participants with the pulmonary function tests, HGS was positively associated with vital capacity (male: b = 0.033 (0.021, 0.045); female: b = 0.033 (0.021, 0.045)), forced expiratory volume in 1 s (male: b = 0.023 (0.014, 0.032); female: b = 0.019 (0.010, 0.028)) and maximal voluntary ventilation (male: b = 1.186 (0.665, 1.708); female: b = 0.965 (0.453, 1.476)) in both genders (all P < 0.001). Conclusions These results suggested that greater HGS was associated with favorable cardiopulmonary function in Chinese adults, thus HGS might be an indicator of cardiopulmonary function.
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Affiliation(s)
- Rong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10, Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Wei Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10, Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Lili Xia
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10, Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Xinghua Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10, Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Biao Zhang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 3, Dongdan, Dongcheng District, Beijing, 100005, China
| | - Feng Liu
- Shanxi Provincial Disease Prevention and Control Center, No. 3, Building East Street, Beilin District, Xi'an, Shaanxi, 710054, China
| | - Jingang Ma
- Shanxi Provincial Disease Prevention and Control Center, No. 3, Building East Street, Beilin District, Xi'an, Shaanxi, 710054, China
| | - Zhiping Hu
- Shanxi Provincial Disease Prevention and Control Center, No. 3, Building East Street, Beilin District, Xi'an, Shaanxi, 710054, China
| | - Yajun Li
- Shanxi Provincial Disease Prevention and Control Center, No. 3, Building East Street, Beilin District, Xi'an, Shaanxi, 710054, China
| | - Dongxue Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10, Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Jiajia Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10, Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10, Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China.,Municipal Key Laboratory of Clinical Epidemiology, Beijing, China
| | - Guangliang Shan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences, No. 3, Dongdan, Dongcheng District, Beijing, 100005, China
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Aldaas OM, Igata S, Raisinghani A, Kraushaar M, DeMaria AN. Accuracy of left ventricular ejection fraction determined by automated analysis of handheld echocardiograms: A comparison of experienced and novice examiners. Echocardiography 2019; 36:2145-2151. [DOI: 10.1111/echo.14546] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 12/12/2022] Open
Affiliation(s)
- Omar M. Aldaas
- Division of Cardiology at the University of California San Diego Health System San Diego California
| | - Sachiyo Igata
- Division of Cardiology at the University of California San Diego Health System San Diego California
| | - Ajit Raisinghani
- Division of Cardiology at the University of California San Diego Health System San Diego California
| | - Megan Kraushaar
- Division of Cardiology at the University of California San Diego Health System San Diego California
| | - Anthony N. DeMaria
- Division of Cardiology at the University of California San Diego Health System San Diego California
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65
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Bobenko A, Schoenrath F, Knierim JH, Friede T, Verheyen N, Mehra MR, Haykowsky M, Herrmann-Lingen C, Duvinage A, Pieske-Kraigher E, Halle M, Falk V, Pieske B, Edelmann F. Exercise training in patients with a left ventricular assist device (Ex-VAD): rationale and design of a multicentre, prospective, assessor-blinded, randomized, controlled trial. Eur J Heart Fail 2019; 21:1152-1159. [PMID: 30924265 DOI: 10.1002/ejhf.1431] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 01/04/2019] [Accepted: 01/05/2019] [Indexed: 12/28/2022] Open
Abstract
AIMS Left ventricular assist device (LVAD) therapy is a promising option for patients with advanced heart failure (HF), refractory to guideline-mandated medical treatment either as a bridge to heart transplantation or as lifelong therapy. Functional capacity improves after LVAD implantation but remains reduced in patients with long-term LVAD therapy. Exercise training (ET) improves functional capacity and quality of life (QoL) in HF and may provide incremental benefits in patients supported with LVAD therapy. METHODS The primary objective of Ex-VAD is to investigate whether a 12-week supervised ET can improve peak oxygen uptake (peakVO2 ) measured by cardiopulmonary exercise testing (CPET) on an ergometer. The study is powered to demonstrate a group difference of 3 mL/min/kg in peakVO2 at week 12, with a power of 0.9 and a standard deviation of 5 mL/min/kg. After baseline assessments to determine whether ET is safe, 66 patients at six trial sites with advanced HF and LVAD therapy will be randomized 2:1 to supervised ET or to the control arm of usual care alone. Patients randomized to ET will perform supervised aerobic endurance and resistance ET (three times/week) for 12 weeks. At baseline and during follow-up, anthropometry, CPET, echocardiography (at rest and exercise), and QoL evaluation will be performed. Blood samples will be collected to examine cardiac-specific relevant biomarkers. Overall physical activity, training sessions, and adherence will be monitored and documented throughout the study using accelerometers and patient diaries. CONCLUSIONS The Ex-VAD trial will assess the effects of a supervised ET programme on peakVO2 and QoL in patients with LVAD. As LVAD therapy moves from crisis support to ambulatory functional enhancement, this trial will provide a rationale to improve functional capacity and, in perspective, cardiovascular outcomes in LVAD-supported patients with advanced HF.
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Affiliation(s)
- Anna Bobenko
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Felix Schoenrath
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Jan H Knierim
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Nicolas Verheyen
- Department of Cardiology, Medical University of Graz, Graz, Austria
| | - Mandeep R Mehra
- Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mark Haykowsky
- College of Nursing and Health Innovation, University of Texas at Arlington, Arlington, TX, USA
| | - Christoph Herrmann-Lingen
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
- Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - André Duvinage
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | | | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, Technische Universität München, Munich, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - Volkmar Falk
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Department of Cardiothoracic Surgery, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Burkert Pieske
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- Department of Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Frank Edelmann
- Department of Internal Medicine and Cardiology, Charité University Medicine Berlin, Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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Karamnov S, Burbano-Vera N, Shook DC, Fox JA, Shernan SK. A Novel 3-Dimensional Approach for the Echocardiographic Evaluation of Mitral Valve Area After Repair for Degenerative Disease. Anesth Analg 2019; 130:300-306. [PMID: 31453871 DOI: 10.1213/ane.0000000000004379] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Currently available 2-dimensional (2D) echocardiographic methods for accurately assessing the mitral valve orifice area (MVA) after mitral valve repair (MVr) are limited due to its complex 3-dimensional (3D) geometry. We compared repaired MVAs obtained with commonly used 2D and 3D echocardiographic methods to a 3D orifice area (3DOA), which is a novel echocardiographic measurement and independent of geometric assumptions. METHODS Intraoperative 2D and 3D transesophageal echocardiography (TEE) images from 20 adult cardiac surgery patients who underwent MVr for mitral regurgitation obtained immediately after repair were retrospectively reviewed. MVAs obtained by pressure half-time (PHT), 2D planimetry (2DP), and 3D planimetry (3DP) were compared to those derived by 3DOA. RESULTS MVAs (mean value ± standard deviation [SD]) after MVr were obtained by PHT (3 ± 0.6 cm), 2DP (3.58 ± 0.75 cm), 3D planimetry (3DP; 2.78 ± 0.74 cm), and 3DOA (2.32 ± 0.76 cm). MVAs obtained by the 3DOA method were significantly smaller compared to those obtained by PHT (mean difference, 0.68 cm; P = .0003), 2DP (mean difference, 1.26 cm; P < .0001), and 3DP (mean difference, 0.46 cm; P = .003). In addition, MVA defined as an area ≤1.5 cm was identified by 3DOA in 2 patients and by 3DP in 1 patient. CONCLUSIONS Post-MVr MVAs obtained using the novel 3DOA method were significantly smaller than those obtained by conventional echocardiographic methods and may be consistent with a higher incidence of MVA reduction when compared to 2D techniques. Further studies are still needed to establish the clinical significance of 3D echocardiographic techniques used to measure MVA after MVr.
