951
|
Stengl H, Ganeshan R, Hellwig S, Blaszczyk E, Fiebach JB, Nolte CH, Bauer A, Schulz-Menger J, Endres M, Scheitz JF. Cardiomyocyte Injury Following Acute Ischemic Stroke: Protocol for a Prospective Observational Cohort Study. JMIR Res Protoc 2021; 10:e24186. [PMID: 33544087 PMCID: PMC7895641 DOI: 10.2196/24186] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/30/2020] [Accepted: 12/15/2020] [Indexed: 01/01/2023] Open
Abstract
Background Elevated cardiac troponin, which indicates cardiomyocyte injury, is common after acute ischemic stroke and is associated with poor functional outcome. Myocardial injury is part of a broad spectrum of cardiac complications that may occur after acute ischemic stroke. Previous studies have shown that in most patients, the underlying mechanism of stroke-associated myocardial injury may not be a concomitant acute coronary syndrome. Evidence from animal research and clinical and neuroimaging studies suggest that functional and structural alterations in the central autonomic network leading to stress-mediated neurocardiogenic injury may be a key underlying mechanism (ie, stroke-heart syndrome). However, the exact pathophysiological cascade remains unclear, and the diagnostic and therapeutic implications are unknown. Objective The aim of this CORONA-IS (Cardiomyocyte injury following Acute Ischemic Stroke) study is to quantify autonomic dysfunction and to decipher downstream cardiac mechanisms leading to myocardial injury after acute ischemic stroke. Methods In this prospective, observational, single-center cohort study, 300 patients with acute ischemic stroke, confirmed via cerebral magnetic resonance imaging (MRI) and presenting within 48 hours of symptom onset, will be recruited during in-hospital stay. On the basis of high-sensitivity cardiac troponin levels and corresponding to the fourth universal definition of myocardial infarction, 3 groups are defined (ie, no myocardial injury [no cardiac troponin elevation], chronic myocardial injury [stable elevation], and acute myocardial injury [dynamic rise/fall pattern]). Each group will include approximately 100 patients. Study patients will receive routine diagnostic care. In addition, they will receive 3 Tesla cardiovascular MRI and transthoracic echocardiography within 5 days of symptom onset to provide myocardial tissue characterization and assess cardiac function, 20-min high-resolution electrocardiogram for analysis of cardiac autonomic function, and extensive biobanking. A follow-up for cardiovascular events will be conducted 3 and 12 months after inclusion. Results After a 4-month pilot phase, recruitment began in April 2019. We estimate a recruitment period of approximately 3 years to include 300 patients with a complete cardiovascular MRI protocol. Conclusions Stroke-associated myocardial injury is a common and relevant complication. Our study has the potential to provide a better mechanistic understanding of heart and brain interactions in the setting of acute stroke. Thus, it is essential to develop algorithms for recognizing patients at risk and to refine diagnostic and therapeutic procedures. Trial Registration Clinicaltrials.gov NCT03892226; https://www.clinicaltrials.gov/ct2/show/NCT03892226. International Registered Report Identifier (IRRID) DERR1-10.2196/24186
Collapse
Affiliation(s)
- Helena Stengl
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany
| | - Ramanan Ganeshan
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Simon Hellwig
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Edyta Blaszczyk
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Jochen B Fiebach
- Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian H Nolte
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner site Berlin, Berlin, Germany
| | - Axel Bauer
- Working group on biosignal analysis, department of Cardiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Jeanette Schulz-Menger
- German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,Working Group on Cardiovascular Magnetic Resonance, Experimental and Clinical Research Center, a Joint Cooperation Between the Charité - Universitätsmedizin Berlin, Department of Internal Medicine and Cardiology and the Max-Delbrueck Center for Molecular Medicine, and HELIOS Klinikum Berlin Buch, Department of Cardiology and Nephrology, Berlin, Germany
| | - Matthias Endres
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany.,German Center for Neurodegenerative Diseases (DZNE), Partner site Berlin, Berlin, Germany.,Excellence Cluster NeuroCure, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jan F Scheitz
- Department of Neurology, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Center for Stroke Research Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany.,Berlin Institute of Health, Berlin, Germany.,German Center for Cardiovascular Research (DZHK), partner site Berlin, Berlin, Germany
| |
Collapse
|
952
|
Atrial performance in healthy subjects following high altitude exposure at 4100 m: 2D speckle-tracking strain analysis. Int J Cardiovasc Imaging 2021; 37:1891-1902. [PMID: 33547622 PMCID: PMC8255257 DOI: 10.1007/s10554-021-02173-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/22/2021] [Indexed: 12/18/2022]
Abstract
High altitude (HA) exposure has been considered as a cardiac stress and might impair ventricular diastolic function. Atrial contraction is involved in ventricular passive filling, however the atrial performance to HA exposure is poorly understood. This study aimed to evaluate the effect of short-term HA exposure on bi-atrial function. Physiological and 2D-echocardiographic data were collected in 82 healthy men at sea level (SL, 400 m) and 4100 m after an ascent within 7 days. Atrial function was measured using volumetric and speckle-tracking analyses during reservoir, conduit and contractile phases of cardiac cycle. Following HA exposure, significant decreases of reservoir and conduit function indexes were observed in bi-atria, whereas decreases of contractile function indexes were observed in right atrium (RA), estimated via RA active emptying fraction (SL 41.7 ± 13.9% vs. HA 35.4 ± 12.2%, p = 0.001), strain during the contractile phase [SL 13.5 (11.4, 17.8) % vs. HA 12.3 (9.3, 15.9) %, p = 0.003], and peak strain rate during the contractile phase [SL − 1.76 (− 2.24, − 1.48) s−1 vs. HA − 1.57 (− 2.01, − 1.23) s−1, p = 0.002], but not in left atrium (LA). In conclusion, short-term HA exposure of healthy individuals impairs bi-atrial performance, mostly observed in RA. Especially, atrial contractile function decreases in RA rather than LA, which seems not to compensate for decreased ventricular filling after HA exposure. Our findings may provide a novel evidence for right-sided heart dysfunction to HA exposure.
Collapse
|
953
|
Jadczyk T, Kurzelowski R, Golba KS, Wilczek J, Caluori G, Maffessanti F, Biernat J, Gruszczynska K, Cybulska M, Emmert MY, Parma Z, Baranski K, Dutka M, Kalanska-Lukasik B, Starek Z, Wojakowski W. Local electromechanical alterations determine the left ventricle rotational dynamics in CRT-eligible heart failure patients. Sci Rep 2021; 11:3267. [PMID: 33547401 PMCID: PMC7865069 DOI: 10.1038/s41598-021-82793-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/24/2020] [Indexed: 12/26/2022] Open
Abstract
Left ventricle, LV wringing wall motion relies on physiological muscle fiber orientation, fibrotic status, and electromechanics (EM). The loss of proper EM activation can lead to rigid-body-type (RBT) LV rotation, which is associated with advanced heart failure (HF) and challenges in resynchronization. To describe the EM coupling and scar tissue burden with respect to rotational patterns observed on the LV in patients with ischemic heart failure with reduced ejection fraction (HFrEF) left bundle branch block (LBBB). Thirty patients with HFrEF/LBBB underwent EM analysis of the left ventricle using an invasive electro-mechanical catheter mapping system (NOGA XP, Biosense Webster). The following parameters were evaluated: rotation angle; rotation velocity; unipolar/bipolar voltage; local activation time, LAT; local electro-mechanical delay, LEMD; total electro-mechanical delay, TEMD. Patients underwent late-gadolinium enhancement cMRI when possible. The different LV rotation pattern served as sole parameter for patients’ grouping into two categories: wringing rotation (Group A, n = 6) and RBT rotation (Group B, n = 24). All parameters were aggregated into a nine segment, three sector and whole LV models, and compared at multiple scales. Segmental statistical analysis in Group B revealed significant inhomogeneities, across the LV, regarding voltage level, scar burdening, and LEMD changes: correlation analysis showed correspondently a loss of synchronization between electrical (LAT) and mechanical activation (TEMD). On contrary, Group A (relatively low number of patients) did not present significant differences in LEMD across LV segments, therefore electrical (LAT) and mechanical (TEMD) activation were well synchronized. Fibrosis burden was in general associated with areas of low voltage. The rotational behavior of LV in HF/LBBB patients is determined by the local alteration of EM coupling. These findings serve as a strong basic groundwork for a hypothesis that EM analysis may predict CRT response. Clinical trial registration: SUM No. KNW/0022/KB1/17/15.
Collapse
Affiliation(s)
- Tomasz Jadczyk
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland.,Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
| | - Radoslaw Kurzelowski
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - Krzysztof S Golba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Guido Caluori
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic.,IHU-LIRYC, Inserm U1045 (CRBCT), Bordeaux, France
| | - Francesco Maffessanti
- Center for Computational Medicine in Cardiology, Università Della Svizzera Italiana, Lugano, Switzerland
| | - Jolanta Biernat
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | | | - Magdalena Cybulska
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
| | - Maximilian Y Emmert
- Department of Cardiovascular Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany.,Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Berlin, Germany.,Institute for Regenerative Medicine (IREM), University of Zurich, Zurich, Switzerland
| | - Zofia Parma
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - Kamil Baranski
- Department of Epidemiology, Medical University of Silesia, Katowice, Poland
| | - Mieczyslaw Dutka
- Department of Biochemistry and Molecular Biology, Faculty of Health Sciences, University of Bielsko-Biala, Bielsko-Biała, Poland
| | - Barbara Kalanska-Lukasik
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland
| | - Zdenek Starek
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic.,1st Department of Internal Medicine-Cardioangiology, St. Anne's University Hospital in Brno, Brno, Czech Republic
| | - Wojciech Wojakowski
- Department of Cardiology and Structural Heart Disease, Medical University of Silesia, Ziołowa 45-47, Katowice, Poland.
| |
Collapse
|
954
|
Echocardiographic Features of Cardiomyopathy in Emery-Dreifuss Muscular Dystrophy. Cardiol Res Pract 2021; 2021:8812044. [PMID: 33614169 PMCID: PMC7878080 DOI: 10.1155/2021/8812044] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/17/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background Emery-Dreifuss muscular dystrophy (EDMD) is a very rare type of muscular dystrophy characterized by musculoskeletal abnormalities accompanied by cardiac defects. Two most common genetic subtypes are EDMD1 due to EMD and EDMD2 caused by LMNA gene mutations. The aim of the study was to characterize and compare the cardiac morphology and function in the two main genetic subgroups of EDMD with the use of echocardiography. Methods 41 patients with EDMD (29 EDMD1 and 12 EDMD2) as well as 25 healthy controls were enrolled in our study. Transthoracic echo with the use of a prescribed protocol was performed. Results Highly statistically significant differences with regard to left ventricle (LV) volumes between the EDMD and the control group were found. 51% of EDMD patients had an enlarged left atrium and as many as 71% had an enlarged right atrium. The LV ejection fraction (LVEF) was significantly lower in EDMD patients than in the control group which corresponded also with a lower systolic velocity of the mitral annulus. 43% of EDMD patients had LVEF below the normal limit. Diastolic dysfunction was detected in 17% of EDMD patients. There were no significant differences between the two types of EDMD in terms of diameters and volumes of any chamber, as well as the systolic function of both left and right ventricles. Conclusions A significant number of EDMD patients present LV dilatation and different degrees of systolic dysfunction. Dilatation of the atria dominates over ventricle dilatation. We did not present any significant differences between EDMD1 and EDMD2 in terms of the morphology and the function of the heart.
Collapse
|
955
|
Kagemoto Y, Ferrufino RA, Lyvers JT, Ortoleva J, Weintraub AR, Pandian NG, Thomas JD, Cobey FC. Tissue Doppler Imaging (E/e') and Pulmonary Capillary Wedge Pressure in Patients With Severe Aortic Stenosis. J Cardiothorac Vasc Anesth 2021; 35:1646-1653. [PMID: 33642168 DOI: 10.1053/j.jvca.2021.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Although American and European consensus statements advocate using the ratio of the transmitral E velocity and tissue Doppler early diastolic mitral annular velocity (E/e') in the assessment of left-sided heart filling pressures, recent reports have questioned the reliability of this ratio to predict left atrial pressures in a variety of disease states. The authors hypothesized that there is a clinically significant correlation between E/e' and pulmonary capillary wedge pressure (PCWP) in patients with severe aortic stenosis. DESIGN Retrospective cohort study. PARTICIPANTS The study comprised 733 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve replacement for severe aortic stenosis. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS PCWP and E/e'ave (average of the lateral and medial annulus tissue Doppler velocities) were measured with a pulmonary artery catheter and transthoracic echocardiography during preprocedural evaluation. Patients were grouped by left ventricular ejection fraction (LVEF) ≥50% and LVEF <50%. Spearman rank correlation, analysis of variance, and t and chi-square tests were used to analyze the data. Seventy-nine patients met the inclusion criteria. There was no significant correlation between E/e'ave and PCWP (n = 79, Spearman r = 0.096; p = 0.3994). This correlation did not improve when ventricular function was considered (LVEF <50%: n = 11, Spearman r = -0.097; p = 0.776 and LVEF ≥50%: n = 68, Spearman r = 0.116; p = 0.345). There was no statistically significant difference in mean PCWP between each range of E/e'ave. CONCLUSION A clinically relevant relationship between E/e' and PCWP was not observed in patients with severe aortic stenosis.
Collapse
Affiliation(s)
- Yoko Kagemoto
- Massachusetts General Hospital, Anesthesia, Critical Pain and Medicine, Boston, MA
| | - Renan A Ferrufino
- Tufts Medical Center, Anesthesiology and Perioperative Medicine, Boston, MA
| | - Jeffrey T Lyvers
- Advocate Aurora St. Luke's Hospital, Department of Anesthesia, Milwaukee, WI
| | - Jamel Ortoleva
- Tufts Medical Center, Anesthesiology and Perioperative Medicine, Boston, MA
| | - Andrew R Weintraub
- Tufts Medical Center, Department of Medicine, Division of Cardiology, Boston, MA
| | - Natesa G Pandian
- Hoag Hospital, Department of Medicine, Division of Cardiology, Newport Beach, CA
| | - James D Thomas
- Northwestern University, Department of Medicine, Division of Cardiology, Chicago, IL
| | - Frederick C Cobey
- Tufts Medical Center, Anesthesiology and Perioperative Medicine, Boston, MA.
| |
Collapse
|
956
|
Upadhyaya K, Ugonabo I, Satam K, Hull SC. Echocardiographic Evaluation of the Thoracic Aorta: Tips and Pitfalls. AORTA (STAMFORD, CONN.) 2021; 9:1-8. [PMID: 34607379 PMCID: PMC8490003 DOI: 10.1055/s-0041-1724005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
By convention, the ascending aorta is measured by echo from leading edge to leading edge. "Leading edge" connotes the edge of the aortic wall that is closest to the probe (at the top of the inverted "V" of the ultrasound image). By transthoracic echo (TTE), the leading edges are the outer anterior wall and inner posterior wall. By transesophageal echo (TEE), the leading edges are the outer posterior wall and inner anterior wall. Aortic measurements should be taken (by convention) in diastole (when the aorta is moving least). Simple TTE is 70 to 85% sensitive in diagnosing ascending aortic dissection. TEE sensitivity approaches 100%, though the tracheal carina imposes a blind spot on TEE, impeding visualization of distal ascending aorta and proximal aortic arch. While computed tomography angiography may be superior for defining full anatomic extent of aortic dissection, echocardiography is superior in assessing functional consequences such as mechanism and severity of aortic regurgitation, evidence of myocardial ischemia when complicated by coronary dissection, or evidence of tamponade physiology when pericardial effusion is present. Reverberation artifact can mimic a dissection flap. A true flap moves independently of the outer aortic wall which can be confirmed by M-mode. Color flow respects a true flap but does not respect a reverberation artifact. Assessment for bicuspid aortic valve (BAV) morphology should be done in systole, not diastole. In diastole, when the valve is closed, the raphé can make a bicuspid valve appear trileaflet. Doming in the parasternal long axis (PLAX) view and an eccentric closure line on PLAX M-mode should also raise suspicion for BAV.
