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Alencar-Filho AC, Ferreira JMBB, Salinas JL, Fabbri C, Monteiro WM, Siqueira AM, Okoshi K, Lacerda MVG, Okoshi MP. Cardiovascular changes in patients with non-severe Plasmodium vivax malaria. IJC HEART & VASCULATURE 2016; 11:12-16. [PMID: 28616519 PMCID: PMC5441355 DOI: 10.1016/j.ijcha.2016.03.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 03/04/2016] [Indexed: 11/19/2022]
Abstract
Background Cardiovascular system involvement in patients with Plasmodium vivax malaria has been poorly addressed. The aim of this study was to evaluate cardiac structures and function, and serum markers of cardiovascular injury in patients with the non-severe form of vivax malaria in Manaus, Amazonas State, Brazil. Methods and results We prospectively evaluated 26 patients with vivax malaria in an outpatient referral hospital and compared results with a control group of 25 gender- and age-matched healthy individuals. Patients underwent clinical evaluation, laboratory tests, and transthoracic echocardiography at first evaluation (day zero, D0) and seven days (D7) after malaria diagnosis. At D0 echocardiography showed higher left ventricular (LV) systolic diameter (28.8 ± 2.82 vs 30.9 ± 4.03 mm; p = 0.037) and LV diastolic volume (82.4 ± 12.3 vs 93.8 ± 25.9 ml; p = 0.05), and lower LV ejection fraction (Teicholz method: 73.2 ± 6.59 vs 68.4 ± 4.87%; p = 0.004) in patients compared to controls. Right ventricle (RV) fractional area change (54.7 ± 5.11 vs 50.5 ± 6.71%; p = 0.014) was lower, and RV myocardial performance index (0.21 ± 0.07 vs 0.33 ± 0.19; p = 0.007), and pulmonary vascular resistance (1.13 ± 0.25 vs 1.32 ± 0.26 Woods unit; p = 0.012) were higher in patients than controls. Patients presented higher serum levels of unconjugated bilirubin (0.24 ± 0.15 vs 1.30 ± 0.89 mg/dL; p < 0.001), soluble vascular cell adhesion molecule–1 (sVCAM-1; 453 ± 143 vs 1983 ± 880 ng/mL; p < 0.001), N-terminal prohormone brain natriuretic peptide (0.59 ± 0.86 vs 1.08 ± 0.81 pg/mL; p = 0.045), and troponin T (861 ± 338 vs 1037 ± 264 pg/mL; p = 0.045), and lower levels of plasma nitrite (13.42 ± 8.15 vs 8.98 ± 3.97 μM; p = 0.016) than controls. Most alterations had reversed by D7. Conclusion Patients with non-severe Plasmodium vivax malaria present subclinical reversible cardiovascular changes.
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Affiliation(s)
| | | | | | - Camila Fabbri
- North University Center, Pharmacy School, Manaus, Brazil
| | - Wuelton Marcelo Monteiro
- Amazonas State University (UEA), Manaus, Brazil.,Tropical Disease Center "Dr. Heitor Vieira Dourado", Manaus, Brazil
| | - Andre Machado Siqueira
- National Institute of Infectology Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Murase M. Assessing ventricular function in preterm infants using tissue Doppler imaging. Expert Rev Med Devices 2016; 13:325-38. [DOI: 10.1586/17434440.2016.1153966] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Rosa GM, Gigli L, Tagliasacchi MI, Di Iorio C, Carbone F, Nencioni A, Montecucco F, Brunelli C. Update on cardiotoxicity of anti-cancer treatments. Eur J Clin Invest 2016; 46:264-84. [PMID: 26728634 DOI: 10.1111/eci.12589] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/30/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND AIMS Anti-cancer treatments markedly improved the prognosis of patients, but unfortunately might be hampered by cardiotoxicity. Both symptomatic and asymptomatic clinical forms of heart failure have been reported, which may be reversible or irreversible. The aim of this review is to provide an overview of the antineoplastic agents associated with cardiac toxicity and of the available diagnostic techniques. METHODS AND METHODS This narrative review is based on material from MEDLINE and PUBMED up to November 2015. We looked at the terms antineoplastic drugs and cardiac toxicity in combination with echocardiography, troponins, cardiac magnetic resonance, and positron emission tomography. RESULTS Anthracyclines, monoclonal antibodies, fluoropyrimidines, taxanes, alkylating agents, vinka alkaloids were reported to induce different clinical manifestations of cardioxicity. Chest radiotherapy is also associated with various forms of cardiac damage, which are indistinguishable from those found in patients with heart disease of other aetiologies and that may even appear several years after administration. Among diagnostic techniques, echocardiography is a noninvasive, cost-effective, and widely available imaging tool. Nuclear imaging and cardiac magnetic resonance may be used but are not so widely available and are more difficult to perform. Finally, some biomarkers, such as troponins, may be used to evaluate cardiac damage, but establishing the optimal timing of troponin assessment remains unclear and defining the cut-off point for positivity is still an important goal. CONCLUSIONS Cardiotoxicity of anti-cancer treatments is associated with development of heart failure. Novel diagnostic tools might be relevant to early recognize irreversible forms cardiac diseases.