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Affiliation(s)
- Sergey Karamnov
- From the Department of Anesthesiology, Perioperative and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Brennan AP, Eskander A, Zois J, Burns AT. An Unusual Case of Shock Following an Elective Caesarean Delivery. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2019; 42:88-91. [PMID: 31324480 DOI: 10.1016/j.jogc.2019.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/13/2019] [Accepted: 03/18/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND The differential diagnosis of peripartum chest pain and cardiogenic shock is broad and includes pulmonary embolism, amniotic fluid embolism, peripartum and Takotsubo cardiomyopathy, myocardial infarction, and anaesthetic complications. CASE A 31-year-old woman with Addison's disease underwent an elective caesarean section that was complicated by chest pain and cardiogenic shock. After initial resuscitation, she was transferred to a tertiary hospital, and urgent transthoracic echocardiography revealed severe systolic dysfunction. She was treated with an increased dose of hydrocortisone and intravenous furosemide and improved. Follow-up imaging showed improvement of left ventricular systolic function. CONCLUSION In patients with cardiogenic shock after delivery, early transthoracic echocardiography is a non-invasive tool that can rapidly narrow the differential diagnosis.
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Affiliation(s)
| | - Alex Eskander
- Mercy Hospital for Women, Heidelberg, Melbourne, Australia
| | - John Zois
- Department of Anaesthesia, Northern Health Melbourne, Australia
| | - Andrew T Burns
- Department of Cardiology, St Vincent's Hospital Melbourne, Australia
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Rosenblum H, Castano A, Alvarez J, Goldsmith J, Helmke S, Maurer MS. TTR (Transthyretin) Stabilizers Are Associated With Improved Survival in Patients With TTR Cardiac Amyloidosis. Circ Heart Fail 2019; 11:e004769. [PMID: 29615436 DOI: 10.1161/circheartfailure.117.004769] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 03/01/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND TTR (transthyretin) cardiac amyloidosis is caused by dissociation of TTR into monomers, which misassemble into amyloid fibrils. TTR stabilizers act at the dimer-dimer interface to prevent dissociation. We investigated differences in survival among patients with TTR cardiac amyloidosis on stabilizer medications compared with those not on stabilizers. METHODS AND RESULTS A retrospective study of patients with TTR cardiac amyloidosis presenting to a single center was conducted. Baseline characteristics were compared between those treated with stabilizers and those not treated with stabilizers. Cox proportional hazards modeling assessed for univariate predictors of the composite outcome of death or orthotopic heart transplant (OHT). Multivariable Cox proportional hazards assessed whether stabilizer treatment was independently associated with improved death or OHT after controlling for significant univariate predictors. One hundred twenty patients (mean age, 75±8, 88% male) were included: 29 patients who received stabilizers and 91 patients who did not. Stabilizer use was associated with a lower risk of the combined end point of death or OHT (hazard ratio, 0.32; 95% confidence interval, 0.18-0.58; P<0.0001). Subjects treated with stabilizers were more likely to be of White race (93% versus 55%; P<0.001), classified as New York Heart Association classes I and II (79% versus 38%; P=0.002), less likely to have a mutation (10% versus 36%; P=0.010), have lower troponin I (median 0.06 versus 0.12 ng/mL; P=0.002), and higher left ventricular ejection fraction (49% versus 40%; P=0.011), suggesting earlier stage of disease. In multivariable Cox analysis, the association between stabilizer and death or OHT persisted when adjusted for all noncollinear univariate predictors with P<0.05 (hazard ratio, 0.37; 95% confidence interval, 0.19-0.75; P=0.003). CONCLUSIONS TTR stabilizers are associated with decreased death and OHT in TTR cardiac amyloidosis. These results need to be confirmed by ongoing randomized clinical trials.
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Affiliation(s)
- Hannah Rosenblum
- Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital
| | - Adam Castano
- Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital
| | - Julissa Alvarez
- Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital
| | - Jeff Goldsmith
- Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital
| | - Stephen Helmke
- Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital
| | - Mathew S Maurer
- Department of Medicine, Division of Cardiology, Columbia University Medical Center/New York-Presbyterian Hospital.
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Moreno Garijo J, Cypel M, McRae K, Machuca T, Cunningham V, Slinger P. The Evolving Role of Extracorporeal Membrane Oxygenation in Lung Transplantation: Implications for Anesthetic Management. J Cardiothorac Vasc Anesth 2019; 33:1995-2006. [DOI: 10.1053/j.jvca.2018.10.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Indexed: 01/09/2023]
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Fagiry MA, Hassan IA, Mahmoud MZ. Two-dimensional echocardiography in the diagnosis of ischemic heart disease. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2019. [DOI: 10.1080/16878507.2019.1594129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Affiliation(s)
- Moram A. Fagiry
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Diagnostic Radiologic Technology Department, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Ikhlas A. Hassan
- Diagnostic Radiologic Technology Department, College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Mustafa Z. Mahmoud
- Radiology and Medical Imaging Department, College of Applied Medical Sciences, Prince Sattam bin Abdulaziz University, Al-Kharj, Saudi Arabia
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Abstract
BACKGROUND Late Fontan survivors are at high risk to experience heart failure and death. Therefore, the current study sought to investigate the role of non-invasive diagnostics as prognostic markers for failure of the systemic ventricle following Fontan procedure. METHODS This monocentric, longitudinal observational study included 60 patients with a median age of 24.5 (19-29) years, who were subjected to cardiac magnetic resonance imaging, echocardiography, cardiopulmonary exercise testing, and blood analysis. The primary endpoint of this study was decompensated heart failure with symptoms at rest, peripheral and/or pulmonary edema, and/or death. RESULTS During a follow-up of 24 months, 5 patients died and 5 patients suffered from decompensated heart failure. Clinical (NYHA class, initial surgery), functional (VO2 peak, ejection fraction, cardiac index), circulating biomarkers (N-terminal pro brain natriuretic peptide), and imaging parameters (end diastolic volume index, end systolic volume index, mass-index, contractility, afterload) were significantly related to the primary endpoint. Multi-variate regression analysis identified afterload as assessed by cardiac magnetic resonance imaging as an independent predictor of the primary endpoint (hazard ratio 1.98, 95% confidence interval 1.19-3.29, p = 0.009). CONCLUSION We identified distinct parameters of cardiopulmonary exercise testing, cardiac magnetic resonance imaging, and blood testing as markers for future decompensated heart failure and death in patients with Fontan circulation. Importantly, our data also identify increased afterload as an independent predictor for increased morbidity and mortality. This parameter is easy to assess by non-invasive cardiac magnetic resonance imaging. Its modulation may represent a potential therapeutic approach target in these high-risk patients.
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Scott JM, Martin D, Ploutz-Snyder R, Downs M, Dillon EL, Sheffield-Moore M, Urban RJ, Ploutz-Snyder LL. Efficacy of Exercise and Testosterone to Mitigate Atrophic Cardiovascular Remodeling. Med Sci Sports Exerc 2019; 50:1940-1949. [PMID: 29570536 DOI: 10.1249/mss.0000000000001619] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Early and consistent evaluation of cardiac morphology and function throughout an atrophic stimulus is critically important for the design and optimization of interventions. This randomized controlled trial was designed 1) to characterize the time course of unloading-induced morphofunctional remodeling and 2) to examine the effects of exercise with and without low-dose testosterone supplementation on cardiac biomarker, structural, and functional parameters during unloading. METHODS Twenty-six subjects completed 70 d of head-down tilt bed rest (BR): 9 were randomized to exercise training (Ex), 8 to EX and low-dose testosterone (ExT), and 9 remained sedentary (CONT). Exercise consisted of high-intensity, continuous, and resistance exercise. Cardiac morphology (left ventricular mass [LVM]) and mechanics (longitudinal, radial, and circumferential strain and twist), cardiovascular biomarkers, and cardiorespiratory fitness (V˙O2peak) were assessed before, during, and after BR. RESULTS Sedentary BR resulted in a progressive decline in LVM, longitudinal, radial, and circumferential strain in CONT, whereas Ex and ExT mitigated decreases in LVM and function. Twist was increased throughout BR in sedentary BR, whereas after an initial increase at BR7, there were no further changes in twist in Ex and ExT. HDL cholesterol was significantly decreased in all groups compared with pre-BR (P < 0.007). There were no significant changes in other cardiovascular biomarkers. Change in twist was significantly related to change in V˙O2max (R = 0.68, P < 0.01). CONCLUSION An integrated approach with evaluation of cardiac morphology, mechanics, V˙O2peak, and biomarkers provides extensive phenotyping of cardiovascular atrophic remodeling. Exercise training and exercise training with low-dose testosterone supplementation abrogates atrophic remodeling.