Collapse
Affiliation(s)
- Krishna Upadhyaya
- Section of Cardiovascular Medicine, Columbia St. Mary's Hospital, Milwaukee, Wisconsin
| | - Ifeoma Ugonabo
- Division of Cardiovascular Diseases, University of Tennessee-Methodist, Knoxville, Tennessee
| | - Keyuree Satam
- Section of Cardiovascular Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Sarah C Hull
- Section of Cardiovascular Medicine, Columbia St. Mary's Hospital, Milwaukee, Wisconsin
| |
Collapse
|
957
|
Antakly-Hanon Y, Ben Hamou A, Garçon P, Moeuf Y, Banu I, Fumery M, Voican A, Abassade P, Oriez C, Chatellier G, Dupuy O, Cador R, Komajda M. Asymptomatic left ventricular dysfunction in patients with type 2 diabetes free of cardiovascular disease and its relationship with clinical characteristics: The DIACAR cohort study. Diabetes Obes Metab 2021; 23:434-443. [PMID: 33118250 DOI: 10.1111/dom.14236] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/02/2020] [Accepted: 10/25/2020] [Indexed: 12/28/2022]
Abstract
AIMS To assess the prevalence, type and clinical factors associated with left ventricular (LV) dysfunction in patients with type 2 diabetes mellitus (T2DM) by performing a comprehensive echocardiographic Doppler assessment including speckle tracking. METHODS Two hundred T2DM patients without overt cardiovascular disease were prospectively enrolled in a single-centre cohort study between 2018 and 2019. RESULTS Left ventricular mass was increased in 24 patients (12%) and relative wall thickness (h/r) was increased in 46 patients (23%). Left atrial (LA) enlargement was observed in 27 patients (13.6%) and global longitudinal strain (GLS) was reduced in 38 patients (20.3%). In univariate analysis, LV hypertrophy (LVH) or increased h/r were associated with age, renal function, hypertension and B-type natriuretic peptide (BNP) plasma level. LA dilation was associated with age, history of hypertension, diabetes duration and complications, insulin treatment, BNP level and renal function. GLS was associated with body mass index (BMI) and, in a borderline manner, with diabetes duration. In multivariate analysis, hypertension was associated with LVH and with h/r and a borderline relationship was observed for female gender (LVH), age and insulin treatment (h/r). Age, hypertension and, in a borderline manner, insulin treatment were associated with LA dilation. BMI and shorter diabetes duration were associated with reduced GLS. CONCLUSION A high prevalence of asymptomatic cardiac dysfunction/structural abnormalities was observed in patients with T2DM without overt cardiac disease and was associated with either age, diabetes duration or treatment and with comorbidities including hypertension and obesity. Whether these preclinical abnormalities are associated with poor outcomes warrants further study.
Collapse
Affiliation(s)
| | - Adrien Ben Hamou
- Department of Diabetology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Philippe Garçon
- Department of Cardiology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Yoann Moeuf
- Department of Cardiology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Isabela Banu
- Department of Diabetology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Maxime Fumery
- Department of Cardiology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Adela Voican
- Department of Diabetology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Philippe Abassade
- Department of Cardiology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Constance Oriez
- Department of Diabetology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Gilles Chatellier
- Department of Statistics, Bioinformatics and Public Health, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges-Pompidou, Paris, France
- Université de Paris, Paris, France
| | - Olivier Dupuy
- Department of Diabetology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Romain Cador
- Department of Cardiology, Fondation Hôpital Saint-Joseph, Paris, France
| | - Michel Komajda
- Department of Cardiology, Fondation Hôpital Saint-Joseph, Paris, France
- Paris Sorbonne Université, Paris, France
| |
Collapse
|
958
|
Nalliah CJ, Bell JR, Raaijmakers AJA, Waddell HM, Wells SP, Bernasochi GB, Montgomery MK, Binny S, Watts T, Joshi SB, Lui E, Sim CB, Larobina M, O'Keefe M, Goldblatt J, Royse A, Lee G, Porrello ER, Watt MJ, Kistler PM, Sanders P, Delbridge LMD, Kalman JM. Epicardial Adipose Tissue Accumulation Confers Atrial Conduction Abnormality. J Am Coll Cardiol 2021; 76:1197-1211. [PMID: 32883413 DOI: 10.1016/j.jacc.2020.07.017] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/02/2020] [Accepted: 07/09/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Clinical studies have reported that epicardial adipose tissue (EpAT) accumulation associates with the progression of atrial fibrillation (AF) pathology and adversely affects AF management. The role of local cardiac EpAT deposition in disease progression is unclear, and the electrophysiological, cellular, and molecular mechanisms involved remain poorly defined. OBJECTIVES The purpose of this study was to identify the underlying mechanisms by which EpAT influences the atrial substrate for AF. METHODS Patients without AF undergoing coronary artery bypass surgery were recruited. Computed tomography and high-density epicardial electrophysiological mapping of the anterior right atrium were utilized to quantify EpAT volumes and to assess association with the electrophysiological substrate in situ. Excised right atrial appendages were analyzed histologically to characterize EpAT infiltration, fibrosis, and gap junction localization. Co-culture experiments were used to evaluate the paracrine effects of EpAT on cardiomyocyte electrophysiology. Proteomic analyses were applied to identify molecular mediators of cellular electrophysiological disturbance. RESULTS Higher local EpAT volume clinically correlated with slowed conduction, greater electrogram fractionation, increased fibrosis, and lateralization of cardiomyocyte connexin-40. In addition, atrial conduction heterogeneity was increased with more extensive myocardial EpAT infiltration. Cardiomyocyte culture studies using multielectrode arrays showed that cardiac adipose tissue-secreted factors slowed conduction velocity and contained proteins with capacity to disrupt intermyocyte electromechanical integrity. CONCLUSIONS These findings indicate that atrial pathophysiology is critically dependent on local EpAT accumulation and infiltration. In addition to myocardial architecture disruption, this effect can be attributed to an EpAT-cardiomyocyte paracrine axis. The focal adhesion group proteins are identified as new disease candidates potentially contributing to arrhythmogenic atrial substrate.
Collapse
Affiliation(s)
- Chrishan J Nalliah
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - James R Bell
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia; Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Helen M Waddell
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Simon P Wells
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia; Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Gabriel B Bernasochi
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Simon Binny
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Troy Watts
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Subodh B Joshi
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Elaine Lui
- Department of Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Choon Boon Sim
- Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Marco Larobina
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Michael O'Keefe
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - John Goldblatt
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Alistair Royse
- Department of Cardiothoracic Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Geoffrey Lee
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Enzo R Porrello
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia; Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Matthew J Watt
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Peter M Kistler
- Department of Cardiology, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Prashanthan Sanders
- Australia Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Lea M D Delbridge
- Department of Physiology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Jonathan M Kalman
- Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Victoria, Australia.
| |
Collapse
|
959
|
Zamzmi G, Hsu LY, Li W, Sachdev V, Antani S. Harnessing Machine Intelligence in Automatic Echocardiogram Analysis: Current Status, Limitations, and Future Directions. IEEE Rev Biomed Eng 2021; 14:181-203. [PMID: 32305938 PMCID: PMC8077725 DOI: 10.1109/rbme.2020.2988295] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Echocardiography (echo) is a critical tool in diagnosing various cardiovascular diseases. Despite its diagnostic and prognostic value, interpretation and analysis of echo images are still widely performed manually by echocardiographers. A plethora of algorithms has been proposed to analyze medical ultrasound data using signal processing and machine learning techniques. These algorithms provided opportunities for developing automated echo analysis and interpretation systems. The automated approach can significantly assist in decreasing the variability and burden associated with manual image measurements. In this paper, we review the state-of-the-art automatic methods for analyzing echocardiography data. Particularly, we comprehensively and systematically review existing methods of four major tasks: echo quality assessment, view classification, boundary segmentation, and disease diagnosis. Our review covers three echo imaging modes, which are B-mode, M-mode, and Doppler. We also discuss the challenges and limitations of current methods and outline the most pressing directions for future research. In summary, this review presents the current status of automatic echo analysis and discusses the challenges that need to be addressed to obtain robust systems suitable for efficient use in clinical settings or point-of-care testing.
Collapse
|
960
|
Arvanitaki A, Giannakoulas G, Triantafyllidou E, Feloukidis C, Boutou AK, Garyfallos A, Karvounis H, Dimitroulas T. Peripheral microangiopathy in precapillary pulmonary hypertension: a nailfold video capillaroscopy prospective study. Respir Res 2021; 22:27. [PMID: 33478514 PMCID: PMC7819216 DOI: 10.1186/s12931-021-01622-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/10/2021] [Indexed: 12/21/2022] Open
Abstract
Background Although pulmonary vascular bed has been the main subject of research for many years in pulmonary hypertension (PH), interest has recently started to divert towards the possibility of a co-existing peripheral microangiopathy. The aim of the current study was to investigate the presence of nailfold video-capillaroscopic (NVC) structural changes in patients with precapillary PH and to identify possible associations of NVC measurements with markers of disease severity. Methods Α prospective case–control study was performed in 28 consecutive patients with precapillary PH [14 with idiopathic pulmonary arterial hypertension (IPAH) and 14 with chronic thromboembolic pulmonary hypertension (CTEPH)] and 30 healthy controls. NVC quantitative and qualitative parameters were evaluated using Optilia Digital Capillaroscope. To ensure inter-observer repeatability capillaroscopic images were reviewed by two independent investigators. For multiple comparisons among continuous variables, one-way ANOVA or the Kruskal–Wallis test were used. Differences between the groups were tested with post-hoc analysis with adjustment for multiple comparisons (Bonferroni test). Results Both IPAH (71.4% were women, mean age 53.1 ± 13.4 years) and CTEPH (64.3% women, mean age 60.9 ± 14.4 years) groups presented reduced capillary density compared to healthy controls (8.4 ± 1.2 loops/mm and 8.0 ± 1.2 loops/mm vs. 9.7 ± 0.81 loops/mm, p < 0.001) and increased loop width (15.7 ± 3.9 μm and 15.8 ± 1.9 μm vs. 11.5 ± 2.3 μm, p < 0.001). More than half of patients with IPAH presented microhaemorrhages on capillary nailfold, while increased shape abnormalities in capillary morphology and more capillary thrombi per linear mm were detected in patients with CTEPH compared to patients with IPAH and healthy controls. All PH patients presented a non-specific NVC pattern compared to controls (p < 0.001). Conclusion The findings of the study reveal a degree of significant peripheral microvascular alterations in patients with IPAH and CTEPH, suggesting a generalized impairment of peripheral microvasculature in pulmonary vascular disease.
Collapse
Affiliation(s)
- Alexandra Arvanitaki
- Department of Cardiology III - Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, 48149, Muenster, Germany.,Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece.,Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - George Giannakoulas
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Eva Triantafyllidou
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - Christos Feloukidis
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Afroditi K Boutou
- Department of Respiratory Medicine, G. Papanikolaou Hospital, Thessaloniki, Greece
| | - Alexandros Garyfallos
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece
| | - Haralambos Karvounis
- Department of Cardiology, AHEPA University Hospital, Medical School, Aristotle University of Thessaloniki, 1 St. Kyriakidi Street, 54636, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration University Hospital, Medical School, Aristotle University of Thessaloniki, 49 Konstantinoupoleos Street, 54642, Thessaloniki, Greece.
| |
Collapse
|
961
|
Nadar SK, Mujtaba Shaikh M, Al Jabri S, Najeeb Rawahi M. The deleterious effect of intracardiac pacing leads on right ventricular function. Qatar Med J 2021; 2020:40. [PMID: 33447539 PMCID: PMC7780728 DOI: 10.5339/qmj.2020.40] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 04/30/2020] [Indexed: 12/03/2022] Open
Abstract
Aim: The aim of this study was to evaluate the progression of tricuspid regurgitation (TR) in patients with pacemaker leads across the tricuspid valve and assess the clinical effect on right ventricular (RV) function. Methods: Patients who had undergone permanent pacemaker implantation at our institution over an 8-year period were identified. Those who had an echo (for any indication) pre- and postdevice implantation were included in this study, and their data assessed. Clinical information was obtained from their medical records. A total of 65 patients (mean age 70 ± 13 years, 31 (48%) males, and 34 (52%) females) were enrolled in the study. Results: The median interval of echo after implantation was 12 (12 to 24) months. Before implantation, 29 patients had TR, which increased to 51 (78%) during follow up, indicating that 22 patients developed new TR. Of those with preexisting TR, the grade of TR had worsened by at least one grade in 17 patients. RV function as measured by tricuspid annular plane systolic excursion (TAPSE) had decreased from 1.87 ± 0.44 to 1.68 ± 0.42 (p = 0.002). Eighteen patients had developed signs of right heart failure (either breathlessness with raised jugular venous pressure or pedal edema or both), of which 13 had only new pedal edema. Conclusion: There is a definite progression of TR in patients with a pacing lead across the tricuspid valve (TV) associated with an increase in the incidence of right heart failure. Patients with a pacing lead across the TV should be followed closely for signs of right heart failure.