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Affiliation(s)
- Gian Marco Rosa
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Lorenzo Gigli
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Maria Isabella Tagliasacchi
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Cecilia Di Iorio
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Federico Carbone
- Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, Geneva University, Geneva, Switzerland
| | - Alessio Nencioni
- Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Istituto Nazionale per la Ricerca Sul Cancro, Genoa, Italy
| | - Fabrizio Montecucco
- Division of Cardiology, Foundation for Medical Researches, Department of Medical Specialties, Geneva University, Geneva, Switzerland.,First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino-IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
| | - Claudio Brunelli
- Division of Cardiology, Department of Internal Medicine, University of Genoa - IRCCS Azienda Ospedaliera Universitaria San Martino - IST Istituto Nazionale per la Ricerca sul Cancro, Genoa, Italy
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Gupta-Malhotra M, Hamzeh RK, Poffenbarger T, McNiece-Redwine K, Hashmi SS. Myocardial Performance Index in Childhood Onset Essential Hypertension and White Coat Hypertension. Am J Hypertens 2016; 29:379-87. [PMID: 26271107 DOI: 10.1093/ajh/hpv123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 07/03/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND As a global measure of ventricular systolic and diastolic function, the myocardial performance index (MPI) can be an early indicator of hypertensive cardiomyopathy in children with essential hypertension (EH). METHODS Children with untreated newly diagnosed EH and white coat hypertension (WCH) by a 24-hour ambulatory blood pressure monitoring (ABPM), both groups without any identifiable etiology for the hypertension, were enrolled for the study. Echocardiograms and vascular ultrasounds for carotid artery intimal medial thickness were performed on all children prior to therapy. Diastolic function (peak E and A velocities, E/A ratio, isovolumic relaxation time, and deceleration times) and MPI were evaluated by simultaneous transmitral and transaortic spectral Doppler flow velocities. Systolic function was evaluated by shortening fraction and ejection fraction. RESULTS A cohort of 66 children (24 with EH, 42 with WCH, males 61%, median age of 13 years, range 10-17 years) were enrolled in the study. The demographic, anthropometric, laboratory tests, vascular ultrasound, and conventional echocardiographic parameters were similar between the 2 groups. There was a very small difference in MPI between the EH and WCH children (0.28 SD: 0.07 vs. 0.31 SD: 0.08, P = 0.045). However, in EH children, MPI increased by 0.14 units for every 10 unit increase in mean ABPM systolic BP (95% confidence interval: 0.03-0.25). CONCLUSIONS We found the increasing MPI was associated with increasing 24-hour mean systolic BP in children with EH. Therefore, MPI may have utility as a single, quick, noninvasive method of detection and tracking of subclinical hypertensive heart disease.
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Affiliation(s)
- Monesha Gupta-Malhotra
- Division of Pediatric Cardiology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA; Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA;
| | - Rabih K Hamzeh
- Division of Pediatric Cardiology, Texas Tech University, El Paso, Texas, USA
| | - Tim Poffenbarger
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Memorial Hermann Hospital, The University of Texas Health Science Center, Houston, Texas, USA
| | - Karen McNiece-Redwine
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Arkansas, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Syed Shahrukh Hashmi
- Pediatric Research Center, Department of Pediatrics, The University of Texas Health Science Center, Texas, USA
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105
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Goroshi M, Chand D. Myocardial Performance Index (Tei Index): A simple tool to identify cardiac dysfunction in patients with diabetes mellitus. Indian Heart J 2016; 68:83-7. [PMID: 26896273 PMCID: PMC4759491 DOI: 10.1016/j.ihj.2015.06.022] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2015] [Accepted: 06/12/2015] [Indexed: 01/07/2023] Open
Abstract
Background Cardiac dysfunction is the major cause of morbidity and mortality in diabetes. Myocardial Performance Index (MPI/Tei Index) includes both systolic and diastolic time intervals to assess the global cardiac dysfunction. Our aim was to assess the MPI in patients with type 2 diabetes. Material and methods This hospital-based analytic observational study was performed in the tertiary care center. The conventional Doppler parameters, tissue Doppler-derived E/E′ and MPI, were measured in all patients. Results 100 patients with type 2 diabetes were included in the study. 65 patients showed diastolic dysfunction, 33 with Grade I diastolic dysfunction, 23 with Grade II diastolic dysfunction, and 14 patients with Grade III diastolic dysfunction. The conventional Doppler showed abnormality in 44% of patients (33 patients with Grade I and 14 patient with Grade III). 23 patients were in Grade II diastolic dysfunction (12 patients showed reversal E/A on valsalva maneuver and 11 patients showed abnormality in tissue Doppler-derived E/E′, E/E′ > 15). MPI with cut-off 0.36 was found to have 94% sensitivity, 100 specificity, and 94% PPV for the detection of cardiac dysfunction. MPI negatively correlated with systolic dysfunction (rho = 0.455, p < 0.001) and positively correlated with grade of diastolic dysfunction (rho = 0.832, p < 0.001) and NYHA grading of dyspnea (rho = 0.872, p < 0.001) Conclusions MPI as a single parameter can be used for assessment in diabetic cardiac dysfunction.