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Ploutz-Snyder LL, Downs M, Goetchius E, Crowell B, English KL, Ploutz-Snyder R, Ryder JW, Dillon EL, Sheffield-Moore M, Scott JM. Exercise Training Mitigates Multisystem Deconditioning during Bed Rest. Med Sci Sports Exerc 2019; 50:1920-1928. [PMID: 29924746 DOI: 10.1249/mss.0000000000001618] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
INTRODUCTION This study investigated the safety and effectiveness of a new integrated aerobic and resistance exercise training prescription (SPRINT) using two different sets of exercise equipment: a suite of large International Space Station-like exercise equipment similar to what is found on the International Space Station and a single device with aerobic and resistance exercise capability in the spaceflight analog of bed rest (BR). METHODS Subjects (n = 34) completed 70 d of 6° head down tilt BR: 9 were randomized to remain sedentary (CONT), 9 to exercise training using traditional equipment (EX), 8 to exercise using traditional equipment and low-dose testosterone supplementation (ExT), and 8 to exercise using a combined resistance and aerobic flywheel device. Peak aerobic capacity, ventilatory threshold, cardiac morphology and function (echocardiography), muscle mass (magnetic resonance imaging) and strength/power (isokinetic, leg press, and vertical jump), and bone health (bone mineral density, blood and urine bone markers) were assessed before and after BR. RESULTS The SPRINT protocol mitigated BR-induced muscle and cardiac deconditioning regardless of the exercise device used. Molecular markers of bone did not change in the CONT or EX groups. Peak aerobic capacity was maintained from pre- to post-BR in all exercise groups similarly, whereas significant declines were observed in the CONT group (~10%). Significant interaction effects between the CONT group and all EX groups were observed for muscle performance including leg press total work, isokinetic upper and lower leg strength, vertical jump power, and maximal jump height as well as muscle size. CONCLUSIONS This is the first trial to evaluate multisystem deconditioning and the role of an integrated exercise countermeasure. These findings have important implications for the design and implementation of exercise-based countermeasures on future long-duration spaceflight missions.
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Affiliation(s)
| | | | | | | | | | | | | | - Edgar Lichar Dillon
- Department of Internal Medicine, University of Texas Medical Branch, Galveston, TX
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Abu-Khalaf MM, Safonov A, Stratton J, Wang S, Hatzis C, Park E, Pusztai L, Gross CP, Russell R. Examining the cost-effectiveness of baseline left ventricular function assessment among breast cancer patients undergoing anthracycline-based therapy. Breast Cancer Res Treat 2019; 176:261-270. [PMID: 31020471 DOI: 10.1007/s10549-019-05178-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 02/19/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of consensus to guide which breast cancer patients require left ventricular function assessment (LVEF) prior to anthracycline therapy; the cost-effectiveness of screening this patient population has not been previously evaluated. METHODS We performed a retrospective analysis of the Yale Nuclear Cardiology Database, including 702 patients with baseline equilibrium radionuclide angiography (ERNA) scan prior to anthracycline and/or trastuzumab therapy. We sought to examine associations between abnormal baseline LVEF and potential cardiac risk factors. Additionally, we designed a Markov model to determine the incremental cost-effectiveness ratio (ICER) of ERNA screening for women aged 55 with stage I-III breast cancer from a payer perspective over a lifetime horizon. RESULTS An abnormal LVEF was observed in 2% (n = 14) of patients. There were no significant associations on multivariate analysis performed on self-reported risk factors. Our analysis showed LVEF screening is cost-effective with ICER of $45,473 per QALY gained. For a willingness-to-pay threshold of $100,000/ QALY, LVEF screening had an 81.9% probability of being cost-effective. Under the same threshold, screening was cost-effective for non-anthracycline cardiotoxicity risk of RR ≤ 0.58, as compared to anthracycline regimens. CONCLUSIONS Age, preexisting cardiac risk factors and coronary artery disease did not predict a baseline abnormal LVEF. While the prevalence of an abnormal baseline LVEF is low in patients with breast cancer, our results suggest that cardiac screening prior to anthracycline is cost-effective.
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Affiliation(s)
- Maysa M Abu-Khalaf
- Section of Solid Tumors, Sidney Kimmel Cancer Center, Thomas Jefferson University, 1025 Walnut Street, 7th Floor, Philadelphia, PA, 19107, USA.
| | - Anton Safonov
- Hospital of University of Pennsylvania, Philadelphia, PA, USA
| | | | - Shiyi Wang
- Yale University School of Public Health, New Haven, CT, USA
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Christos Hatzis
- Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Esther Park
- Diagnostic Radiology Department, UCLA, Los Angeles, CA, USA
| | - Lajos Pusztai
- Section of Medical Oncology, Yale University School of Medicine, New Haven, CT, USA
| | - Cary P Gross
- Cancer Outcomes, Public Policy, and Effectiveness Research (COPPER) Center, Yale University School of Medicine, New Haven, CT, USA
| | - Raymond Russell
- Cardiovascular Institute of Rhode Island, Warren Alpert Medical School of Brown University, Providence, RI, USA
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WAMAMI: emergency physicians can accurately identify wall motion abnormalities in acute myocardial infarction. Am J Emerg Med 2019; 37:2224-2228. [PMID: 30987914 DOI: 10.1016/j.ajem.2019.03.037] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 03/19/2019] [Accepted: 03/25/2019] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE The ability to identify wall motion abnormalities may be useful for emergency clinicians, but is not typically evaluated in point-of-care echocardiograms. We sought to determine if emergency physicians with basic training in emergency echocardiography could identify regional wall motion abnormalities (RWMA) in patients admitted with ST-elevation myocardial infarction (STEMI). METHODS We prospectively enrolled patients with admitted with STEMI. Resident physicians with basic training in emergency ultrasound, blinded to other patient data, performed a point-of-care echocardiogram to evaluate for RWMA. If present, they also recorded the suspected territory of the RWMA. We calculated test performance characteristics and compared the agreement between point-of-care and comprehensive echocardiogram for RWMA and territory. RESULTS 75 patients with STEMI were enrolled, and 62% had a RMWA. RWMA were identified with excellent test performance characteristics (sensitivity 88% (95% CI 75-96); specificity 92% (95% CI 75-99)). There was substantial agreement between the point-of-care echocardiogram and reference standard (K = 0.79; 95% CI: 0.64-0.94). CONCLUSIONS Emergency physicians with core training in point-of-care echocardiography can accurately identify RMWA.
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van Zyl M, Witt CM, Bhatia S, Khasawneh M, Gaba P, Lenz CJ, Rosenbaum AN, Aung H, Hodge DO, McLeod CJ, Asirvatham SJ. Paced QRS morphology predicts incident left ventricular systolic dysfunction and atrial fibrillation. Indian Pacing Electrophysiol J 2019; 19:40-46. [PMID: 30858056 PMCID: PMC6450823 DOI: 10.1016/j.ipej.2019.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 02/22/2019] [Accepted: 03/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The prognostic significance of paced QRS complex morphology on surface ECG remains unclear. This study aimed to assess long-term outcomes associated with variations in the paced QRS complex. METHODS Adult patients who underwent dual-chamber pacemaker implantation with 20% or more ventricular pacing and a 12-lead ECG showing a paced complex were included. The paced QRS was analyzed in leads I and aVL. Long-term clinical and echocardiographic outcomes were compared at 5 years. RESULTS The study included 844 patients (43.1% female; age 75.0 ± 12.1). Patients with a longer paced QRS (pQRS) duration in lead I had a lower rate of atrial fibrillation (HR 0.80; p = 0.03) and higher rate of systolic dysfunction (HR 1.17; p < 0.001). Total pacing complex (TPC) duration was linked to higher rates of ICD implantation (HR 1.18; p = 0.04) and systolic dysfunction (HR 1.22, p < 0.001). Longer paced intrinsicoid deflection (pID) was associated with less atrial fibrillation (HR 0.75; p = 0.01), more systolic dysfunction (HR 1.17; p < 0.001), ICD implantation (HR 1.23; p = 0.04), and CRT upgrade (HR 1.23; p = 0.03). Exceeding thresholds for TPC, pQRS, and pID of 170, 146, and 112 ms in lead I, respectively, was associated with a substantial increase in systolic dysfunction over 5 years (p < 0.001). CONCLUSIONS Longer durations of all tested parameters in lead I were associated with increased rates of left ventricular systolic dysfunction. ICD implantation and CRT upgrade were also linked to increased TPC and pID durations. Paradoxically, patients with longer pID and pQRS had less incident atrial fibrillation.