Collapse
Affiliation(s)
- Sunil K Nadar
- Department of Medicine, Sultan Qaboos University Hospital, P.O. Box 38, Al Khod. Muscat 123, Oman E-mail:
| | - Muhammad Mujtaba Shaikh
- Department of Medicine, Sultan Qaboos University Hospital, P.O. Box 38, Al Khod. Muscat 123, Oman E-mail:
| | - Sheikha Al Jabri
- Department of Medicine, Sultan Qaboos University Hospital, P.O. Box 38, Al Khod. Muscat 123, Oman E-mail:
| | - Mohamed Najeeb Rawahi
- Department of Medicine, Sultan Qaboos University Hospital, P.O. Box 38, Al Khod. Muscat 123, Oman E-mail:
| |
Collapse
|
962
|
Echocardiographic evaluation of pulmonary hypertension, right ventricular function, and right ventricular-pulmonary arterial coupling in patients with rheumatoid arthritis. Clin Rheumatol 2021; 40:2651-2656. [PMID: 33443606 DOI: 10.1007/s10067-020-05544-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 12/01/2020] [Accepted: 12/09/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) patients are at increased risk for developing cardiovascular disease, including right heart failure. The evaluation of right ventricle (RV) using the relationship between tricuspid annular plane systolic excursion (TAPSE) and right ventricular systolic pressure (RVSP) is of clinical prognostic relevance. Mild echocardiographic pulmonary hypertension (ePH) has been associated with worse RV function. The aim of this study was to evaluate RV function as measured by TAPSE to RVSP ratio in rheumatoid arthritis patients compared to matched healthy controls. METHOD A case-control study with 67 RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and 45 matching controls was included. A transthoracic echocardiogram was performed to all patients. TAPSE was measured as the distance traveled from end-diastole to end-systole. RVSP was calculated using the modified Bernoulli equation. Comparisons were done using Chi-square and Mann-Whitney's U test or Student's t test. RESULTS Patients with RA had significantly reduced ventricular function (TAPSE 23 [21-25] vs 25 [23-26], p = 0.033) and TAPSE/RVSP ratio was significantly lower in RA-patients than controls (TAPSE to RVSP ratio 0.809 [0.67-1.01] vs 0.933 [0.79-1.11], p = 0.009). RA-patients with mild ePH had similar RV function, evaluated by TAPSE, in comparison to RA-patients with normal RVSP. CONCLUSION RA-patients had worse RV function measured by TAPSE and worse TAPSE/RVSP ratio than controls. Also, RA-patients with mild ePH had reduced right ventricular-pulmonary arterial coupling in comparison with patients with RA and normal RVSP. These echocardiographic findings could justify aggressive treatment for these patients and assess their evolution. Key Points • Right ventricular (RV) function and RV coupling with the pulmonary artery (RV-PA coupling) were worse in patients with RA in comparison to healthy controls. • Values of right ventricular systolic pressure (RVSP) were similar between RA-patients and non-RA controls. • Prevalence of normal RVSP, mild echocardiographic pulmonary hypertension (ePH), and pulmonary hypertension was similar between RA-patients and non-RA matched controls •Patients with RA and mild ePH had reduced RV-PA coupling in comparison with RA-patients with normal RVSP.
Collapse
|
963
|
Johansen MC, Doria de Vasconcellos H, Nazarian S, Lima JAC, Gottesman RF. The Investigation of Left Atrial Structure and Stroke Etiology: The I-LASER Study. J Am Heart Assoc 2021; 10:e018766. [PMID: 33442991 PMCID: PMC7955322 DOI: 10.1161/jaha.120.018766] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Left atrial (LA) function is important in stroke, but often poorly characterized. We evaluated the association of 2-dimensional speckle tracking echocardiography LA variables with stroke subtype (cardioembolic stroke [CS] or cryptogenic stroke versus other). The hypothesis is worse LA active function is associated with CS, but not cryptogenic strokes. Methods and Results In this prospective cohort (2017-2019), left ventricular/LA structure and function were quantified by 2-dimensional and speckle tracking echocardiography in 151 patients with stroke. Strain/strain rate curves for the 3 components of the LA cycle, ie, (1) Reservoir (global longitudinal strain [Srmax]), (2) Conductive (early LA Sr [Sre]), and (3) Active (late LA strain [Sra]) were evaluated, masked to stroke subtype. Associations of cardiac features with stroke subtype were tested using multivariable logistic regressions. Odds of CS were increased in patients with a larger LA systolic diameter (odds ratio [OR], 2.96, 95% CI, 1.14-7.69) but reduced in patients with a higher Srmax (better reservoir) (OR, 0.80, 95% CI, 0.67-0.97). Lower Sra (worse function) was associated with an increased odds of CS (OR, 1.72, 95% CI, 1.07-2.76) but not independent of atrial fibrillation. Higher active LA emptying fraction (better active phase) was associated with reduced odds of CS (OR, 0.74, 95% CI, 0.57-0.95) or cryptogenic stroke (OR, 0.82, 95% CI, 0.68-0.98) versus other subtypes; other associations between cryptogenic stroke and speckle tracking echocardiography were not found. Conclusions Markers of LA structure and function were associated with CS. Similar associations were not found for cryptogenic stroke, which might suggest different underlying mechanisms, given study limitations. Further understanding could aid stroke diagnosis and secondary stroke prevention research.
Collapse
Affiliation(s)
- Michelle C Johansen
- Department of Neurology The Johns Hopkins University School of Medicine Baltimore MD
| | | | - Saman Nazarian
- Department of Cardiology The University of Pennsylvania Perelman School of Medicine Philadelphia PA
| | - Joao A C Lima
- Department of Cardiology The Johns Hopkins University School of Medicine Baltimore MD
| | - Rebecca F Gottesman
- Department of Neurology The Johns Hopkins University School of Medicine Baltimore MD
| |
Collapse
|
964
|
Churchill TW, Groezinger E, Kim JH, Loomer G, Guseh JS, Wasfy MM, Isselbacher EM, Lewis GD, Weiner RB, Schmied C, Baggish AL. Association of Ascending Aortic Dilatation and Long-term Endurance Exercise Among Older Masters-Level Athletes. JAMA Cardiol 2021; 5:522-531. [PMID: 32101252 DOI: 10.1001/jamacardio.2020.0054] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Importance Aortic dilatation is frequently encountered in clinical practice among aging endurance athletes, but the distribution of aortic sizes in this population is unknown. It is additionally uncertain whether this may represent aortic adaptation to long-term exercise, similar to the well-established process of ventricular remodeling. Objective To assess the prevalence of aortic dilatation among long-term masters-level male and female athletes with about 2 decades of exercise exposure. Design, Setting, and Participants This cross-sectional study evaluated aortic size in veteran endurance athletes. Masters-level rowers and runners aged 50 to 75 years were enrolled from competitive athletic events across the United States from February to October 2018. Analysis began January 2019. Exposures Long-term endurance exercise. Main Outcomes and Measures The primary outcome was aortic size at the sinuses of Valsalva and the ascending aorta, measured using transthoracic echocardiography in accordance with contemporary guidelines. Aortic dimensions were compared with age, sex, and body size-adjusted predictions from published nomograms, and z scores were calculated where applicable. Results Among 442 athletes (mean [SD] age, 61 [6] years; 267 men [60%]; 228 rowers [52%]; 214 runners [48%]), clinically relevant aortic dilatation, defined by a diameter at sinuses of Valsalva or ascending aorta of 40 mm or larger, was found in 21% (n = 94) of all participants (83 men [31%] and 11 women [6%]). When compared with published nomograms, the distribution of measured aortic size displayed a rightward shift with a rightward tail (all P < .001). Overall, 105 individuals (24%) had at least 1 z score of 2 or more, indicating an aortic measurement greater than 2 SDs above the population mean. In multivariate models adjusting for age, sex, body size, hypertension, and statin use, both elite competitor status (rowing participation in world championships or Olympics or marathon time under 2 hours and 45 minutes) and sport type (rowing) were independently associated with aortic size. Conclusions and Relevance Clinically relevant aortic dilatation is common among aging endurance athletes, raising the possibility of vascular remodeling in response to long-term exercise. Longitudinal follow-up is warranted to establish corollary clinical outcomes in this population.
Collapse
Affiliation(s)
- Timothy W Churchill
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Erich Groezinger
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Jonathan H Kim
- Division of Cardiology, Emory Clinical Cardiovascular Research Institute, Atlanta, Georgia
| | - Garrett Loomer
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - J Sawalla Guseh
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Meagan M Wasfy
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | - Eric M Isselbacher
- Echocardiography Laboratory, Massachusetts General Hospital, Boston.,Thoracic Aortic Center, Massachusetts General Hospital, Boston
| | - Gregory D Lewis
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston
| | - Rory B Weiner
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| | | | - Aaron L Baggish
- Cardiovascular Performance Program, Massachusetts General Hospital, Boston.,Echocardiography Laboratory, Massachusetts General Hospital, Boston
| |
Collapse
|
965
|
Morra S, Hossein A, Rabineau J, Gorlier D, Racape J, Migeotte PF, van de Borne P. Assessment of left ventricular twist by 3D ballistocardiography and seismocardiography compared with 2D STI echocardiography in a context of enhanced inotropism in healthy subjects. Sci Rep 2021; 11:683. [PMID: 33436841 PMCID: PMC7804966 DOI: 10.1038/s41598-020-79933-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
Ballistocardiography (BCG) and Seismocardiography (SCG) assess the vibrations produced by cardiac contraction and blood flow, respectively, by means of micro-accelerometers and micro-gyroscopes. From the BCG and SCG signals, maximal velocities (VMax), integral of kinetic energy (iK), and maximal power (PMax) can be computed as scalar parameters, both in linear and rotational dimensions. Standard echocardiography and 2-dimensional speckle tracking imaging echocardiography were performed on 34 healthy volunteers who were infused with increasing doses of dobutamine (5-10-20 μg/kg/min). Linear VMax of BCG predicts the rates of left ventricular (LV) twisting and untwisting (both p < 0.0001). The linear PMax of both SCG and BCG and the linear iK of BCG are the best predictors of the LV ejection fraction (LVEF) (p < 0.0001). This result is further confirmed by mathematical models combining the metrics from SCG and BCG signals with heart rate, in which both linear PMax and iK strongly correlate with LVEF (R = 0.7, p < 0.0001). In this setting of enhanced inotropism, the linear VMax of BCG, rather than the VMax of SCG, is the metric which best explains the LV twist mechanics, in particular the rates of twisting and untwisting. PMax and iK metrics are strongly associated with the LVEF and account for 50% of the variance of the LVEF.
Collapse
Affiliation(s)
- Sofia Morra
- Department of Cardiovascular Diseases, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Amin Hossein
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Jérémy Rabineau
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Damien Gorlier
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Judith Racape
- Research Centre in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre-François Migeotte
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiovascular Diseases, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| |
Collapse
|
966
|
Bianco F, Colaneri M, Bucciarelli V, Surace FC, Iezzi FV, Primavera M, Biasi A, Giusti G, Berton E, Baldoni M, Renda G, Baldinelli A, Gallina S, Pozzi M. Echocardiographic screening for the anomalous aortic origin of coronary arteries. Open Heart 2021; 8:openhrt-2020-001495. [PMID: 33431619 PMCID: PMC7802674 DOI: 10.1136/openhrt-2020-001495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 12/06/2020] [Accepted: 12/29/2020] [Indexed: 01/26/2023] Open
Abstract
Aims We sought to determine the diagnostic performance, clinical profiles and outcomes of anomalous aortic origin of coronary arteries (AAOCA) using a standardised echocardiographic approach in young adults and athletes. Methods In 2015–2019, we screened 5998 outpatients (age 16 years (Q1–Q3: 11, 36)), referred for routine echocardiography, using four specific echocardiographic windows: parasternal short/long axis and apical 4/5-chambers view. Coronary CT confirmed AAOCA. For the performance analysis, 300 coronary-CT scans were available; two independent and double-blinded physicians retrospectively reviewed echocardiographic images. Results A total of 47 AAOCA was diagnosed; the overall prevalence was 0.0078%. Over 5 years, we found a significant increment of AAOCA diagnostic rate (P for trend=0.002). Syncope (n=17/47) and palpitations (n=6/47) were prevalent symptoms. All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgery, while 20 underwent a conservative medical treatment. All patients are alive at a median follow-up of 3±1.6 years; only surgical repairs restarted their activity. Our method showed better sensitivity than traditional short-axis evaluation: 93% vs 83%, p=0.0030 (AUC 0.96 (95% CI 0.92, 0.99) and AUC 0.89 (95% CI 0.83, 0.95), respectively), with a good interobserver agreement (95%, k=0.83, p<0.001). Conclusions The application of a standardised echocardiographic approach for AAOCA detection led to a significantly increased rate of identified anomalies. This approach demonstrated higher sensitivity than the traditional echocardiographic assessment. Implementing this protocol in clinical practice may help improve the AAOCA diagnosis in young adults and athletes. Trial registration number NCT04224090.
Collapse
Affiliation(s)
- Francesco Bianco
- Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Abruzzo, Italy .,Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Massimo Colaneri
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Valentina Bucciarelli
- Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Abruzzo, Italy.,Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Francesca Chiara Surace
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Federica Valentina Iezzi
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Martina Primavera
- Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Abruzzo, Italy
| | - Annaclara Biasi
- Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Abruzzo, Italy
| | - Giuliano Giusti
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Emanuela Berton
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Monica Baldoni
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Giulia Renda
- Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Abruzzo, Italy
| | - Alessandra Baldinelli
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| | - Sabina Gallina
- Department of Neuroscience, Imaging and Clinical Sciences, Universita degli Studi Gabriele d'Annunzio Chieti e Pescara, Chieti, Abruzzo, Italy
| | - Marco Pozzi
- Pediatric and Congenital Cardiology and Cardiac Surgery, Azienda Ospedaliero Universitaria Ospedali Riuniti di Ancona Umberto I G M Lancisi G Salesi, Ancona, Marche, Italy
| |
Collapse
|
967
|
Wang L, Cai L, Chen X, Zheng Z. Paroxysmal supraventricular tachycardia as a major clinical presentation of the primary coronary sinus lymphoma: A case report. Medicine (Baltimore) 2021; 100:e24225. [PMID: 33429817 PMCID: PMC7793383 DOI: 10.1097/md.0000000000024225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/16/2020] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Primary cardiac lymphoma is a rare tumor, especially a tumor located in coronary sinus (CS). The most common symptom of cardiac tumors is dyspnea, accounting for 64%, followed by chest pain, accounting for 26%. However, the cases with paroxysmal supraventricular tachycardia (SVT) as a major clinical presentation are extremely rare. PATIENT CONCERNS We report a 55-year-old female patient with primary CS lymphoma and paroxysmal SVT. DIAGNOSES After the surgical resection, pathology revealed the evidence of diffuse large B-cell lymphoma. INTERVENTIONS The patient underwent chemotherapy after CS tumor resection. OUTCOMES The patient was disease-free during the 6-month follow-up. LESSONS CS enlargement may be the cause of SVT. Echocardiography should focus on the CS section to arrive at the right diagnosis.