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Affiliation(s)
- Martin van Zyl
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Chance M Witt
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Subir Bhatia
- Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA
| | - Majd Khasawneh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Prakriti Gaba
- Mayo Medical School, Mayo Clinic, Rochester, MN, USA
| | - Charles J Lenz
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Htin Aung
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - David O Hodge
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
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Roshen M, John S, Ahmet S, Amersey R, Gupta S, Collins G. Paired surveys for patients and physiologists in echocardiography: a single-centre experience. Echo Res Pract 2019; 6:1-6. [PMID: 30540562 PMCID: PMC6320332 DOI: 10.1530/erp-18-0064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 12/11/2018] [Indexed: 11/24/2022] Open
Abstract
The British Society of Echocardiography (BSE) highlights the importance of patient questionnaires as part of the quality improvement process, To this end, we implemented a novel system whereby paired surveys were completed by patients and physiologists for transthoracic echocardiography scans, allowing for parallel comparison of the experiences of service providers and end users. Anonymised questionnaires were completed for each scan by the patient and physiologist for outpatient echocardiographic scans in a teaching hospital. In 26% of the responses, patient found the scans at least slightly painful, and in 24% of scans physiologists were in discomfort. The most common reason given by physiologists for technically difficult or inadequate scans was patient discomfort. In 38% of the scans at least one person (the patient or the physiologist) was in at least some discomfort. Comparative data showed that the scans reported as most painful by patients were also reported by the physiologists as difficult and uncomfortable. In summary, these results demonstrate the feasibility of implementing paired surveys. Patient information leaflets by the BSE and National Health Service (NHS) describe echocardiography as painless but the results here indicate this is not always the case.
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78
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Parbhudayal RY, Güçlü A, Zweerink A, Biesbroek PS, Croisille P, Clarysse P, Michels M, Stooker W, Vonk ABA, van der Ven PM, van Rossum AC, van der Velden J, Nijveldt R. Myocardial adaptation after surgical therapy differs for aortic valve stenosis and hypertrophic obstructive cardiomyopathy. Int J Cardiovasc Imaging 2019; 35:1089-1100. [PMID: 30825136 PMCID: PMC6534665 DOI: 10.1007/s10554-019-01563-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 02/12/2019] [Indexed: 11/28/2022]
Abstract
Surgical therapies in aortic valve stenosis (AVS) and hypertrophic obstructive cardiomyopathy (HOCM) aim to relief intraventricular pressure overload and improve clinical outcome. It is currently unknown to what extent myocardial adaptation concurs with restoration of intraventricular pressures, and whether this is similar in both patient groups. The aim of this study was to investigate changes in myocardial adaptation after surgical therapies for AVS and HOCM. Ten AVS and ten HOCM patients were enrolled and underwent cardiac magnetic resonance cine imaging and myocardial tagging prior to, and 4 months after aortic valve replacement (AVR) and septal myectomy, respectively. Global left ventricular (LV) analyses were derived from cine images. Circumferential strain was assessed from myocardial tagging images at the septal and lateral wall of the mid ventricle. Pressure gradients significantly decreased in both AVS and HOCM after surgery (p < 0.01), with a concomitant decrease in left atrial volume (p < 0.05) suggesting lower diastolic filling pressures. Also, LV volumes, mass and septal wall thickness decreased in both, but to a larger extent in AVS than in HOCM patients. AVR improved wall thickening (p < 0.05) and did not change systolic strain rate. Myectomy did not affect wall thickening and reduced septal systolic strain rate (p = 0.03). Both AVR and myectomy induced positive structural remodeling in line with a reduction of pressure overload. A concomitant recovery in systolic function however was found in AVR only. The systolic functional deterioration in HOCM patients seems to be inherent to myectomy and the ongoing and irreversible disease.
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Affiliation(s)
- Rahana Y Parbhudayal
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.,Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Ahmet Güçlü
- Department of Cardiology, Isala Klinieken, Zwolle, The Netherlands
| | - Alwin Zweerink
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - P Stefan Biesbroek
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Pierre Croisille
- Univ Lyon, UJM-Saint-Etienne, INSA, CNRS UMR 5520, Inserm U1206, Creatis, 42023, Sint-Etienne, France
| | - Patrick Clarysse
- Univ Lyon, INSA-Lyon, Université Claude Bernard Lyon 1, UJM-Saint Etienne, CNRS, Inserm, Creatis UMR 5220, U1206, 69621, Lyon, France
| | - Michelle Michels
- Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Wim Stooker
- Department of Cardiothoracic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
| | - Alexander B A Vonk
- Department of Cardiothoracic Surgery, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Peter M van der Ven
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, Amsterdam, The Netherlands.,The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Robin Nijveldt
- Department of Cardiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
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Seecheran NA, Maharaj A, Boodhai B, Seecheran R, Seecheran V, Persad S, Ramsaroop K, Sandy S, Giddings S, Sakhamuri S, Ali R, Motilal S, Teelucksingh S, Tello-Montoliu A. Prevalence of clOpidogrel 'resIstaNce' in a selected population of patients undergoing elective percutaneous coronary intervention at a tertiary cardiovascular centre in Trinidad: the POINT pilot study. Open Heart 2019; 6:e000841. [PMID: 30997117 PMCID: PMC6443217 DOI: 10.1136/openhrt-2018-000841] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 11/12/2018] [Accepted: 01/20/2019] [Indexed: 11/03/2022] Open
Abstract
Objectives This novel, pilot study aimed to assess the estimated prevalence of high on-treatment platelet reactivity (HPR) in Trinidad and Tobago. Methods Patients (n=40) who were awaiting elective percutaneous coronary intervention on maintenance dual antiplatelet therapy (DAPT) with aspirin 81 mg daily and clopidogrel 75 mg or loaded at least 48 hours prior were recruited. Platelet reactivity with the VerifyNow P2Y12 assay (Accriva Diagnostics, San Diego, California, USA) was assessed prior to cardiac catheterisation. Results 60.7% (17/28) of the South Asian (Indo-Trinidadians) patients had HPR, whereas 14.3% (1/7) of Africans and 40% (2/5) of mixed ethnicity had HPR. There was a significant association between HPR (P2Y12 reaction units >208) and ethnicity with South Asians (Indo-Trinidadians) (OR 5.4; 95% CI 1.18 to 24.66, p=0.029). Conclusions This pilot study serves to introduce the preliminary observation that the estimated prevalence of HPR is considerably higher within the heterogeneous population in Trinidad at 50% as compared with predominantly Caucasian studies. Furthermore, the HPR is significantly higher in South Asians (Indo-Trinidadians) (>60% of patients) which has severe clinical repercussions considering the cardiovascular disease pandemic. Clopidogrel may not be a satisfactory or optimal antiplatelet agent in this subgroup, and therefore, another more potent antiplatelet such as ticagrelor should be used instead. Further large-scale studies are imperative to confirm these findings. (Funded by the University of the West Indies, St. Augustine; POINT ClinicalTrials.gov number, NCT03667066.).