Collapse
Affiliation(s)
- Ling Wang
- Department of Ultrasound, Zhuji People's Hospital of Zhejiang Province, Zhuji
| | - Lixia Cai
- Department of Ultrasound, Zhuji People's Hospital of Zhejiang Province, Zhuji
| | - Xiangyu Chen
- Department of Ultrasound, Zhuji People's Hospital of Zhejiang Province, Zhuji Affiliated Hospital of Shaoxing University, Zhuji, China
| | - Zhelan Zheng
- Department of Ultrasound, The First Affiliated Hospital of Zhejiang University, Zhejiang
| |
Collapse
|
968
|
Krhut J, Wohlfahrt P, Pudich J, Kufová E, Borovička V, Bílková K, Sýkora R, Mokriš J, Cífková R, Zachoval R, Zvara P. Cardiovascular safety of mirabegron in individuals treated for spinal cord injury- or multiple sclerosis-induced neurogenic detrusor overactivity. Int Urol Nephrol 2021; 53:1089-1095. [PMID: 33417146 DOI: 10.1007/s11255-020-02774-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 12/22/2020] [Indexed: 12/17/2022]
Abstract
PURPOSE To analyze cardiovascular safety of mirabegron in patients with spinal cord injury (SCI)- and multiple sclerosis (MS)-induced neurogenic detrusor overactivity (NDO) in a prospective, randomized, double-blind, placebo-controlled study. METHODS Seventy-eight patients were enrolled into the study, and 66 of them were included into the final analysis. In 49 (74.2%), NDO developed due to suprasacral SCI, 17 (25.8%) suffered from NDO due to MS. Eleven patients were previously treated for hypertension and one for arrhythmia. All study participants received placebo for 2 weeks run-in period. Subsequently, eligible subjects were randomized for 4 weeks of active treatment with mirabegron 50 mg once daily (Group A; n = 32) or placebo (Group B; n = 34). Data from resting electrocardiography (ECG), 24-h ECG and blood pressure monitoring, and echocardiographic examination, were used for cardiovascular safety assessment. All reported variables were evaluated at time of randomization and at the end of the study. Longitudinal changes of variables within the groups and differences between the groups were assessed using nonparametric Kruskal-Wallis test, and p ≤ 0.05 was considered statistically significant. RESULTS No statistically significant longitudinal changes were found in safety variables, except for prolongation of QT interval in placebo group (p = 0.0328) recorded by resting ECG. No significant difference between the Groups A and B, in any of the variables, was observed. A single cardiovascular study drug-related adverse event was recorded in a patient with cervical SCI (3.13%). CONCLUSIONS Our results suggest that mirabegron can be safely used in the treatment of patients with SCI- and MS-induced NDO.
Collapse
Affiliation(s)
- Jan Krhut
- Department of Urology, University Hospital, Tř. 17. listopadu 1790, 708 52, Ostrava, Czech Republic. .,Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic.
| | - Peter Wohlfahrt
- Center for Cardiovascular Prevention, 1st Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Jiří Pudich
- Department of Cardiology, University Hospital, Ostrava, Czech Republic
| | - Eliška Kufová
- Department of Cardiology, University Hospital, Ostrava, Czech Republic
| | - Vladimír Borovička
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Karolína Bílková
- Spinal Cord Rehabilitation Unit, Rehabilitation Center, Kladruby, Czech Republic
| | - Radek Sýkora
- Department of Urology, University Hospital, Tř. 17. listopadu 1790, 708 52, Ostrava, Czech Republic.,Department of Surgical Studies, Medical Faculty, Ostrava University, Ostrava, Czech Republic
| | - Jan Mokriš
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Renata Cífková
- Center for Cardiovascular Prevention, 1st Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Roman Zachoval
- Department of Urology, 3rd Faculty of Medicine of Charles University and Thomayer Hospital, Prague, Czech Republic
| | - Peter Zvara
- Department of Clinical Research, Biomedical Laboratory and Research Unit of Urology, University of Southern Denmark, Odense, Denmark.,Department of Urology, Odense University Hospital, Odense, Denmark
| |
Collapse
|
969
|
Rearick C, Castaneda J, Weber J, Edstrom E, Cassidy K, Arora V, Ward RP. An Electronic Health Record Intervention to Increase Utilization of Limited Transthoracic Echocardiography. J Am Soc Echocardiogr 2021; 34:551-552. [PMID: 33412250 DOI: 10.1016/j.echo.2020.12.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/30/2020] [Accepted: 12/30/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Corey Rearick
- Department of Medicine University of Chicago Medicine, Chicago, Illinois
| | - Jason Castaneda
- Department of Medicine University of Chicago Medicine, Chicago, Illinois
| | - Joseph Weber
- Department of Medicine University of Chicago Medicine, Chicago, Illinois
| | - Eve Edstrom
- Department of Medicine University of Chicago Medicine, Chicago, Illinois
| | - Kimisha Cassidy
- Department of Medicine University of Chicago Medicine, Chicago, Illinois
| | - Vineet Arora
- Department of Medicine University of Chicago Medicine, Chicago, Illinois
| | - R Parker Ward
- Department of Medicine University of Chicago Medicine, Chicago, Illinois
| |
Collapse
|
970
|
Ekmen N, Can G, Yozgat A, Can H, Bayraktar MF, Demirkol ME, Akdoğan Kayhan M, Sasani H. Evaluation of epicardial adipose tissue and carotid intima-media thickness as a marker of atherosclerosis in patients with inflammatory bowel disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:643-648. [PMID: 33393342 DOI: 10.17235/reed.2020.7394/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM this study aimed to compare carotid intima media (CIMT) and epicardial adipose tissue (EAT) measurements, which are considered as markers for the detection of early atherosclerosis in healthy controls and inflammatory bowel disease (IBD) cases. METHODS a total of 60 IBD patients (25 Crohn's disease and 35 ulcerative colitis) and 60 healthy patients (as a control group) were included in the study. The measurements of CIMT and EAT were performed using echocardiography and ultrasonography, respectively. Statistical analysis was used to determine the relationship between the parameters. RESULTS the thickness of bilateral (right and left) CIMT and EAT were significantly higher in IBD than in the control group (p < 0.05). There was a positive correlation between EAT and bilateral (right and left) CIMT in IBD patients (p < 0.05). CONCLUSION IBD is associated with an increased thickness of EAT and CIMT. Chronic inflammation in IBD may increase the risk of atherosclerotic heart disease. Thus, only measuring the thickness of EAT and CIMT can be used as an objective, easy, simple, affordable, non-invasive and accessible assessment method in order to screen for this risk.
Collapse
Affiliation(s)
- Nergiz Ekmen
- Gastroenterogy, Faculty of Medicine. Gazi University, Turkey
| | - Güray Can
- Gastroenterology, Faculty of Medicine. Abant Izzet Baysal University, Turkey
| | - Ahmet Yozgat
- Gastroenterology, Faculty of Medicine. Ufuk University, Türkiye
| | - Hatice Can
- Nephrology, Faculty of Medicine. Inönü University, Turkey
| | | | | | - Meral Akdoğan Kayhan
- Gastroenterology, Ankara Bilkent City Hospital. University of Health Sciences, Turkey
| | - Hadi Sasani
- Radiology, Faculty of Medicine. Tekirdağ Namik Kemal University, Turkey
| |
Collapse
|
971
|
Prognostic potential of layer-specific global longitudinal strain in patients with non-ST-segment elevated acute coronary syndrome and preserved left ventricular ejection fraction. Int J Cardiovasc Imaging 2021; 37:1301-1309. [PMID: 33389360 DOI: 10.1007/s10554-020-02119-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 11/24/2020] [Indexed: 10/22/2022]
Abstract
This study sought to investigate the prognostic potential of layer-specific global longitudinal strain (GLS) in predicting cardiac events among non-ST-segment elevated acute coronary syndrome (NSTE-ACS) patients with preserved LVEF. In this prospective study, we enrolled 160 consecutive NSTE-ACS patients with preserved LVEF (≥ 50%) who underwent successful percutaneous coronary intervention (PCI). Transthoracic two-dimensional echocardiography examinations were performed within 48 h of admission (before PCI). Cardiac events were defined as all-cause death, re-infarction, and hospitalization for heart failure. During a median follow-up of 30.2 months, 23 patients (14.4%) developed cardiac events. GLS for all three myocardial layers were reduced in patients with adverse outcome (all P < 0.001). Yet GLSendo (area under curves = 0.85) and GLSmid (area under curves = 0.83) showed relatively higher predictive power than GLSepi when identifying patients with cardiac events. The best cut-off value of GLSendo was - 20.8%, with a diagnostic sensitivity and specificity of 87% and 71% respectively. A significant increase in the risk of cardiac events development was shown among patients with impaired layer GLS (log-rank test, P < 0.001). In conclusion, NSTE-ACS patients with preserved LVEF, layer GLS assessed before PCI all had good abilities to predict cardiac events, which might provide more prognostic information against conventional echocardiographic risk factors.
Collapse
|
972
|
Suzuki A, Yoshida A, Shiga T, Tanino S, Saito C, Arai K, Suzuki T, Ashihara K, Hagiwara N. Left atrial volume index to predict long-term recovery of the left ventricular ejection fraction in patients with heart failure and reduced ejection fraction. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_29_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
973
|
Guzzetti E, Tastet L, Annabi MS, Capoulade R, Shen M, Bernard J, García J, Le Ven F, Arsenault M, Bédard E, Larose E, Clavel MA, Pibarot P. Effect of Regional Upper Septal Hypertrophy on Echocardiographic Assessment of Left Ventricular Mass and Remodeling in Aortic Stenosis. J Am Soc Echocardiogr 2021; 34:62-71. [DOI: 10.1016/j.echo.2020.08.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 08/13/2020] [Accepted: 08/13/2020] [Indexed: 01/09/2023]
|
974
|
Baycan OF, Barman HA, Atici A, Tatlisu A, Bolen F, Ergen P, Icten S, Gungor B, Caliskan M. Evaluation of biventricular function in patients with COVID-19 using speckle tracking echocardiography. Int J Cardiovasc Imaging 2021; 37:135-144. [PMID: 32803484 PMCID: PMC7429089 DOI: 10.1007/s10554-020-01968-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Accepted: 08/08/2020] [Indexed: 01/08/2023]
Abstract
A new infectious outbreak sustained by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is now spreading all around the world. The aim of this study was to evaluate the prognostic value of left ventricular global longitudinal strain (LV-GLS) and right ventricular longitudinal strain (RV-LS) in patients with coronavirus disease 2019 (COVID-19). In this prospective, single-center study, data were gathered from patients treated for COVID-19 between April 15 and April 30, 2020. Two-dimensional echocardiography (2-DE) and speckle tracking echocardiography (STE) images were obtained for all patients. Patients were divided into three groups: those with severe COVID-19 infection, those with non-severe COVID-19 infection, and those without COVID-19 infection (the control group). Data regarding clinical characteristics and laboratory findings were obtained from electronic medical records. The primary endpoint was in-hospital mortality. A total of 100 patients hospitalized for COVID-19 were included in this study. The mean age of the severe group (n = 44) was 59.1 ± 12.9, 40% of whom were male. The mean age of the non-severe group (n = 56) was 53.7 ± 15.1, 58% of whom were male. Of these patients, 22 died in the hospital. In patients in the severe group, LV-GLS and RV-LS were decreased compared to patients in the non-severe and control groups (LV-GLS: - 14.5 ± 1.8 vs. - 16.7 ± 1.3 vs. - 19.4 ± 1.6, respectively [p < 0.001]; RV-LS: - 17.2 ± 2.3 vs. - 20.5 ± 3.2 vs. - 27.3 ± 3.1, respectively [p < 0.001]). The presence of cardiac injury, D-dimer, arterial oxygen saturation (SaO2), LV-GLS (OR 1.63, 95% confidence interval [CI] 1.08-2.47; p = 0.010) and RV-LS (OR 1.55, 95% CI 1.07-2.25; p = 0.019) were identified as independent predictors of mortality via multivariate analysis. LV-GLS and RV-LS are independent predictors of in-hospital mortality in patients with COVID-19.
Collapse
Affiliation(s)
- Omer Faruk Baycan
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Hasan Ali Barman
- Department of Cardiology, Institute of Cardiology, Istanbul University - Cerrahpasa, Istanbul, Turkey.
| | - Adem Atici
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Adem Tatlisu
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Furkan Bolen
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Pınar Ergen
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Sacit Icten
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| | - Baris Gungor
- Department of Cardiology, Dr. Siyami Ersek Training and Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Mustafa Caliskan
- Department of Cardiology, Faculty of Medicine, Goztepe Training and Research Hospital, Istanbul Medeniyet University, Istanbul, Turkey
| |
Collapse
|
975
|
Kinematic Optimization for the Design of a Collaborative Robot End-Effector for Tele-Echography. ROBOTICS 2021. [DOI: 10.3390/robotics10010008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Tele-examination based on robotic technologies is a promising solution to solve the current worsening shortage of physicians. Echocardiography is among the examinations that would benefit more from robotic solutions. However, most of the state-of-the-art solutions are based on the development of specific robotic arms, instead of exploiting COTS (commercial-off-the-shelf) arms to reduce costs and make such systems affordable. In this paper, we address this problem by studying the design of an end-effector for tele-echography to be mounted on two popular and low-cost collaborative robots, i.e., the Universal Robot UR5, and the Franka Emika Panda. In the case of the UR5 robot, we investigate the possibility of adding a seventh rotational degree of freedom. The design is obtained by kinematic optimization, in which a manipulability measure is an objective function. The optimization domain includes the position of the patient with regards to the robot base and the pose of the end-effector frame. Constraints include the full coverage of the examination area, the possibility to orient the probe correctly, have the base of the robot far enough from the patient’s head, and a suitable distance from singularities. The results show that adding a degree of freedom improves manipulability by 65% and that adding a custom-designed actuated joint is better than adopting a native seven-degrees-freedom robot.
Collapse
|
976
|
Gan GCH, Bhat A, Chen HHL, Gu KH, Fernandez F, Kadappu KK, Byth K, Eshoo S, Thomas L. Left Atrial Reservoir Strain by Speckle Tracking Echocardiography: Association With Exercise Capacity in Chronic Kidney Disease. J Am Heart Assoc 2020; 10:e017840. [PMID: 33372523 PMCID: PMC7955492 DOI: 10.1161/jaha.120.017840] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Background Left atrial (LA) function plays a pivotal role in modulating left ventricular performance. The aim of our study was to evaluate the relationship between resting LA function by strain analysis and exercise capacity in patients with chronic kidney disease (CKD) and evaluate its utility compared with exercise E/e'. Methods and Results Consecutive patients with stage 3 and 4 CKD without prior cardiac history were prospectively recruited from outpatient nephrology clinics and underwent clinical evaluation and resting and exercise stress echocardiography. Resting echocardiographic parameters including E/e' and phasic LA strain (LA reservoir [LASr], conduit, and contractile strain) were measured and compared with exercise E/e'. A total of 218 (63.9±11.7 years, 64% men) patients with CKD were recruited. Independent clinical parameters associated with exercise capacity were age, estimated glomerular filtration rate, body mass index, and sex (P<0.01 for all), while independent resting echocardiographic parameters included E/e', LASr, and LA contractile strain (P<0.01 for all). Among resting echocardiographic parameters, LASr demonstrated the strongest positive correlation to metabolic equivalents achieved (r=0.70; P<0.01). Receiver operating characteristic curves demonstrated that LASr (area under the curve, 0.83) had similar diagnostic performance as exercise E/e' (area under the curve, 0.79; P=0.20 on DeLong test). A model combining LASr and clinical metrics showed robust association with metabolic equivalents achieved in patients with CKD. Conclusions LASr, a marker of decreased LA compliance is an independent correlate of exercise capacity in patients with stage 3 and 4 CKD, with similar diagnostic value to exercise E/e'. Thus, LASr may serve as a resting biomarker of functional capacity in this population.