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Affiliation(s)
- Naveen Anand Seecheran
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Aarti Maharaj
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Brent Boodhai
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Rajeev Seecheran
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Valmiki Seecheran
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Sangeeta Persad
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Koomatie Ramsaroop
- Department of Medicine, North Central Regional Health Authority, Champ Fleurs, Trinidad and Tobago
| | - Sherry Sandy
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Stanley Giddings
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Sateesh Sakhamuri
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Ronan Ali
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Shastri Motilal
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
| | - Surujpal Teelucksingh
- Clinical Medical Sciences, University of the West Indies at Saint Augustine Faculty of Medical Sciences, Saint Augustine, Trinidad and Tobago
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Fonseca R, Jose K, Marwick TH. Understanding decision-making in cardiac imaging: determinants of appropriate use. Eur Heart J Cardiovasc Imaging 2019; 19:262-268. [PMID: 29206942 DOI: 10.1093/ehjci/jex257] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/27/2017] [Indexed: 11/14/2022] Open
Abstract
Aims Appropriate Use Criteria (AUC) for echocardiography were developed in 2007 to facilitate decision-making, reduce variability in test utilization, and encourage rational use of imaging. However, there is little evidence that the AUC have favourably influenced ordering behaviour. This study explores the factors that contribute to clinicians requesting echocardiograms with a focus on appropriate use. Methods and results Semi-structured face-to-face interviews with cardiologists and non-cardiologists who had requested echocardiograms were conducted at an Australian tertiary hospital. The interview guide included hypothetical clinical scenarios to better understand decision-making in ordering echocardiograms and the actions they could take when receiving test reports. Interviews underwent thematic analysis. Seventeen clinicians were interviewed, ten of whom were cardiologists. All participants ordered echocardiograms to support their clinical decision-making. Awareness of the AUC was low. The categorization of tests as 'appropriate' or 'inappropriate' was considered ineffective as it failed to reflect the decision-making process. The decision to request echocardiograms was influenced by a number of personal and systemic factors as well as guidelines and protocols. Training and experience, patients' expectations, and management of uncertainty were key personal factors. Systemic factors involved the accessibility of services and health insurance status of the patient. Conclusion Factors that influenced the ordering of echocardiograms by clinicians at a tertiary care hospital did not appear to be amenable to control with AUC. Alternative approaches may be more effective than the AUC in addressing the overuse of echocardiography.
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Affiliation(s)
- Ricardo Fonseca
- Cardiovascular Imaging group, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Kim Jose
- Cardiovascular Imaging group, Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, Tasmania 7000, Australia
| | - Thomas H Marwick
- Cardiovascular Imaging group, Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, Victoria 3004, Australia
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The clinical utility of baseline cardiac assessments prior to adjuvant anthracycline chemotherapy in breast cancer: a systematic review and meta-analysis. Breast Cancer Res Treat 2019; 174:357-363. [PMID: 30603999 DOI: 10.1007/s10549-018-05114-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 12/20/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cardiac assessment with multi-gated acquisition scan (MUGA) or echocardiography (ECHO) is commonly employed prior to adjuvant anthracycline-based chemotherapy (AA). However, the clinical utility of routine baseline cardiac assessments prior to AA for early-stage breast cancer (EBC) is unknown. OBJECTIVES To determine: (i) the clinical utility of routine baseline cardiac assessments prior to AA for EBC and (ii) identify patients in whom baseline cardiac assessments may not be warranted. METHODS A systematic review of the literature was conducted to identify all relevant studies that met predefined criteria. The clinical utility was defined by: (i) the rates of abnormal baseline left ventricular ejection fraction (LVEF) and (ii) the rates of change in chemotherapy decisions prompted by baseline LVEF results. RESULTS Eight studies met our criteria, of whom six (n = 2545) reported rates of abnormal LVEF and six (n = 1713) reported rates of change in chemotherapy decision. Overall, 2.5% (95% CI 2.0-4.0%) of patients had abnormal baseline LVEF and 1.6% (95% CI 1.0-3.0%) had a change in chemotherapy decision. In subset analyses, the underlying imaging modality (ECHO vs. MUGA) or inclusion of patients with metastatic disease (YES vs. NO) did not significantly affect these rates. There were no consistently identified underlying predictors of abnormal baseline LVEF across studies. CONCLUSIONS Routine baseline cardiac assessments prior to AA in all EBC patients have low yield and infrequently affect clinical management. Future studies should further examine potential predictors of abnormal cardiac functions in an attempt to identify low risk patients in whom routine baseline LVEF assessment may not be warranted and prevent delay in chemotherapy administration.
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Peddi P, Master SR, Dwary AD, Ravipati HP, Patel AH, Pasam A, Katikaneni PK, Shi R, Burton GV, Chu QD. Utility of routine pretreatment evaluation of left ventricular ejection fraction in breast cancer patients receiving anthracyclines. Breast J 2019; 25:62-68. [DOI: 10.1111/tbj.13182] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 06/09/2018] [Accepted: 06/18/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Prakash Peddi
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Samip R. Master
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Ashish D. Dwary
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Hari P. Ravipati
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Abhishek H. Patel
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Avinash Pasam
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Pavan K. Katikaneni
- Department of Medicine Division of Cardiology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Runhua Shi
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Gary V. Burton
- Department of Medicine Division of Hematology and Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
| | - Quyen D. Chu
- Department of Surgery Division of Surgical Oncology Louisiana State University Health Science Center‐Shreveport Shreveport Louisiana
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Lima JBD, Silveira ADD, Saffi MAL, Menezes MG, Piardi DS, Ramm LDCR, Zanini M, Stein RMNR. Vasodilation and Reduction of Systolic Blood Pressure after One Session of High-Intensity Interval Training in Patients With Heart Failure with Preserved Ejection Fraction. Arq Bras Cardiol 2018; 111:699-707. [PMID: 30365604 PMCID: PMC6248251 DOI: 10.5935/abc.20180202] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Accepted: 05/23/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Heart failure with preserved ejection fraction (HFpEF) is a multifactorial syndrome characterized by a limited exercising capacity. High-intensity interval training (HIIT) is an emerging strategy for exercise rehabilitation in different settings. In patients with HFpEF, HIIT subacute effects on endothelial function and blood pressure are still unknown. OBJECTIVE To evaluate the subacute effect of one HIIT session on endothelial function and blood pressure in patients with HFpEF. METHODS Sixteen patients with HFpEF underwent a 36-minute session of HIIT on a treadmill, alternating four minutes of high-intensity intervals with three minutes of active recovery. Brachial artery diameter, flow-mediated dilation, and blood pressure were assessed immediately before and 30 minutes after the HIIT session. In all analyses, p <0.05 was considered statistically significant. RESULTS There was an increase in brachial artery diameter (pre-exercise: 3.96 ± 0.57 mm; post-exercise: 4.33 ± 0.69 mm; p < 0.01) and a decrease in systolic blood pressure (pre-exercise: 138 ± 21 mmHg; post-exercise: 125 ± 20 mmHg; p < 0.01). Flow-mediated dilation (pre-exercise: 5.91 ± 5.20%; post-exercise: 3.55 ± 6.59%; p = 0.162) and diastolic blood pressure (pre-exercise: 81 ± 11 mmHg; post-exercise: 77 ± 8 mmHg; p = 1.000) did not change significantly. There were no adverse events throughout the experiment. CONCLUSIONS One single HIIT session promoted an increase in brachial artery diameter and reduction in systolic blood pressure, but it did not change flow-mediated dilation and diastolic blood pressure.