Collapse
Affiliation(s)
- Gary C H Gan
- Department of Cardiology Blacktown Hospital Sydney NSW Australia.,Department of Cardiology Westmead Hospital Sydney NSW Australia.,University of New South Wales Sydney NSW Australia.,Western Sydney University Sydney NSW Australia
| | - Aditya Bhat
- Department of Cardiology Blacktown Hospital Sydney NSW Australia.,University of New South Wales Sydney NSW Australia.,Western Sydney University Sydney NSW Australia
| | - Henry H L Chen
- Department of Cardiology Blacktown Hospital Sydney NSW Australia
| | - Kennith H Gu
- Department of Cardiology Blacktown Hospital Sydney NSW Australia.,Western Sydney University Sydney NSW Australia
| | | | - Krishna K Kadappu
- University of New South Wales Sydney NSW Australia.,Western Sydney University Sydney NSW Australia.,Department of Cardiology Liverpool Hospital Sydney NSW Australia.,Department of Cardiology Campbelltown Hospital Sydney NSW Australia
| | - Karen Byth
- Research and Education Network Western Sydney Local Health District Sydney NSW Australia
| | - Suzanne Eshoo
- Department of Cardiology Blacktown Hospital Sydney NSW Australia.,Western Sydney University Sydney NSW Australia
| | - Liza Thomas
- Department of Cardiology Westmead Hospital Sydney NSW Australia.,University of New South Wales Sydney NSW Australia.,University of Sydney Sydney NSW Australia
| |
Collapse
|
977
|
Anfinogenova ND, Vasiltseva OY, Vrublevsky AV, Vorozhtsova IN, Popov SV, Smorgon AV, Mochula OV, Ussov WY. Right Atrial Thrombosis and Pulmonary Embolism: A Narrative Review. Semin Thromb Hemost 2020; 46:895-907. [PMID: 33368111 DOI: 10.1055/s-0040-1718399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Prompt diagnosis of pulmonary embolism (PE) remains challenging, which often results in a delayed or inappropriate treatment of this life-threatening condition. Mobile thrombus in the right cardiac chambers is a neglected cause of PE. It poses an immediate risk to life and is associated with an unfavorable outcome and high mortality. Thrombus residing in the right atrial appendage (RAA) is an underestimated cause of PE, especially in patients with atrial fibrillation. This article reviews achievements and challenges of detection and management of the right atrial thrombus with emphasis on RAA thrombus. The capabilities of transthoracic and transesophageal echocardiography and advantages of three-dimensional and two-dimensional echocardiography are reviewed. Strengths of cardiac magnetic resonance imaging (CMR), computed tomography, and cardiac ventriculography are summarized. We suggest that a targeted search for RAA thrombus is necessary in high-risk patients with PE and atrial fibrillation using transesophageal echocardiography and/or CMR when available independently on the duration of the disease. High-risk patients may also benefit from transthoracic echocardiography with right parasternal approach. The examination of high-risk patients should involve compression ultrasonography of lower extremity veins along with the above-mentioned technologies. Algorithms for RAA thrombus risk assessment and protocols aimed at identification of patients with RAA thrombosis, who will potentially benefit from treatment, are warranted. The development of treatment protocols specific for the diverse populations of patients with right cardiac thrombosis is important.
Collapse
Affiliation(s)
- Nina D Anfinogenova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Oksana Y Vasiltseva
- Unit of Aorta and Coronary Artery Surgery, E. Meshalkin National Medical Research Center, Ministry of Health of Russian Federation, Novosibirsk, Russia
| | - Alexander V Vrublevsky
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Irina N Vorozhtsova
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Sergey V Popov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Andrey V Smorgon
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Olga V Mochula
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| | - Wladimir Y Ussov
- Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russia
| |
Collapse
|
978
|
Li L, Ai Y, Huang L, Ai M, Peng Q, Zhang L. Can bioimpedance cardiography assess hemodynamic response to passive leg raising in critically ill patients: A STROBE-compliant study. Medicine (Baltimore) 2020; 99:e23764. [PMID: 33371141 PMCID: PMC7748328 DOI: 10.1097/md.0000000000023764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/18/2020] [Indexed: 11/26/2022] Open
Abstract
Passive leg raising (PLR) is a convenient and reliable test to predict fluid responsiveness. The ability of thoracic electrical bioimpedance cardiography (TEB) to monitor changes of cardiac output (CO) during PLR is unknown.In the present study, we measured CO in 61 patients with shock or dyspnea by TEB and transthoracic echocardiography (TTE) during PLR procedure. Positive PLR responsiveness was defined as the velocity-time integral (VTI) ≥10% after PLR. TTE measured VTI in the left ventricular output tract. The predictive value of TEB parameters in PLR responders was tested. Furthermore, the agreement of absolute CO values between TEB and TTE measurements was assessed.Among the 61 patients, there were 28 PLR-responders and 33 non-responders. Twenty-seven patients were diagnosed with shock and 34 patients with dyspnea, with 55.6% (15/27) and 54.6% (18/34) non-responders, respectively. A change in TEB measured CO (ΔCO) ≥9.8% predicted PLR responders with 75.0% sensitivity and 78.8% specificity, the area under the receiver operating characteristic curve (AUROC) was 0.79. The Δd2Z/dt2 (a secondary derivative of the impedance wave) showed the best predictive value with AUROC of 0.90, the optimal cut point was -7.1% with 85.7% sensitivity and 87.9% specificity. Bias between TEB and TTE measured CO was 0.12 L/min, and the percentage error was 65.8%.TEB parameters had promising performance in predicting PLR responders, and the Δd2Z/dt2 had the best predictive value. The CO values measured by TEB were not interchangeable with TTE in critically ill settings.
Collapse
|
979
|
Grandis M, Obici L, Luigetti M, Briani C, Benedicenti F, Bisogni G, Canepa M, Cappelli F, Danesino C, Fabrizi GM, Fenu S, Ferrandes G, Gemelli C, Manganelli F, Mazzeo A, Melchiorri L, Perfetto F, Pradotto LG, Rimessi P, Tini G, Tozza S, Trevisan L, Pareyson D, Mandich P. Recommendations for pre-symptomatic genetic testing for hereditary transthyretin amyloidosis in the era of effective therapy: a multicenter Italian consensus. Orphanet J Rare Dis 2020; 15:348. [PMID: 33317601 PMCID: PMC7734774 DOI: 10.1186/s13023-020-01633-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 11/27/2020] [Indexed: 12/13/2022] Open
Abstract
Hereditary transthyretin amyloidosis (ATTRv, v for variant) is a late-onset, autosomal dominant disease caused by progressive extracellular deposition of transthyretin amyloid fibrils, leading to organ damage and death. For other late-onset fatal diseases, as Huntington’s disease, protocols for pre-symptomatic genetic testing (PST) are available since decades. For ATTRv, limited experience has been reported to date, mostly gathered before the availability of approved therapies. We aimed at developing recommendations for a safe and feasible PST protocol in ATTRv in the era of emerging treatments, taking also into account Italian patients’ characteristics and healthcare system rules. After an initial survey on ongoing approaches to PST for ATTRv in Italy, two roundtable meetings were attended by 24 experts from 16 Italian centers involved in the diagnosis and care of this disease. Minimal requirements for PST offer and potential critical issues were highlighted. By November 2019, 457 families affected by ATTRv with 209 molecularly confirmed pre-symptomatic carriers were counted. The median age at PST was 41.3 years of age, regardless of the specific mutation. Half of the Italian centers had a multidisciplinary team, including a neurologist, an internist, a cardiologist, a medical geneticist and a psychologist, although in most cases not all the specialists were available in the same center. A variable number of visits was performed at each site. Experts agreed that PST should be offered only in the context of genetic counselling to at risk individuals aged 18 or older. Advertised commercial options for DNA testing should be avoided. The protocol should consist of several steps, including a preliminary clinical examination, a pre-test information session, an interval time, the genetic test and a post-test session with the disclosure of the test results, in the context of an experienced multidisciplinary team. Recommendations for best timing were also defined. Protocols for PST in the context of ATTRv can be refined to offer at risk individuals the best chance for early diagnosis and timely treatment start, while respecting autonomous decisions and promoting safe psychological adjustment to the genetic result.
Collapse
Affiliation(s)
- M Grandis
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - L Obici
- Amyloidosis Research and Treatment Center, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - M Luigetti
- UOC Neurologia, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.,Università Cattolica del Sacro Cuore, Rome, Italy
| | - C Briani
- Department of Neuroscience, University of Padova, Padova, Italy
| | - F Benedicenti
- Medical Genetics, Azienda Sanitaria Dell'Alto Adige, Bolzano, Italy
| | - G Bisogni
- Centro Clinico Nemo Adulti-Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - M Canepa
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - F Cappelli
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - C Danesino
- Molecular Medicine Department, University of Pavia, Pavia, Italy
| | - G M Fabrizi
- Department of Neurosciences, Biomedicine and Movement Sciences, Section of Neurology, University of Verona and University Hospital GB Rossi, Verona, Italy
| | - S Fenu
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - G Ferrandes
- IRCCS Policlinico San Martino, Genova, Italy
| | - C Gemelli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,Neuromuscular Omnicentre (NEMO)-Fondazione Serena Onlus, Arenzano, GE, Italy
| | - F Manganelli
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - A Mazzeo
- Unit of Neurology and Neuromuscular Diseases, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - L Melchiorri
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - F Perfetto
- Tuscan Regional Amyloidosis Center, Careggi University Hospital, Firenze, Italy
| | - L G Pradotto
- Department of Neurosciences, University of Turin, Torino, Italy.,Division of Neurology and Neurorehabilitazion, IRCCS Istituto Auxologico Italiano, Piancavallo, VB, Italy
| | - P Rimessi
- Medical Genetics Unit, Azienda Ospedaliero Universitaria Di Ferrara, Ferrara, Italy
| | - G Tini
- Cardiovascular Disease Unit, IRCCS Policlinico San Martino, Genova, and IRCCS Italian Cardiovascular Network, Department of Internal Medicine, University of Genova, Genova, Italy
| | - S Tozza
- Department of Neuroscience, Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Napoli, Italy
| | - L Trevisan
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy.,IRCCS Policlinico San Martino, Genova, Italy
| | - D Pareyson
- Unit of Rare Neurodegenerative and Neurometabolic Diseases, Department of Clinical Neurosciences, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - P Mandich
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), Section of Medical Genetics, University of Genoa, c/o DIMI Viale Benedetto XV, 6, 16132, Genova, Italy. .,IRCCS Policlinico San Martino, Genova, Italy.
| |
Collapse
|
980
|
Incremental value of carotid elasticity modulus using shear wave elastography for identifying coronary artery disease in patients without carotid plaque. J Hypertens 2020; 39:1210-1220. [PMID: 33323910 DOI: 10.1097/hjh.0000000000002773] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Shear wave elastography (SWE) directly quantifies the local arterial wall stiffness by calculating the elastic modulus. However, whether carotid wall elastic modulus can predict obstructive coronary artery disease (CAD) is not well known. We aimed to investigate the value of carotid wall elastic modulus measured using SWE in identifying obstructive CAD. MATERIALS AND METHODS We prospectively enrolled 61 patients without carotid plaque referred for clinically indicated coronary angiography. Twenty-seven (44.3%) patients were diagnosed with obstructive CAD (≥50% coronary stenosis). The elastic modulus of common carotid artery was quantified using SWE. Ankle--brachial index (ABI) and echocardiographic global cardiac calcium score (GCCS) were measured. RESULTS Patients with obstructive CAD had significantly higher elastic modulus than those without obstructive CAD. The maximum elastic modulus (EMmax) was independently associated with obstructive CAD after adjusting for the Framingham risk score, ABI, and GCCS. EMmax had the highest area under the curve (AUC) to identify obstructive CAD (AUC 0.70; P = 0.003). In the nested models, the model based on the Framingham risk score and ABI (χ2 = 3.74) improved by adding GCCS (χ2 = 9.95) and further improved by adding EMmax (χ2 = 15.86). Adding EMmax to the combined ABI and GCCS model increased integrated discrimination index from 0.10 to 0.19. CONCLUSION Carotid wall elastic modulus measured using SWE is a useful predictor of obstructive CAD in patients without carotid plaque. We demonstrated the incremental and independent value of carotid wall elastic modulus in identifying obstructive CAD compared with clinical risk factors and other imaging predictors, including ABI and GCCS. VIDEO ABSTRACT Please see the video, in Supplemental Digital Content 1, http://links.lww.com/HJH/B551 for more insights from the authors.
Collapse
|
981
|
Seo J, Hong YJ, Kim YJ, Lkhagvasuren P, Cho I, Shim CY, Ha JW, Hong GR. Prevalence, functional characteristics, and clinical significance of right ventricular involvement in patients with hypertrophic cardiomyopathy. Sci Rep 2020; 10:21908. [PMID: 33318610 PMCID: PMC7736330 DOI: 10.1038/s41598-020-78945-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 11/26/2020] [Indexed: 02/04/2023] Open
Abstract
We sought to investigate the prevalence, functional characteristics, and clinical significance of right ventricular (RV) involvement in patients with hypertrophic cardiomyopathy (HCM). A total of 256 patients with HCM who underwent both cardiac magnetic resonance (CMR) imaging and transthoracic echocardiography within 6 months of each other were retrospectively analysed. RV involvement was defined as an increased RV wall thickness ≥ 7 mm on CMR in the segments of the RV free wall. Primary outcomes were defined as the composite of all-cause death, heart transplantation, and unplanned cardiovascular admission. Thirty-seven (14.4%) patients showed RV involvement. Patients with RV involvement showed a significantly higher left ventricular (LV) maximal wall thickness and left atrial volume index. Multivariate Cox model revealed that RV involvement was independently associated with primary outcomes (HR: 2.30, p = 0.024). In a subgroup analysis of patients with speckle tracking echocardiography (n = 190), those with RV involvement had significantly more impaired RV strain, which was independently associated with primary outcomes. RV involvement in patients with HCM correlated with more advanced LV structure and biventricular dysfunction, suggesting an indicator of severe HCM. RV involvement and impaired RV strain have a prognostic value related to clinical adverse events in patients with HCM.
Collapse
Affiliation(s)
- Jiwon Seo
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Yoo Jin Hong
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Young Jin Kim
- Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Purevjargal Lkhagvasuren
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Iksung Cho
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Chi Young Shim
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Jong-Won Ha
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Geu-Ru Hong
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
| |
Collapse
|
982
|
Guan J, Zhang M. Cardiotoxicity of anthracycline-free targeted oncological therapies in HER2-positive breast cancer. Oncol Lett 2020; 21:100. [PMID: 33376533 PMCID: PMC7751370 DOI: 10.3892/ol.2020.12361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022] Open
Abstract
Anthracycline drugs are considered to be pivotal drugs in numerous chemotherapy regimens for breast cancer. However, the cardiotoxicity associated with the treatment is an important issue to be addressed. With the emergence of increasingly diverse antitumor drugs, anthracycline-free therapies are able to reduce the cardiotoxicity caused by anthracycline drugs while ensuring that a therapeutic effect is achieved. In the present review, anthracycline-free oncological therapy regimens for the treatment of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer and the associated cardiovascular toxicity are discussed, as well as some monitoring strategies. It is recommended that patients with HER2-positive breast cancer patients should receive adjuvant chemotherapy with single or dual-targeted therapy, with or without endocrine therapy according to the hormone receptor status determined by immunohistochemical examination. The main side effects of targeted therapy include cardiac dysfunction, hypertension and arrhythmia. According to individual risk stratification, it is recommended that patients should be periodically monitored using echocardiography, electrocardiography and serum markers, to enable the timely detection of the cardiovascular adverse reactions associated with tumor treatment, thereby preventing the morbidity and mortality caused by the cardiotoxicity of these drugs.