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Affiliation(s)
- Juliana Beust de Lima
- Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | | | | | - Márcio Garcia Menezes
- Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | - Diogo Silva Piardi
- Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
| | | | - Maurice Zanini
- Hospital de Clínicas de Porto Alegre - Universidade Federal do Rio Grande do Sul, Porto Alegre, RS - Brazil
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Purza R, Wąsowicz M, Moreno Garijo J. Esophageal Perforation After Transesophageal Echocardiography During Cardiac Surgery and Delayed Diagnosis. J Cardiothorac Vasc Anesth 2018; 33:587-588. [PMID: 30297260 DOI: 10.1053/j.jvca.2018.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Razvan Purza
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Marcin Wąsowicz
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
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85
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Moya L, Moreno J, Lombo M, Guerrero C, Aristizábal D, Vera A, Melgarejo E, Conta J, Gómez C, Valenzuela D, Ángel M, Achury H, Duque R, Triana Á, Gelves J, Pinzón A, Caicedo A, Cuéllar C, Sandoval J, Pérez J, Rico-Mendoza A, Porras-Ramírez A. Consenso de expertos sobre el manejo clínico de la hipertensión arterial en Colombia. Sociedad Colombiana de Cardiología y Cirugía. REVISTA COLOMBIANA DE CARDIOLOGÍA 2018. [DOI: 10.1016/j.rccar.2018.09.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
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86
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Augenstein JA, Deen J, Thomas A, Moser E, Stone K, Reid J, Burns R. Pediatric Emergency Medicine Simulation Curriculum: Cardiac Tamponade. MEDEDPORTAL : THE JOURNAL OF TEACHING AND LEARNING RESOURCES 2018; 14:10758. [PMID: 30800958 PMCID: PMC6342367 DOI: 10.15766/mep_2374-8265.10758] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 09/01/2018] [Indexed: 05/02/2023]
Abstract
Introduction Cardiac tamponade is an uncommon presentation to the pediatric emergency department and requires early recognition and emergent intervention. Methods We developed this patient simulation case to simulate a low-frequency, high-acuity scenario for pediatric emergency medicine fellows and resident physicians in emergency medicine, pediatrics, and family medicine. We ran the case in a pediatric emergency department using a high-fidelity pediatric mannequin and equipment found in the clinical environment, including a bedside ultrasound machine. The case involved a 10-year-old patient with Hodgkin lymphoma who presented with fever, neutropenia, and shock and was found to have a pericardial effusion with tamponade after evaluation. The providers were expected to identify signs and symptoms of shock, as well as cardiac tamponade, and demonstrate appropriate emergent evaluation and management. Required personnel included a simulation technician, instructors, and a nurse. Debriefing tools tailored specifically for this scenario were created to facilitate a formal debriefing and formative learner assessment at the end of the simulation. Results This case has been implemented with 10 pediatric emergency medicine fellows during two 3-year cycles of fellow education. Session feedback reflected a high level of satisfaction with the case and an increased awareness of bedside ultrasound in the identification of cardiac tamponade. Discussion This resource for teaching the critical components for diagnosing and managing unstable cardiac tamponade in the pediatric patient, including use of bedside ultrasound, was well received by pediatric emergency medicine fellows.
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Affiliation(s)
| | - Jason Deen
- Assistant Professor, Department of Pediatrics, University of Washington School of Medicine
| | - Anita Thomas
- Assistant Professor, Department of Pediatrics, University of Washington School of Medicine
| | | | - Kimberly Stone
- Associate Professor, Department of Pediatrics, University of Washington School of Medicine
| | - Jennifer Reid
- Associate Professor, Department of Pediatrics, University of Washington School of Medicine
| | - Rebekah Burns
- Assistant Professor, Department of Pediatrics, University of Washington School of Medicine
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87
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Vallakati A, Konda B, Lenihan DJ, Baliga RR. Management of Cancer Therapeutics-Related Cardiac Dysfunction. Heart Fail Clin 2018; 14:553-567. [PMID: 30266364 DOI: 10.1016/j.hfc.2018.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Improvements in detection and treatment of cancer have resulted in a significant increase in cancer survivors. However, cancer survivorship comes with long-term risk of adverse effects of cancer therapies, including cardiomyopathy, heart failure, arrhythmias, ischemic heart disease, atherosclerosis, thrombosis, and hypertension. There is a renewed interest in understanding the pathophysiology of cancer therapeuticserelated cardiac dysfunction. In recent years, efforts have been directed to the management of cancer therapeuticserelated cardiac dysfunction. This article discusses the pathophysiology and molecular mechanisms that contribute to cancer therapeutics-related cardiac dysfunction and presents an napproach to the evaluation and treatment of these patients.
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Affiliation(s)
- Ajay Vallakati
- Division of Cardiovascular Diseases, Department of Internal Medicine, The Ohio State University, 410 West 10th, Avenue, Columbus, OH 43210, USA.
| | - Bhavana Konda
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University, A440 Starling Loving Hall, 320 West 10th Avenue, Columbus, OH 43210, USA
| | - Daniel J Lenihan
- Division of Cardiovascular Diseases, Department of Internal Medicine, Washington University, St Louis, MO 63110, USA
| | - Ragavendra R Baliga
- Division of Cardiovascular Diseases, Department of Internal Medicine, The Ohio State University, 410 West 10th, Avenue, Columbus, OH 43210, USA
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88
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Liu D, Hu K, Liebner E, Weidemann F, Herrmann S, Ertl G, Frantz S, Nordbeck P. Value of low-dose dobutamine stress echocardiography on defining true severe low gradient aortic stenosis in patients with preserved left ventricular ejection fraction. Int J Cardiovasc Imaging 2018; 34:1877-1887. [PMID: 30039338 PMCID: PMC6245091 DOI: 10.1007/s10554-018-1416-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 07/17/2018] [Indexed: 12/02/2022]
Abstract
Low-dose dobutamine stress echocardiography (DSE) is a valuable tool to distinguish true-severe (TS) from pseudo-severe (PS) low gradient aortic valve stenosis (LGAS) in patients with reduced left ventricular ejection fraction (LVEF). However, only scanty studies reported the clinical utility of DSE in differentiating TS-LGAS patients with preserved LVEF. We investigated the clinical utility of DSE in LGAS patients with preserved LVEF and the echocardiographic determinants suggestive of TS-LGAS. 130 consecutive LGAS patients [indexed aortic valve area (AVA) ≤ 0.6cm2/m2 and mean trans-aortic pressure gradient (PGmean) < 40mmHg] with preserved (≥ 50%, n = 63) and reduced (< 50%, n = 67) LVEF were included. DSE defined TS-LGAS (projected AVA ≤ 1 cm2) in 61.2% patients with reduced LVEF and in 68.3% patients with preserved LVEF. Multivariate logistic regression analysis showed that baseline AVA was an independent determinant of TS-LGAS both in LVEF ≥ 50% (OR 0.45, P = 0.004) and LVEF < 50% groups (OR 0.55, P = 0.005). Reduced septal and lateral mitral annular plane systolic excursion (MAPSE, OR 0.72 and 0.75, P = 0.013 and 0.016) and septal TDI-s´ were significantly associated with TS-LGAS in patients with LVEF ≥ 50%. Higher systolic pulmonary artery pressure (SPAP, OR 1.43, P = 0.045) was associated with TS-LGAS in patients with LVEF < 50%. DSE is useful to define TS-LGAS also in patients with preserved LVEF. Lower baseline AVA values are linked with TS-LGAS in both patients with reduced and preserved LVEF. Reduced MAPSE and septal TDI-s´ are suggestive of TS-LGAS in patients with preserved LVEF, while higher SPAP is associated with TS-LGAS in patients with reduced LVEF.
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Affiliation(s)
- Dan Liu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Kai Hu
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Eva Liebner
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - Frank Weidemann
- Medizinische Klinik I des Klinikum Vest, Recklinghausen, Germany
| | - Sebastian Herrmann
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Georg Ertl
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Stefan Frantz
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany.,Comprehensive Heart Failure Center, Würzburg, Germany
| | - Peter Nordbeck
- Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany. .,Comprehensive Heart Failure Center, Würzburg, Germany. .,Medizinische Klinik und Poliklinik I, Comprehensive Heart Failure Center, University Hospital Würzburg, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
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89
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Westphal JG, Rigopoulos AG, Bakogiannis C, Ludwig SE, Mavrogeni S, Bigalke B, Doenst T, Pauschinger M, Tschöpe C, Schulze PC, Noutsias M. The MOGE(S) classification for cardiomyopathies: current status and future outlook. Heart Fail Rev 2018; 22:743-752. [PMID: 28721466 DOI: 10.1007/s10741-017-9641-4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiomyopathies are complex diseases of multifactorial pathogenesis and have a high morbidity and mortality. Over the past decades, several revisions of classifications and definitions of cardiomyopathies have been proposed, primarily focusing on the phenotypic characterization of cardiomyopathies. The MOGE(S) classification system published in 2013 encompasses the classification of rapidly growing knowledge on genetic mutations, acquired causes (i.e., intramyocardial inflammation, viral infections), and further conditions involved in the induction of cardiomyopathies (e.g., storage diseases, toxicity). It is based on five attributes, including morphofunctional characteristics (M), organ involvement (O), genetic or familial inheritance pattern (G), etiological annotation (E), and optional information about the heart failure functional status (S). This review summarizes the development, the cornerstones of the MOGE(S) classification, and the published data on the clinical relevance of the MOGE(S) classification. We furthermore discuss new issues which might be considered for future updates of the MOGE(S) classification of cardiomyopathies.
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Affiliation(s)
- Julian G Westphal
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum, 107747, Jena, Germany
| | - Angelos G Rigopoulos
- Department of Cardiology, Leopoldina Hospital Schweinfurt, Gustav-Adolf-Strasse, 897422, Schweinfurt, Germany.,Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany
| | - Constantinos Bakogiannis
- 3rd Department of Cardiology, Ippokrateio Hospital, Aristotle University of Thessaloniki, Konstantinoupoleos, 4954642, Thessaloniki, Greece
| | - Sarah E Ludwig
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum, 107747, Jena, Germany
| | - Sophie Mavrogeni
- Onassis Cardiac Surgery Center, 50 Esperou Street, 175-61, Palaeo Faliro, Athens, Greece
| | - Boris Bigalke
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), Hindenburgdamm, 3012200, Berlin, Germany
| | - Torsten Doenst
- Department of Cardiothoracic Surgery, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany
| | - Matthias Pauschinger
- Department of Cardiology, Internal Medicine 8, Nuremberg General Hospital, Paracelsus Medical University, Nuremberg, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.,Deutsches Zentrum für Herz Kreislaufforschung (DZHK)-Standort Berlin, Charité-Universitätsmedizin Berlin, Campus Virchow Klinikum (CVK), Berlin, Germany.,Berlin Center for Regenerative Therapies (BCRT), Campus Virchow Klinikum (CVK), Berlin, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum, 107747, Jena, Germany
| | - Michel Noutsias
- Department of Internal Medicine I, Division of Cardiology, Pneumology, Angiology and Intensive Medical Care, University Hospital Jena, Friedrich-Schiller-University Jena, Am Klinikum, 107747, Jena, Germany. .,Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Ernst-Grube-Straße 40, D-06120, Halle (Saale), Germany.
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90
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Bozkurt B, Germanakis I, Stylianou Y. A study of time-frequency features for CNN-based automatic heart sound classification for pathology detection. Comput Biol Med 2018; 100:132-143. [PMID: 29990646 DOI: 10.1016/j.compbiomed.2018.06.026] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 06/24/2018] [Accepted: 06/24/2018] [Indexed: 10/28/2022]
Abstract
This study concerns the task of automatic structural heart abnormality risk detection from digital phonocardiogram (PCG) signals aiming at pediatric heart disease screening applications. Recently, various systems based on convolutional neural networks trained on time-frequency representations of segmental PCG frames have been presented that outperform systems using hand-crafted features. This study focuses on the segmentation and time-frequency representation components of the CNN-based designs. We consider the most commonly used features (MFCC and Mel-Spectrogram) used in state-of-the-art systems and a time-frequency representation influenced by domain-knowledge, namely sub-band envelopes as an alternative feature. Via tests carried on two high quality databases with a large set of possible settings, we show that sub-band envelopes are preferable to the most commonly used features and period synchronous windowing is preferable over asynchronous windowing.
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Affiliation(s)
- Baris Bozkurt
- Electrical and Electronics Engineering Department, Izmir Democracy University, Turkey.
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91
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Suzuki K, Hirano Y, Yamada H, Murata M, Daimon M, Takeuchi M, Seo Y, Izumi C, Akaishi M. Practical guidance for the implementation of stress echocardiography. J Echocardiogr 2018; 16:105-129. [PMID: 29876799 PMCID: PMC6132937 DOI: 10.1007/s12574-018-0382-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023]
Abstract
Exercise stress testing has been widely undertaken for the diagnosis of heart diseases. The accurate assessment of clinical conditions can be conducted by comparing the findings obtained from the results of stress echocardiography with the changes in the blood/heart rate and electrocardiograms. Numerous overseas studies have reported the utility of stress echocardiography in diagnosing myocardial ischemia; in Japan, the use of this modality for this purpose was included in the national health insurance reimbursable list in 2012. Nevertheless, stress echocardiography is far from being a widespread practice in Japan. This might be due to insufficient equipment (e.g., ergometers, space for test implementation) at each medical institution, shortage of technicians and sonographers who are well experienced and who are responsible for obtaining images during stress testing. The other possible reasons include the limited evidence available in Japan and the lack of a standardized testing protocol. Further dissemination of the practice of exercise stress echocardiography in this country is deemed necessary to establish satisfactory evidence for the use of stress echocardiography in the Japanese population. To this end, efforts are underway to develop a standardized protocol and report format to be adopted throughout Japan. We here present a guideline created by the Guideline Development Committee of the Japanese Society of Echocardiography that describes safe and effective stress echocardiography protocols and report formats. The readers are encouraged to perform exercise stress echocardiography using the proposed template for consensus document and report attached to this guideline.
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Affiliation(s)
- Kengo Suzuki
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Hirano
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Hirotsugu Yamada
- Department of Cardiology, Tokushima University Hospital, Tokushima, Japan
| | - Mitsushige Murata
- Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Masao Daimon
- Department of Clinical Laboratory, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chisato Izumi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Akaishi
- Tokai University Tokyo Hospital, 1-2-5 Yoyogi Shibuya-ku, Tokyo, Japan.
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92
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Billa RD, Szpunar S, Zeinali L, Anne P. Yield of Echocardiogram and Predictors of Positive Yield in Pediatric Patients: A Study in an Urban, Community-Based Outpatient Pediatric Cardiology Clinic. Glob Pediatr Health 2018; 5:2333794X18769141. [PMID: 29761136 PMCID: PMC5946345 DOI: 10.1177/2333794x18769141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 02/12/2018] [Indexed: 11/15/2022] Open
Abstract
The yield of outpatient echocardiograms varies based on the indication for the echocardiogram and the age of the patient. The purpose of this study was to determine the cumulative yield of outpatient echocardiograms by age group and reason for the test. A secondary aim was to determine the predictors of a positive echocardiogram in an outpatient cardiology clinic at a large community teaching hospital. We retrospectively reviewed the charts of 891 patients who had a first-time echocardiogram between 2011 and 2015. Positive yield was defined as echocardiographic findings that explained the reason for the echocardiogram. The overall positive yield was 8.2%. Children between birth and 3 months of age had the highest yield (34.2%), and children between 12 and 18 years of age had the lowest yield (1%). Patients with murmurs (18.1%) had the highest yield compared with patients with other signs or symptoms. By age group and reason, the highest yields were as follows: 0 to 3 months of age, murmur (39.2%); 4 to 11 months of age, >1 symptom (50%); and 1 to 5 years of age, shortness of breath (66.7%). Based on our study, the overall yield of echocardiograms in the outpatient pediatric setting is low. Age and symptoms should be considered before ordering an echocardiogram.
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Affiliation(s)
| | - Susan Szpunar
- St. John Hospital and Medical Center, Detroit, MI, USA
| | - Lida Zeinali
- UBMD Women & Children's Hospital of Buffalo, Buffalo, NY, USA
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93
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Franchi F, Cameli M, Taccone FS, Mazzetti L, Bigio E, Contorni M, Mondillo S, Scolletta S. Assessment of left ventricular ejection fraction in critically ill patients at the time of speckle tracking echocardiography: intensivists in training for echocardiography versus experienced operators. Minerva Anestesiol 2018; 84:1270-1278. [PMID: 29648414 DOI: 10.23736/s0375-9393.18.12249-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The biplane Simpson's method is considered the gold standard to assess and monitor left ventricular (LV) ejection fraction (EF) in critically ill patients. Recently, a new semi-automatic technique based on speckle tracking echocardiography called "Auto-EF" has been introduced. We compared LVEF values obtained with biplane Simpson's method and Auto-EF by two groups of operators: trainee echocardiography intensivists and experienced echocardiographers. METHODS A standard transthoracic echocardiography was performed on 37 patients. According to image quality 29 patients were selected. Each inexperienced and experienced operator executed an off-line analysis using both Simpson's method and Auto-EF. LVEF obtained by the two groups of operators were then compared. RESULTS EF values assessed with Simpson's method showed a moderate correlation (r=0.70, P<0.01) between inexperienced and experienced operators. The Bland-Altman analysis showed a mean bias of 0.3% with limits of agreement (LoA) from -24.4 to +25.1%. Values obtained with Auto-EF showed a good correlation (r=0.94, P<0.01) with a mean bias of 0.2% and LoA from -10.1 to +10.4%. CONCLUSIONS Due to its semiautomatic nature, for inexpert operators Auto-EF seems more reproducible than the traditional Simpson's method for monitoring left ventricular function in critically ill patients.