Collapse
Affiliation(s)
- Jingyuan Guan
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Mei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| |
Collapse
|
983
|
Hackett DA, Mitchell L, Clarke JL, Hagstrom AD, Keogh J, McLellan C. Relationship between echocardiogram and physical parameters in experienced resistance trainers: a pilot study. J Sports Med Phys Fitness 2020; 61:1290-1300. [PMID: 33269882 DOI: 10.23736/s0022-4707.20.11615-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND A paucity of research exists concerning physiological factors influencing heart structure and function in strength athletes. This pilot study investigated whether body composition and muscle performance are associated with indices of cardiac structure and function in experienced resistance trainers. METHODS A cross-sectional study designed was employed to address the study aim. Seventeen males (median age 33.0 years) and eight females (median age 32.5 years) with backgrounds in bodybuilding and powerlifting participated in this study. Muscle performance, body composition and echocardiographic measures were performed. Mann-Whitney U-tests were used to examine differences between males and females. Spearman's Rho partial correlation analyses (adjusting for sex) were conducted to examine relationships between physical and echocardiogram parameters. RESULTS Moderate to strong positive correlations were found between fat-free mass and aortic root, right ventricular internal dimension, interventricular septum thickness, left ventricular posterior wall thickness, left atrium area, left ventricular end-diastolic volume, and left ventricular end-systolic volume (r: 0.43-0.76, P≤0.03). Moderate to strong positive correlations were found between leg press 1RM and aortic root, left ventricular internal dimension diastole, left atrium area, left ventricular end-diastolic volume, and left ventricular end-systolic volume (r: 0.49-0.67, P≤0.02). CONCLUSIONS Resistance trainers with greater fat-free mass and lower body strength appear to have larger cardiac structures. Changes in heart size and function are likely to result from long-term strenuous resistance training. Due to the suspected prevalence of performance enhancing drug use among powerlifters and bodybuilders, care is required to rule out pathological conditions.
Collapse
Affiliation(s)
- Daniel A Hackett
- Exercise, Health and Performance Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, Australia -
| | - Lachlan Mitchell
- National Nutrition Surveillance Center, School of Public Health, Physiotherapy and Sport Science, University College Dublin, Dublin, Ireland
| | - Jillian L Clarke
- Exercise, Health and Performance Faculty Research Group, School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Lidcombe, Australia
| | - Amanda D Hagstrom
- School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Justin Keogh
- Faculty of Health Sciences and Medicine, Bond University, Robina, Australia.,Sports Performance Research Center New Zealand, AUT University, Auckland, New Zealand.,Cluster for Health Improvement, Faculty of Science, Health, Education and Engineering, University of the Sunshine Coast, Sippy Downs, Australia.,Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Chris McLellan
- School of Health and Wellbeing, Faculty of Health, Engineering and Sciences, University of Southern Queensland, Ipswich, Australia
| |
Collapse
|
984
|
Jahren TS, Steen EN, Aase SA, Solberg AHS. Estimation of End-Diastole in Cardiac Spectral Doppler Using Deep Learning. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2020; 67:2605-2614. [PMID: 32746157 DOI: 10.1109/tuffc.2020.2995118] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Electrocardiogram (ECG) is often used together with a spectral Doppler ultrasound to separate heart cycles by determining the end-diastole locations. However, the ECG signal is not always recorded. In such cases, the cardiac cycles can be estimated manually from the ultrasound data retrospectively. We present a deep learning-based method for automatic detection of the end-diastoles in spectral Doppler spectrograms. The method uses a combination of a convolutional neural network (CNN) for extracting features and a recurrent neural network (RNN) for modeling temporal relations. In echocardiography, there are three Doppler spectrogram modalities, continuous wave, pulsed wave, and tissue velocity Doppler. Both the training and test data sets include all three modalities. The model was tested on 643 spectrograms coming from different hospitals than in the training data set. For the purposes described in this work, a valid end-diastole detection is defined as a prediction being closer than 60 ms to the reference value. We will refer to these as true detections. Similarly, a prediction farther away is defined as nonvalid or false detections. The method automatically rejects spectrograms where the detection of an end-diastole has low confidence. When setting the algorithm to reject 1.9%, the method achieved 97.7% true detections with a mean error of 14 ms and had 2.5% false detections on the remaining spectrograms.
Collapse
|
985
|
Liu JE, Barac A, Thavendiranathan P, Scherrer-Crosbie M. Strain Imaging in Cardio-Oncology. JACC CardioOncol 2020; 2:677-689. [PMID: 34396282 PMCID: PMC8352045 DOI: 10.1016/j.jaccao.2020.10.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/25/2020] [Accepted: 10/27/2020] [Indexed: 02/07/2023] Open
Abstract
Echocardiographic imaging is crucial for patient management during cardiotoxic cancer therapy. Left ventricular ejection fraction is the most commonly used parameter for identifying left ventricular dysfunction. However, it lacks sensitivity to detect subclinical changes in cardiac function due to cardiotoxic treatment. Global longitudinal strain (GLS) is the best studied strain parameter with established diagnostic and prognostic value. Multiple studies have demonstrated changes in GLS as an early marker of cardiotoxicity. This document serves as a primer to help clinicians in the acquisition and interpretation of strain in cardio-oncology. Cases with embedded videos illustrate a step-by-step approach to obtaining GLS measurements and common pitfalls to avoid. The document includes a concise summary of the indications of GLS in cardio-oncology and its role in guiding oncological therapy. Practical approaches on how to implement strain in the echo laboratory with guidance on training and quality assurance are also discussed.
Collapse
Key Words
- 2D, 2-dimensional
- 3D, 3-dimensional
- ACC, American College of Cardiology
- AL, amyloid light chains
- ASE, American Society of Echocardiography
- CMRI, cardiac magnetic resonance imaging
- CTRCD, cancer treatment–related cardiac dysfunction
- DICOM, Digital Imaging and Communications in Medicine
- EACVI, European Association of Cardiovascular Imaging
- GLS, global longitudinal strain
- LV, left ventricle
- LVEF, left ventricular ejection fraction
- ROI, region of interest
- STE, speckle tracking echocardiography
- VEGF, vascular endothelium growth factor
- cancer
- cardiotoxicity
- echocardiography
- global longitudinal strain
- left ventricular function
Collapse
Affiliation(s)
- Jennifer E. Liu
- Cardiology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York, USA
- Department of Medicine, Weill Cornell Medical College, New York, New York, USA
| | - Ana Barac
- Department of Cardiology, Medstar Washington Hospital Center, MedStar Heart and Vascular Institute, Georgetown University, Washington, DC, USA
| | - Paaladinesh Thavendiranathan
- Department of Medicine, Division of Cardiology, Ted Rogers Program in Cardiotoxicity Prevention, Peter Munk Cardiac Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Marielle Scherrer-Crosbie
- Division of Cardiology, The Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| |
Collapse
|
986
|
Robinson S, Rana B, Oxborough D, Steeds R, Monaghan M, Stout M, Pearce K, Harkness A, Ring L, Paton M, Akhtar W, Bedair R, Battacharyya S, Collins K, Oxley C, Sandoval J, Schofield MBChB R, Siva A, Parker K, Willis J, Augustine DX. A practical guideline for performing a comprehensive transthoracic echocardiogram in adults: the British Society of Echocardiography minimum dataset. Echo Res Pract 2020; 7:G59-G93. [PMID: 33112828 PMCID: PMC7923056 DOI: 10.1530/erp-20-0026] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 10/20/2020] [Indexed: 12/27/2022] Open
Abstract
Since cardiac ultrasound was introduced into medical practice around the middle twentieth century, transthoracic echocardiography has developed to become a highly sophisticated and widely performed cardiac imaging modality in the diagnosis of heart disease. This evolution from an emerging technique with limited application, into a complex modality capable of detailed cardiac assessment has been driven by technological innovations that have both refined 'standard' 2D and Doppler imaging and led to the development of new diagnostic techniques. Accordingly, the adult transthoracic echocardiogram has evolved to become a comprehensive assessment of complex cardiac anatomy, function and haemodynamics. This guideline protocol from the British Society of Echocardiography aims to outline the minimum dataset required to confirm normal cardiac structure and function when performing a comprehensive standard adult echocardiogram and is structured according to the recommended sequence of acquisition. It is recommended that this structured approach to image acquisition and measurement protocol forms the basis of every standard adult transthoracic echocardiogram. However, when pathology is detected and further analysis becomes necessary, views and measurements in addition to the minimum dataset are required and should be taken with reference to the appropriate British Society of Echocardiography imaging protocol. It is anticipated that the recommendations made within this guideline will help standardise the local, regional and national practice of echocardiography, in addition to minimising the inter and intra-observer variation associated with echocardiographic measurement and interpretation.
Collapse
Affiliation(s)
- Shaun Robinson
- North West Anglia NHS Foundation Trust, Peterborough, Cambridgeshire, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | - David Oxborough
- Liverpool John Moores University, Research Institute for Sports and Exercise Science, Liverpool, Merseyside, UK
| | - Rick Steeds
- University Hospitals Birmingham NHS Trust and Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, West Midlands, UK
| | | | - Martin Stout
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Keith Pearce
- University Hospital South Manchester NHS Foundation Trust, Manchester, UK
| | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Essex, UK
| | - Liam Ring
- West Suffolk Hospital NHS Foundation Trust, Bury St Edmunds, Suffolk, UK
| | | | - Waheed Akhtar
- Lincolnshire Heart Centre, United Lincoln Hospitals NHS Trust, Lincoln, Lincolnshire, UK
| | - Radwa Bedair
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | | | | | - Cheryl Oxley
- University Hospitals of the North Midlands, Stoke-on-Trent, Staffordshire, UK
| | | | | | | | - Karen Parker
- East and North Hertfordshire NHS Trust, Stevenage, Hertfordshire, UK
| | - James Willis
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | |
Collapse
|
987
|
Hjorth-Hansen AK, Andersen GN, Graven T, Gundersen GH, Kleinau JO, Mjølstad OC, Skjetne K, Stølen S, Torp H, Dalen H. Feasibility and Accuracy of Tele-Echocardiography, With Examinations by Nurses and Interpretation by an Expert via Telemedicine, in an Outpatient Heart Failure Clinic. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:2313-2323. [PMID: 32436616 DOI: 10.1002/jum.15341] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 04/14/2020] [Accepted: 04/26/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To study the feasibility and accuracy of focused echocardiography by nurses supported by near-real-time interpretation via telemedicine by an experienced cardiologist. METHODS Fifty consecutive patients were included from an outpatient heart failure (HF) clinic. Limited echocardiography was performed by 1 of 3 specialized nurses. The echocardiograms were transferred by a secure transfer model for near-real-time interpretation to 1 out-of-hospital cardiologist, assessing, among others, the left ventricular (LV) internal diameter, end-diastolic volume, ejection fraction, left atrial (LA) indexed end-systolic volume, mitral early inflow velocity (E), the ratio of E to mitral late inflow, and the ratio of E to the mitral annular early diastolic velocity. The reference method was echocardiography by 1 of 4 experienced cardiologists. RESULTS The median age of the population (46% women) was 79 (range, 33-95) years. The assessment and quantification of LA and LV dimensions, volumes, and functional indices were feasible in 94% or more via the telemedical approach. The agreement with reference measurements was very high by the telemedical approach. The mean duration ± SD of the complete telemedical approach from the start of echocardiography until the cardiologist's report was received by the caregiving nurse was 1.32 ± 0.36 (range, 1.58) hours. The correlations with reference to the above-specified indices were r = 0.75 to 0.94. CONCLUSIONS Limited echocardiography by nurses in an outpatient heart failure clinic, supported by interpretation by an out-of-hospital cardiologist, was feasible and reliable. This may reduce geographic disparities and allow more patients to benefit from the advantages of implementing focused echocardiography by noncardiologists in diagnostics and follow-up.
Collapse
Affiliation(s)
- Anna Katarina Hjorth-Hansen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Garrett Newton Andersen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Torbjørn Graven
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Guri Holmen Gundersen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens Olaf Kleinau
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Ole Christian Mjølstad
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway
| | - Kyrre Skjetne
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Stian Stølen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Hans Torp
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Internal Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway
| |
Collapse
|
988
|
Yazaki K, Ejima K, Kataoka S, Higuchi S, Kanai M, Yagishita D, Shoda M, Hagiwara N. Prognostic Significance of Post-Procedural Left Ventricular Ejection Fraction Following Atrial Fibrillation Ablation in Patients With Systolic Dysfunction. Circ Rep 2020; 2:707-714. [PMID: 33693200 PMCID: PMC7937527 DOI: 10.1253/circrep.cr-20-0111] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background:
Atrial fibrillation (AF) ablation is associated with a good prognosis; nevertheless, the effect of post-procedural systolic function on a patient’s prognosis remains uncertain. Methods and Results:
Of 1,077 consecutive patients undergoing AF ablation, the prognosis of 150 patients with abnormal left ventricular ejection fraction (LVEF; <50%) was evaluated. Patients were categorized as having reduced LVEF (rEF; LVEF <40%), mid-range ejection fraction (mrEF; 40%≤LVEF<50%), or preserved LVEF (pEF; LVEF ≥50%). Post-procedural LVEF, evaluated 3 months after the procedure, was post-rEF in 28 patients (19%), post-mrEF in 49 (33%), and post-pEF in 73 (49%). During the median follow-up of 31 months, the cumulative ratios of the composite outcome (heart failure hospitalization or death) in the post-rEF, post-mrEF, and post-pEF groups were 18%, 5%, and 2%, respectively, at 1 year and 50%, 13%, and 4%, respectively, at 3 years (P<0.0001). The post-rEF group had a 4.5- to 5.0-fold higher risk of the outcome compared with the post-pEF group, whereas the post-mrEF group showed no risk after adjusting for confounders, including age ≥65 years, preprocedural LVEF category, and recurrence of atrial tachyarrhythmia. Conclusions:
Patients with post-mrEF had a comparable prognosis to those with post-pEF over a relatively long follow-up, whereas those with post-rEF had the poorest outcome of the 3 groups, regardless of preprocedural LVEF status.
Collapse
Affiliation(s)
- Kyoichiro Yazaki
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Koichiro Ejima
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan.,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University Tokyo Japan
| | - Shohei Kataoka
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Satoshi Higuchi
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Miwa Kanai
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Daigo Yagishita
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan
| | - Morio Shoda
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan.,Clinical Research Division for Heart Rhythm Management, Department of Cardiology, Tokyo Women's Medical University Tokyo Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University School of Medicine Tokyo Japan
| |
Collapse
|
989
|
Goulart C, Caruso F, Arêas G, dos Santos P, Camargo P, de Carvalho L, Roscani M, Mendes R, Borghi-Silva A. Impact of chronic obstructive pulmonary disease on linear and nonlinear dynamics of heart rate variability in patients with heart failure. Braz J Med Biol Res 2020; 54:e10084. [PMID: 33263641 PMCID: PMC7695451 DOI: 10.1590/1414-431x202010084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 09/10/2020] [Indexed: 12/14/2022] Open
Abstract
The objective of this study was to investigate the impact of chronic obstructive pulmonary disease (COPD)-heart failure (HF) coexistence on linear and nonlinear dynamics of heart rate variability (HRV). Forty-one patients (14 with COPD-HF and 27 HF) were enrolled and underwent pulmonary function and echocardiography evaluation to confirm the clinical diagnosis. Heart rate (HR) and R-R intervals (iRR) were collected during active postural maneuver (APM) [supine (10 min) to orthostasis (10 min)], respiratory sinus arrhythmia maneuver (RSA-M) (4 min), and analysis of frequency domain, time domain, and nonlinear HRV. We found expected autonomic response during orthostatic changes with reduction of mean iRR, root mean square of successive differences between heart beats (RMSSD), RR tri index, and high-frequency [HF (nu)] and an increased mean HR, low-frequency [LF (nu)], and LF/HF (nu) compared with supine only in HF patients (P<0.05). Patients with COPD-HF coexistence did not respond to postural change. In addition, in the orthostatic position, higher HF nu and lower LF nu and LF/HF (nu) were observed in COPD-HF compared with HF patients. HF patients showed an opposite response during RSA-M, with increased sympathetic modulation (LF nu) and reduced parasympathetic modulation (HF nu) (P<0.05) compared with COPD-HF patients. COPD-HF directly influenced cardiac autonomic modulation during active postural change and controlled breathing, demonstrating an autonomic imbalance during sympathetic and parasympathetic maneuvers compared with isolated HF.
Collapse
Affiliation(s)
- C.L. Goulart
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - F.R. Caruso
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - G.P.T. Arêas
- Laboratório de Fisiologia Humana, Departamento de Fisiologia, Universidade Federal do Amazonas, Manaus, AM, Brasil
| | - P.B. dos Santos
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - P.F. Camargo
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - L.C.S. de Carvalho
- Centro de Ciência e Tecnologia em Energia e Sustentabilidade, Universidade Federal do Reconcavo da Bahia, Feira de Santana, BA, Brasil
| | - M.G. Roscani
- Departamento de Medicina, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - R.G. Mendes
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| | - A. Borghi-Silva
- Laboratório de Fisioterapia Cardiopulmonar, Departamento de Fisioterapia, Universidade Federal de São Carlos, São Carlos, SP, Brasil
| |
Collapse
|
990
|
Zada M, Lo Q, Boyd AC, Bradley S, Devine K, Denaro CP, Sadick N, Richards DAB, Tchan MC, Thomas L. Basal Segmental Longitudinal Strain: A Marker of Subclinical Myocardial Involvement in Anderson-Fabry Disease. J Am Soc Echocardiogr 2020; 34:405-413.e2. [PMID: 33242609 DOI: 10.1016/j.echo.2020.11.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/12/2020] [Accepted: 11/14/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiac involvement in Anderson-Fabry disease (AFD) is associated with increased left ventricular (LV) wall thickness. The aim of this study was to evaluate if two-dimensional global and regional strain in patients with AFD can identify early myocardial involvement (when LV wall thickness and function are normal). Additionally, the association of altered strain with adverse cardiovascular events was evaluated. METHODS In a retrospective cross-sectional study, 43 patients with AFD, before enzyme replacement therapy (mean age, 44 ± 12 years; 58.1% men), were compared with age- and gender-matched healthy control subjects. The mean follow-up duration among patients with AFD for major adverse cardiovascular events (MACE) was 82 months. RESULTS LV ejection fraction was similar between groups (patients with AFD vs control subjects, 61 ± 8% vs 61 ± 6%; P = .89). However, global longitudinal strain (LS) was impaired in patients with AFD compared with control subjects (-16.5 ± 3.8% vs -20.2 ± 1.7%, P < .001), with greater impairment in patients with AFD with increased LV wall thickness (-15.4 ± 3.9% vs -18.7 ± 2.3%, P < .006). Additionally, LS was most impaired in the basal segments in patients with AFD (-14.8 ± 3.7% vs -20.3 ± 1.1%, P < .001). MACE occurred in 19 of 43 patients (four women, 15 men), and Kaplan-Meier analysis demonstrated that MACE were associated with impaired basal LS. CONCLUSIONS In patients with AFD, altered basal LS is present even in those with normal LV wall thickness and is associated with MACE. Therefore, basal LS should be considered when screening for cardiac involvement in AFD, particularly in female patients with AFD with normal LV wall thickness.
Collapse
Affiliation(s)
- Matthew Zada
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - Queenie Lo
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia
| | | | - Sue Bradley
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia
| | - Kerry Devine
- Genetic Medicine, Westmead Hospital, Sydney, Australia
| | - Charles P Denaro
- Department of Internal Medicine and Aged Care, Royal Brisbane and Women's Hospital, Brisbane, Australia; University of Queensland Faculty of Medicine, Brisbane, Australia
| | - Norman Sadick
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia
| | - David A B Richards
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia
| | | | - Liza Thomas
- Westmead Clinical School, University of Sydney, Westmead Hospital, Sydney, Australia; Department of Cardiology, Westmead Hospital, Sydney, Australia; South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Sydney, Australia.
| |
Collapse
|
991
|
Qin Y, Wu X, Wang J, Li Y, Ding X, Guo D, Jiang Z, Zhu W, Cai Q, Lu X. Value of territorial work efficiency estimation in non-ST-segment-elevation acute coronary syndrome: a study with non-invasive left ventricular pressure-strain loops. Int J Cardiovasc Imaging 2020; 37:1255-1265. [PMID: 33226551 DOI: 10.1007/s10554-020-02110-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 11/12/2020] [Indexed: 11/30/2022]
Abstract
Non-ST-segment-elevation acute coronary syndrome (NSTE-ACS) patients with normal left ventricular (LV) ejection fraction (LVEF) and wall motion require a non-invasive tool to detect LV risk areas. This study utilized non-invasive LV pressure-strain loops to evaluate territorial myocardial work efficiency (WE) for identifying obstructive coronary artery stenosis, in patients with non-obstructive or obstructive coronary artery stenosis NSTE-ACS, the latter with or without occlusion. Global and territorial longitudinal strain (LS) analyses were performed via speckle-tracking imaging before coronary angiography. LV pressure-strain loops estimated global and territorial myocardial work index (MWI), constructive work (CW), wasted work (WW), and WE. Receiver operating characteristic curve analysis was used to determine the optimal cutoff value of independent parameters to detect obstructive coronary artery stenosis. Compared with non-obstructive, obstructive coronary artery stenosis showed significantly lower global and territorial LS, MWI, CW, and WE, and higher WW. Territorial LS, MWI, CW, and WE were significantly worse in territories of coronary occlusion. Territorial WE was the best parameter for predicting obstructive coronary artery stenosis (AUC 0.80, cutoff < 96%, sensitivity 73%, specificity 70%, P < 0.001). In patients with NSTE-ACS with normal wall motion and LVEF, territorial WE is more accurate than territorial LS or MWI to identify LV risk areas.
Collapse
Affiliation(s)
- YunYun Qin
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - XiaoPeng Wu
- Department of Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | | | - YiDan Li
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - XueYan Ding
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - DiChen Guo
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - Zhe Jiang
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - WeiWei Zhu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China
| | - QiZhe Cai
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
| | - XiuZhang Lu
- Department of Echocardiography, Heart Center, Beijing Chao Yang Hospital, Capital Medical University, Beijing, 100020, China.
| |
Collapse
|
992
|
Pellicori P, Platz E, Dauw J, Ter Maaten JM, Martens P, Pivetta E, Cleland JGF, McMurray JJV, Mullens W, Solomon SD, Zannad F, Gargani L, Girerd N. Ultrasound imaging of congestion in heart failure: examinations beyond the heart. Eur J Heart Fail 2020; 23:703-712. [PMID: 33118672 DOI: 10.1002/ejhf.2032] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/12/2020] [Accepted: 10/22/2020] [Indexed: 12/15/2022] Open
Abstract
Congestion, related to pressure and/or fluid overload, plays a central role in the pathophysiology, presentation and prognosis of heart failure and is an important therapeutic target. While symptoms and physical signs of fluid overload are required to make a clinical diagnosis of heart failure, they lack both sensitivity and specificity, which might lead to diagnostic delay and uncertainty. Over the last decades, new ultrasound methods for the detection of elevated intracardiac pressures and/or fluid overload have been developed that are more sensitive and specific, thereby enabling earlier and more accurate diagnosis and facilitating treatment strategies. Accordingly, we considered that a state-of-the-art review of ultrasound methods for the detection and quantification of congestion was timely, including imaging of the heart, lungs (B-lines), kidneys (intrarenal venous flow), and venous system (inferior vena cava and internal jugular vein diameter).
Collapse
Affiliation(s)
- Pierpaolo Pellicori
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - Elke Platz
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jeroen Dauw
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Jozine M Ter Maaten
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands
| | - Pieter Martens
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Doctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
| | - Emanuele Pivetta
- Division of Emergency Medicine and High Dependency Unit, AOU Città della Salute e della Scienza di Torino, Cancer Epidemiology Unit and CPO Piemonte, Department of Medical Sciences, University of Turin, Turin, Italy
| | - John G F Cleland
- Robertson Institute of Biostatistics and Clinical Trials Unit, University of Glasgow, Glasgow, UK
| | - John J V McMurray
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Wilfried Mullens
- Department of Cardiology, Ziekenhuis Oost-Limburg (ZOL), Genk, Belgium.,Biomedical Research Institute, Faculty of Medicine and Life Sciences, LCRC, Hasselt University, Diepenbeek, Belgium
| | - Scott D Solomon
- Cardiovascular Division, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Faiez Zannad
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Nicolas Girerd
- Université de Lorraine, INSERM, Centre d'Investigations Cliniques Plurithématique, INSERM 1433, CHRU de Nancy, Institut Lorrain du Coeur et des Vaisseaux, Nancy, France.,INI-CRCT (Cardiovascular and Renal Clinical Trialists) F-CRIN Network, Nancy, France
| |
Collapse
|
993
|
Mitchell C, Korcarz CE, Zagzebski JA, Stein JH. Effects of ultrasound technology advances on measurement of carotid intima-media thickness: A review. Vasc Med 2020; 26:81-85. [PMID: 33203316 DOI: 10.1177/1358863x20969826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this review, we describe how technological advances in ultrasound imaging related to transducer construction and image processing fundamentally alter generation of ultrasound images to produce better quality images with higher resolution. However, carotid intima-media thickness (IMT) measurements made from images acquired on modern ultrasound systems are not comparable to historical population nomograms that were used to determine wall thickness thresholds that inform atherosclerotic cardiovascular disease risk. Because it is nearly impossible to replicate instrumentation settings that were used to create the reference carotid IMT nomograms and to place an individual's carotid IMT value in or above a clinically relevant percentile, carotid IMT measurements have a very limited role in clinical medicine, but remain a useful research tool when instrumentation, presets, image acquisition, and measurements can be standardized. In addition to new validation studies, it would be useful for the ultrasound imaging community to reach a consensus regarding technical aspects of ultrasound imaging acquisition, processing, and display for blood vessels so standard presets and imaging approaches could reliably yield the same measurements.
Collapse
Affiliation(s)
- Carol Mitchell
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Claudia E Korcarz
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - James A Zagzebski
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - James H Stein
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|
994
|
Gan GCH, Bhat A, Chen HHL, Fernandez F, Byth K, Eshoo S, Thomas L. Determinants of LA reservoir strain: Independent effects of LA volume and LV global longitudinal strain. Echocardiography 2020; 37:2018-2028. [PMID: 33211337 DOI: 10.1111/echo.14922] [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: 09/05/2020] [Revised: 10/22/2020] [Accepted: 10/25/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Left atrial (LA) deformation during the reservoir phase (LASr) has demonstrated strong prognostic value in different clinical settings. Although determinants of left atrial reservoir strain including left atrial relaxation, left atrial compliance, and left ventricular longitudinal systolic function are fairly well defined, there is incomplete information regarding the effect of left atrial volume on this relationship which is the focus of our study. METHOD Consecutive patients without prior cardiac disease referred for transthoracic echocardiography were prospectively recruited. All participants underwent clinical assessment, transthoracic echocardiography (TTE), and screening exercise stress test. Only patients with normal left ventricular ejection fraction (LVEF) without left ventricular hypertrophy (LVH) or myocardial ischemia on stress testing were included. RESULTS A total of 260 patients (57% male, mean age 59 ± 14 years) were included. 70% had hypertension, 33% had diabetes mellitus, and 31% had both HTN and DM. On multivariate analysis, age, e', LAVI, and LV GLS (P < .01 for all) showed an independent association with LASr. Of interest, at lower tertiles of LAVI, a linear decrease in LASr was observed parallel to worsening LV GLS, whilst at higher tertiles of LAVI, the reduction in LASr was non-linear implying that LA enlargement, consequent to LA remodeling, had an incremental effect on LASr. CONCLUSION Age, e', LV GLS, and LAVI were independently associated with LASr. LA remodeling reflected by larger LAVI had an incremental negative association with LASr independent of LV GLS.
Collapse
Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Aditya Bhat
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Henry H L Chen
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia
| | - Fernando Fernandez
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Karen Byth
- Biostatistics Unit, Research and Education Network, Westmead Hospital and The University of Sydney, Sydney, NSW, Australia
| | - Suzanne Eshoo
- Department of Cardiology, Blacktown Hospital, Sydney, NSW, Australia.,Western Sydney University, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
995
|
Soulat-Dufour L, Addetia K, Miyoshi T, Citro R, Daimon M, Fajardo PG, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Diehl M, Schreckenberg M, Mor-Avi V, Asch FM, Lang RM. Normal Values of Right Atrial Size and Function According to Age, Sex, and Ethnicity: Results of the World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr 2020; 34:286-300. [PMID: 33212183 DOI: 10.1016/j.echo.2020.11.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 10/20/2020] [Accepted: 11/10/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The World Alliance Societies of Echocardiography study is a multicenter, international, prospective, cross-sectional study whose aims were to evaluate healthy adult individuals to establish age- and sex-normative values of echocardiographic parameters and to determine whether differences exist among people from different countries and of different ethnicities. The present report focuses on two-dimensional (2D) and three-dimensional (3D) right atrial (RA) size and function. METHODS Transthoracic 2D and 3D echocardiographic images were obtained in 2,008 healthy adult individuals evenly distributed among subgroups according to sex (1,033 men, 975 women) and age 18 to 40 years (n = 854), 41 to 65 years (n = 653), and >65 years (n = 501). For ethnicity, 34.9% were white, 41.6% Asian, and 9.7% black. Images were analyzed in a core laboratory according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. RA measurements included 2D dimensions, 2D and 3D RA volumes (RAVs) indexed to body surface area (BSA), emptying fraction (EmF), and global longitudinal strain, including total/reservoir, passive/conduit, and active/contractile phases. Differences among age and sex categories and among countries were also examined. RESULTS RAVs were larger in men (even after BSA indexing), while 3D total EmF and global longitudinal strain magnitudes were higher in women. For both sexes, there were no significant age-related differences in 2D RAV measurements, but 3D RAV values differed minimally with age, remaining significant after BSA indexing. RA total EmF and reservoir strain and passive EmF and conduit strain magnitude were lower in older groups for both sexes. Interestingly, whereas RA active EmF increased with age, contractile strain magnitude decreased. Considerable geographic variations were identified: Asians of both sexes had significantly lower BSA than non-Asians, and their 2D and 3D end-systolic RAVs were significantly smaller even after BSA indexing. Of note, 2D end-systolic RAVs in this group were considerably lower than normal values provided in the current guidelines. CONCLUSIONS There is significant sex, age, and geographic variability in normal RA size and function parameters. Current guideline-recommended normal ranges for RA size and function parameters should be adjusted geographically on the basis of the results of this study.