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Affiliation(s)
- Federico Franchi
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy -
| | - Matteo Cameli
- Unit of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fabio S Taccone
- Department of Intensive Care, Université Libre de Bruxelles, Erasme Hospital, Brussels, Belgium
| | - Loredana Mazzetti
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Elisa Bigio
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Martina Contorni
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Unit of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sabino Scolletta
- Unit of Intensive Care Medicine, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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94
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Boll G, Lyvers J, Chen FY, Cobey F. Functional Mitral Regurgitation After Aortic Valve Replacement for Aortic Insufficiency. J Cardiothorac Vasc Anesth 2018; 32:e89-e91. [PMID: 29573953 DOI: 10.1053/j.jvca.2018.02.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Indexed: 11/11/2022]
Affiliation(s)
- Griffin Boll
- Division of Cardiac Surgery, Tufts Medical Center, Boston, MA
| | - Jeffrey Lyvers
- Department of Anesthesiology, Duke University, Durham, NC
| | | | - Frederick Cobey
- Department of Anesthesiology, Tufts Medical Center, Boston, MA
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95
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Longo S, Palacios M, Tinti ME, Siri J, de Brahi JI, Cabrera Shulmeyer MC. Intracardiac tromboembolism during liver transplantation. ACTA ACUST UNITED AC 2018; 65:394-397. [PMID: 29571727 DOI: 10.1016/j.redar.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 01/17/2018] [Accepted: 01/19/2018] [Indexed: 11/17/2022]
Abstract
We describe a case of intraoperative cardiac trombosis during orthotopic liver transplant surgery that resulted in intraoperative death. By using transesophageal echocardiography, the cause of the descompensation of the patient could be determined and the mechanism of trombus migration from thrombi from the venous circulation to the left heart was accurately observed.
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Affiliation(s)
- S Longo
- Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina.
| | - M Palacios
- Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - M E Tinti
- Servicio de Radiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - J Siri
- Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
| | - J I de Brahi
- Servicio de Anestesiología, Hospital Privado Universitario de Córdoba, Córdoba, Argentina
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96
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97
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Han SHB, Yau C, Chin EE. Ascites Due to Constrictive Pericardial Disease Not Appreciated on Echocardiogram: A Report of Three Cases. Dig Dis Sci 2018; 63:797-802. [PMID: 29349692 DOI: 10.1007/s10620-018-4920-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 01/07/2018] [Indexed: 12/09/2022]
Affiliation(s)
- Steven-Huy B Han
- Pfleger Liver Institute, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA. .,VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
| | - Celia Yau
- Pfleger Liver Institute, David Geffen School of Medicine at UCLA, 200 UCLA Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA
| | - Eva E Chin
- VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
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98
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Dimitriadis Z, Scholtz S, Scholtz W, Wiemer M, Piper C, Ensminger S, Fox H, Horstkotte D, Faber L. Impact of procedure-related conduction disturbances after transcatheter aortic valve implantation on myocardial performance and survival evaluated by conventional and speckle tracking echocardiography. Echocardiography 2018; 35:621-631. [PMID: 29437242 DOI: 10.1111/echo.13823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES Although procedure-related new cardiac conduction disturbances (CCDs) remain an important issue in transcatheter aortic valve implantation (TAVI), their effect on myocardial function and overall patient outcome remains unclear. The goal of this study was to analyze the influence of procedure-related CCDs on systolic and diastolic LV performance and on patient survival after TAVI. METHODS AND RESULTS Ninety-five patients who underwent TAVI for severe symptomatic aortic stenosis (AS) and had a complete follow-up were evaluated with respect to procedure-related CCDs. Left ventricular (LV) performance was measured using standard echocardiographic parameters and speckle tracking analysis. Survival was assessed during longer-term follow-up (mean: 29.1 ± 16.9 months). After TAVI, the improvement of global LV function expressed as ejection fraction (LVEF; from 45.5 ± 10.0 to 47.8 ± 13.9%, P = .13) was not significant. New CCDs were found in 35.7% of TAVI recipients. A comparison between patients with and without new CCDs showed that LV systolic function improved in those without CCDs, while it tended to deteriorate in patients with CCDs (change in LVEF: 5.5 ± 12.3% vs -4.9% ± 11.5%, P = .001; change in global longitudinal strain (GLS): -1.1 ± 4.6% vs 1.2 ± 4.5%, P = .01). Changes in diastolic function did not differ significantly between the groups (changes in transmitral E/A-ratio: -0.3 ± 0.6 vs -0.5 ± 0.5, P = .1). Kaplan-Meier survival analysis revealed no significant differences between the two cohorts (P = .795). CONCLUSION Procedure-related conduction abnormalities after TAVI lead to an LBBB-related dyssynchrony with impairment of LV performance but not of overall survival.
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Affiliation(s)
- Zisis Dimitriadis
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Smita Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Werner Scholtz
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Marcus Wiemer
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Cornelia Piper
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Stephan Ensminger
- Clinic for Thoracic and Cardiovascular Surgery, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Henrik Fox
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Dieter Horstkotte
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Lothar Faber
- Clinic for Cardiology, Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
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Bergmann I, Büttner B, Teut E, Jacobshagen C, Hinz J, Quintel M, Mansur A, Roessler M. Pre-hospital transthoracic echocardiography for early identification of non-ST-elevation myocardial infarction in patients with acute coronary syndrome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:29. [PMID: 29409525 PMCID: PMC5802056 DOI: 10.1186/s13054-017-1929-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 12/21/2017] [Indexed: 12/02/2022]
Abstract
Background Non-ST elevation myocardial infarction (NSTEMI) is a common manifestation of acute coronary syndrome (ACS), but delayed diagnosis can increase mortality. In this proof of principle study, the emergency physician performed transthoracic echocardiography (TTE) on scene to determine whether NSTEMI could be correctly diagnosed pre-hospitalization. This could expedite admission to the appropriate facility and reduce the delay until initiation of correct therapy. Methods Pre-hospital TTE was performed on scene by the emergency physician in patients presenting with ACS but without ST-elevation in the initial 12-lead electrocardiography (ECG) (NSTE-ACS). A presumptive NSTEMI diagnosis was made if regional wall motion abnormalities (RWMA) were detected. These patients were admitted directly to a specialist cardiac facility. Patient characteristics and pre-admission and post-admission clinical, pre-hospital TTE data, and therapeutic measures were recorded. Results Patients with NSTE-ACS (n = 53; 72.5 ± 13.4 years of age; 23 female) were studied. The 20 patients with pre-hospital RWMA and presumptive NSTEMI, and two without RWMA were conclusively diagnosed with NSTEMI in hospital. Percutaneous coronary intervention was performed in 50% of the patients presumed to have NSTEMI immediately after admission. The RWMA seen before hospital TTE corresponded with the in-hospital ECG findings and/or the supply regions of the occluded coronary vessels seen during PCI in 85% of the cases. The diagnostic sensitivity of pre-hospital TTE for NSTEMI was 90.9% with 100% specificity. Conclusions Pre-hospital transthoracic echocardiography by the emergency physician can correctly diagnose NSTEMI in more than 90% of cases. This can expedite the initiation of appropriate therapy and could thereby conceivably reduce morbidity and mortality. Trial registration Deutsche Register klinischer Studien, DRKS00004919. Registered on 29 April 2013.
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Affiliation(s)
- Ingo Bergmann
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany.
| | - Benedikt Büttner
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Elena Teut
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Claudius Jacobshagen
- Department of Cardiology and Pneumology, University Medical Center, University of Göttingen, Göttingen, Germany
| | - José Hinz
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Michael Quintel
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Ashham Mansur
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
| | - Markus Roessler
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University Medical Center, University of Goettingen, Robert-Koch Str. 40, 37075, Göttingen, Germany
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100
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Transesophageal Echocardiography: Guidelines for Point-of-Care Applications in Cardiac Arrest Resuscitation. Ann Emerg Med 2018; 71:201-207. [DOI: 10.1016/j.annemergmed.2017.09.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/26/2017] [Accepted: 09/01/2017] [Indexed: 12/20/2022]
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