Collapse
Affiliation(s)
| | | | - Tatsuya Miyoshi
- MedStar Health Research Institute, Washington, District of Columbia
| | | | | | | | | | | | | | - Denisa Muraru
- University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | | | - Seung Woo Park
- Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | | | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Yun Zhang
- Qilu Hospital of Shandong University, Jinan, China
| | - Markus Diehl
- TOMTEC Imaging Systems, Unterschleissheim, Germany
| | | | | | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
| | | |
Collapse
|
996
|
Lichtblau M, Bader PR, Saxer S, Berlier C, Schwarz EI, Hasler ED, Furian M, Grünig E, Bloch KE, Ulrich S. Right Atrial Pressure During Exercise Predicts Survival in Patients With Pulmonary Hypertension. J Am Heart Assoc 2020; 9:e018123. [PMID: 33146048 PMCID: PMC7763735 DOI: 10.1161/jaha.120.018123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/30/2020] [Indexed: 12/29/2022]
Abstract
Background We investigated changes in right atrial pressure (RAP) during exercise and their prognostic significance in patients assessed for pulmonary hypertension (PH). Methods and Results Consecutive right heart catheterization data, including RAP recorded during supine, stepwise cycle exercise in 270 patients evaluated for PH, were analyzed retrospectively and compared among groups of patients with PH (mean pulmonary artery pressure [mPAP] ≥25 mm Hg), exercise-induced PH (exPH; resting mPAP <25 mm Hg, exercise mPAP >30 mm Hg, and mPAP/cardiac output >3 Wood Units (WU)), and without PH (noPH). We investigated RAP changes during exercise and survival over a median (quartiles) observation period of 3.7 (2.8-5.6) years. In 152 patients with PH, 58 with exPH, and 60 with noPH, median (quartiles) resting RAP was 8 (6-11), 6 (4-8), and 6 (4-8) mm Hg (P<0.005 for noPH and exPH versus PH). Corresponding peak changes (95% CI) in RAP during exercise were 5 (4-6), 3 (2-4), and -1 (-2 to 0) mm Hg (noPH versus PH P<0.001, noPH versus exPH P=0.027). RAP increase during exercise correlated with mPAP/cardiac output increase (r=0.528, P<0.001). The risk of death or lung transplantation was higher in patients with exercise-induced RAP increase (hazard ratio, 4.24; 95% CI, 1.69-10.64; P=0.002) compared with patients with unaltered or decreasing RAP during exercise. Conclusions In patients evaluated for PH, RAP during exercise should not be assumed as constant. RAP increase during exercise, as observed in exPH and PH, reflects hemodynamic impairment and poor prognosis. Therefore, our data suggest that changes in RAP during exercise right heart catheterization are clinically important indexes of the cardiovascular function.
Collapse
Affiliation(s)
- Mona Lichtblau
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
| | - Patrick R. Bader
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
- Institute of Intensive Care MedicineUniversity Hospital ZürichZürichSwitzerland
| | - Stéphanie Saxer
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
| | - Charlotte Berlier
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
| | - Esther I. Schwarz
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
| | | | - Michael Furian
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
| | - Ekkehard Grünig
- Centre for Pulmonary HypertensionThoraxklinik Heidelberg gGmbH at Heidelberg University HospitalHeidelbergGermany
| | - Konrad E. Bloch
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
| | - Silvia Ulrich
- Department of PulmonologyUniversity Hospital ZürichZürichSwitzerland
| |
Collapse
|
997
|
An Integrated Imaging and Circulating Biomarker Approach for Secondary Tricuspid Regurgitation. J Pers Med 2020; 10:jpm10040233. [PMID: 33207714 PMCID: PMC7712812 DOI: 10.3390/jpm10040233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 11/17/2022] Open
Abstract
Secondary tricuspid regurgitation (sTR) is frequent among patients with heart failure with reduced ejection fraction (HFrEF), however it confers considerable diagnostic challenges. The assessment of neurohumoral activation may constitute a valuable supplement to the current imaging-based diagnostic process. This study sought to investigate the expression of complementary biomarkers in sTR and to evaluate the effectiveness of integrating their assessment into the diagnostic process. We enrolled 576 HFrEF patients recording echocardiographic and biochemical measurements, i.e., N-terminal pro-B-type natriuretic peptide, mid-regional pro-atrial natriuretic peptide (MR-proANP), mid-regional pro-adrenomedullin, C-terminal pro-endothelin-1 (CT-pro-ET1), and copeptin. Plasma levels of the aforementioned neurohormones were significantly elevated with increasing sTR severity (p < 0.001 for all). CT-pro-ET1 and MR-proANP were the closest related to severe sTR (adj. OR 1.46; 95%CI 1.11–1.91, p = 0.006 and adj. OR 1.45, 95%CI 1.13–1.87, p = 0.004, respectively). In patients with moderate-to-severe sTR, adding selected biomarkers (i.e., CT-pro-ET1 and MR-proANP) resulted in a substantial improvement in the discriminatory power regarding long-term mortality (C-statistic: 0.54 vs. 0.65, p < 0.001; continuous NRI 57%, p < 0.001). Circulating biomarkers closely relate to sTR severity and correlate with hemodynamic and morphologic mechanisms of sTR. Specifically, MR-proANP and CT-pro-ET1 are closely linked to the presence of severe sTR, and a combined assessment with the guideline recommended echocardiographic grading significantly improves individual risk stratification.
Collapse
|
998
|
Sugihara H, Kimura K, Yamanouchi K, Teramoto N, Okano T, Daimon M, Morita H, Takenaka K, Shiga T, Tanihata J, Aoki Y, Inoue-Nagamura T, Yotsuyanagi H, Komuro I. Age-Dependent Echocardiographic and Pathologic Findings in a Rat Model with Duchenne Muscular Dystrophy Generated by CRISPR/Cas9 Genome Editing. Int Heart J 2020; 61:1279-1284. [PMID: 33191355 DOI: 10.1536/ihj.20-372] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Duchenne muscular dystrophy (DMD) is X-linked recessive myopathy caused by mutations in the dystrophin gene. Although conventional treatments have improved their prognosis, inevitable progressive cardiomyopathy is still the leading cause of death in patients with DMD. To explore novel therapeutic options, a suitable animal model with heart involvement has been warranted.We have generated a rat model with an out-of-frame mutation in the dystrophin gene using CRISPR/Cas9 genome editing (DMD rats). The aim of this study was to evaluate their cardiac functions and pathologies to provide baseline data for future experiments developing treatment options for DMD.In comparison with age-matched wild rats, 6-month-old DMD rats showed no significant differences by echocardiographic evaluations. However, 10-month-old DMD rats showed significant deterioration in left ventricular (LV) fractional shortening (P = 0.024), and in tissue Doppler peak systolic velocity (Sa) at the LV lateral wall (P = 0.041) as well as at the right ventricular (RV) free-wall (P = 0.004). These functional findings were consistent with the fibrotic distributions by histological analysis.Although the cardiac phenotype was milder than anticipated, DMD rats showed similar distributions and progression of heart involvement to those of patients with DMD. This animal may be a useful model with which to develop effective drugs and to understand the underlying mechanisms of progressive heart failure in patients with DMD.
Collapse
Affiliation(s)
- Hidetoshi Sugihara
- Department of Veterinary Physiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Koichi Kimura
- The Institute of Medical Science, The University of Tokyo.,Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Keitaro Yamanouchi
- Department of Veterinary Physiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Naomi Teramoto
- Department of Veterinary Physiology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Tomoko Okano
- Department of Laboratory Medicine, The University of Tokyo Hospital
| | - Masao Daimon
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo.,Department of Laboratory Medicine, The University of Tokyo Hospital
| | - Hiroyuki Morita
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| | - Katsu Takenaka
- Department of Laboratory Medicine, The University of Tokyo Hospital
| | - Takanori Shiga
- Department of Veterinary Pathology, Graduate School of Agricultural and Life Sciences, The University of Tokyo
| | - Jun Tanihata
- Department of Molecular Therapy, National Center of Neurology and Psychiatry
| | - Yoshitsugu Aoki
- Department of Molecular Therapy, National Center of Neurology and Psychiatry
| | | | | | - Issei Komuro
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
| |
Collapse
|
999
|
Al Saikhan L, Alobaida M, Bhuva A, Chaturvedi N, Heasman J, Hughes AD, Jones S, Eastwood S, Manisty C, March K, Ghosh AK, Mayet J, Oguntade A, Tillin T, Williams S, Wright A, Park C. Imaging Protocol, Feasibility, and Reproducibility of Cardiovascular Phenotyping in a Large Tri-Ethnic Population-Based Study of Older People: The Southall and Brent Revisited (SABRE) Study. Front Cardiovasc Med 2020; 7:591946. [PMID: 33304933 PMCID: PMC7693529 DOI: 10.3389/fcvm.2020.591946] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 10/05/2020] [Indexed: 11/23/2022] Open
Abstract
Background: People of South Asian and African Caribbean ethnicities living in UK have a high risk of cardiometabolic disease. Limited data exist regarding detailed cardiometabolic phenotyping in this population. Methods enabling this are widely available, but the practical aspects of undertaking such studies in large and diverse samples are seldom reported. Methods: The Southall and Brent Revisited (SABRE) study is the UK's largest tri-ethnic longitudinal cohort. Over 1,400 surviving participants (58-85 years) attended the 2nd study visit (2008-2011); during which, comprehensive cardiovascular phenotyping, including 3D-echocardiography [3D-speckle-tracking (3D-STE)], computed tomography, coronary artery calcium scoring, pulse wave velocity, central blood pressure, carotid artery ultrasound, and retinal imaging, were performed. We describe the methods used with the aim of providing a guide to their feasibility and reproducibility in a large tri-ethnic population-based study of older people. Results: Conventional echocardiography and all vascular measurements showed high feasibility (>90% analyzable of clinic attendees), but 3D-echocardiography (3DE) and 3D-STE were less feasible (76% 3DE acquisition feasibility and 38% 3D-STE feasibility of clinic attendees). 3D-STE feasibility differed by ethnicity, being lowest in South Asian participants and highest in African Caribbean participants (p < 0.0001). Similar trends were observed in men (P < 0.0001) and women (P = 0.005); however, in South Asians, there were more women with unreadable 3D-images compared to men (67 vs. 58%). Intra- and inter-observer variabilities were excellent for most of conventional and advanced echocardiographic measures. The test-retest reproducibility was good-excellent and fair-good for conventional and advanced echocardiographic measures, respectively, but lower than when re-reading the same images. All vascular measures demonstrated excellent or fair-good reproducibility. Conclusions: We describe the feasibility and reproducibility of detailed cardiovascular phenotyping in an ethnically diverse population. The data collected will lead to a better understanding of why people of South Asian and African Caribbean ancestry are at elevated risk of cardiometabolic diseases.
Collapse
Affiliation(s)
- Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Muath Alobaida
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Department of Basic Science, Prince Sultan Bin Abdulaziz College for Emergency Medical Services, King Saud University, Riyadh, Saudi Arabia
| | - Anish Bhuva
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - John Heasman
- National Heart & Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Siana Jones
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Sophie Eastwood
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Charlotte Manisty
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Katherine March
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Arjun K. Ghosh
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
- Cardio-Oncology Service, Department of Cardiology, Barts Heart Centre, Barts Health NHS Trust, St Bartholomew's Hospital, London, United Kingdom
- Cardio-Oncology Service, Department of Cardiology, University College London Hospital, London, United Kingdom
| | - Jamil Mayet
- National Heart & Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Ayodipupo Oguntade
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Suzanne Williams
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Andrew Wright
- National Heart & Lung Institute, Imperial College London and Imperial College Healthcare NHS Trust, Hammersmith Hospital, London, United Kingdom
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing, Department of Population Science & Experimental Medicine, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| |
Collapse
|
1000
|
Liu Y, Chen B, Zhang Y, Zuo W, Li Q, Jin L, Kong D, Pan C, Dong L, Shu X, Ge J. Sources of Variability in Vena Contracta Area Measurement for Tricuspid Regurgitation Severity Grading: Comparison of Technical Settings and Vendors. J Am Soc Echocardiogr 2020; 34:270-278.e1. [PMID: 33166630 DOI: 10.1016/j.echo.2020.10.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 10/22/2020] [Accepted: 10/30/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Previous studies found different cutoffs of vena contracta area (VCA) to define severe tricuspid regurgitation (TR). The aim of this study was to investigate the factors associated with such variability by comparing technical variables and vendors. METHODS Sixty-nine patients with scheduled tricuspid surgery were included in this prospective study. For each patient, TR data sets were obtained on three-dimensional color Doppler transthoracic echocardiography on at least two of three systems: GE Vivid E95 (n = 39), Siemens SC2000 Prime (n = 64), and Philips EPIQ 7C (n = 60). VCA was measured using default settings or with color baseline shifted on all three platforms and with minimal color gain (10%-20%) on the GE platform. RESULTS Color gain reduction and baseline shift caused significant change sin VCA measurement (-46% and 10%, respectively). Intervendor comparison exhibited wide limits of agreement (narrowest range, -74% to 167%), with either default or optimized settings. Different technical settings, platforms, and reference methods all produced different VCA cutoffs for severe TR. CONCLUSIONS VCA measurement in TR is sensitive to technical factors and demonstrates intervendor variability. Technical variables in VCA measurement should be reported in detail to allow comparison among research studies. The same vendor and settings should be used for longitudinal analysis of TR VCA in the same patient in multivendor echocardiography laboratories.
Collapse
Affiliation(s)
- Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Beiqi Chen
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Yue Zhang
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Wuxu Zuo
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Quan Li
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Ling Jin
- Shanghai Medical College, Fudan University, Shanghai, China
| | - Dehong Kong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Lili Dong
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China.
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China; Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China; Shanghai Institute of Cardiovascular Diseases, Shanghai, China
| |
Collapse
|