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Affiliation(s)
- Manjunath Goroshi
- Department of Endocrinology, Seth G S Medical College, KEM Hospital, Parel, Mumbai 400012, India.
| | - Dipti Chand
- Professor, Department of Medicine, Govt. Medical College, Nagpur, Maharashtra, 440003, India
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106
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Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion. Heart Fail Rev 2015; 21:77-94. [DOI: 10.1007/s10741-015-9521-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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107
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Erkens R, Kramer CM, Lückstädt W, Panknin C, Krause L, Weidenbach M, Dirzka J, Krenz T, Mergia E, Suvorava T, Kelm M, Cortese-Krott MM. Left ventricular diastolic dysfunction in Nrf2 knock out mice is associated with cardiac hypertrophy, decreased expression of SERCA2a, and preserved endothelial function. Free Radic Biol Med 2015; 89:906-17. [PMID: 26475037 DOI: 10.1016/j.freeradbiomed.2015.10.409] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 10/09/2015] [Indexed: 11/20/2022]
Abstract
Increased production of reactive oxygen species and failure of the antioxidant defense system are considered to play a central role in the pathogenesis of cardiovascular disease. The transcription factor nuclear factor (erythroid-derived 2)-like 2 (Nrf2) is a key master switch controlling the expression of antioxidant and protective enzymes, and was proposed to participate in protection of vascular and cardiac function. This study was undertaken to analyze cardiac and vascular phenotype of mice lacking Nrf2. We found that Nrf2 knock out (Nrf2 KO) mice have a left ventricular (LV) diastolic dysfunction, characterized by prolonged E wave deceleration time, relaxation time and total diastolic time, increased E/A ratio and myocardial performance index, as assessed by echocardiography. LV dysfunction in Nrf2 KO mice was associated with cardiac hypertrophy, and a downregulation of the sarcoplasmic reticulum Ca(2+)-ATPase (SERCA2a) in the myocardium. Accordingly, cardiac relaxation was impaired, as demonstrated by decreased responses to β-adrenergic stimulation by isoproterenol ex vivo, and to the cardiac glycoside ouabain in vivo. Surprisingly, we found that vascular endothelial function and endothelial nitric oxide synthase (eNOS)-mediated vascular responses were fully preserved, blood pressure was decreased, and eNOS was upregulated in the aorta and the heart of Nrf2 KO mice. Taken together, these results show that LV dysfunction in Nrf2 KO mice is mainly associated with cardiac hypertrophy and downregulation of SERCA2a, and is independent from changes in coronary vascular function or systemic hemodynamics, which are preserved by a compensatory upregulation of eNOS. These data provide new insights into how Nrf2 expression/function impacts the cardiovascular system.
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Affiliation(s)
- Ralf Erkens
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Christian M Kramer
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Wiebke Lückstädt
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Christina Panknin
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Lisann Krause
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Mathias Weidenbach
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Jennifer Dirzka
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Thomas Krenz
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Evanthia Mergia
- Institute for Pharmacology and Toxicology, Ruhr-University Bochum, Bochum, Germany
| | - Tatsiana Suvorava
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany
| | - Miriam M Cortese-Krott
- Cardiovascular Research Laboratory, Division of Cardiology, Pneumology and Angiology, Medical Faculty, Heinrich Heine University of Düsseldorf, Düsseldorf, Germany.
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Vargas PE, Lopez-Candales A. Essential echocardiographic evaluation in patients with suspected pulmonary hypertension: an overview for the practicing physician. Postgrad Med 2015; 128:208-22. [PMID: 26560900 DOI: 10.1080/00325481.2016.1115715] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Prompt and accurate diagnosis of patients presenting with symptoms suggestive of pulmonary arterial hypertension (PAH) is of outmost importance as delays in identifying this clinical entity have detrimental effects on both morbidity and mortality. Initial noninvasive assessment of these patients has traditionally included a number of routine tests of which transthoracic echocardiography (TTE) has been shown to either confirm the presence of structural anomalies of the right ventricle (RV) indicative of PAH or exclude other potential causes of pulmonary hypertension (PH). Consequently, TTE has become a well-validated and readily available imaging tool not only used for this initial screening but also for routine follow-up of PH patients. Since chronic PH is known to unbalance the normal hemodynamic and mechanical homeostatic interaction between the RV and pulmonary circulation; the resulting response is that of an abnormal RV remodeling, clinically translated into progressive RV hypertrophy and dilatation. An enlarged and hypertrophied RV not only would eventually lose effective contractility but also this gradual decline in RV systolic function is the main abnormality in determining adverse clinical outcomes. Therefore, it is of outmost importance that TTE examination be comprehensive but most importantly accurate and reproducible. This review aims to highlight the most important objective measures that can be routinely employed, without added complexity, that will certainly enhance the interpretation and advance our understanding of the hemodynamic and mechanical abnormalities that PH exerts on the RV.
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Affiliation(s)
- Pedro E Vargas
- a Cardiovascular Medicine Division , University of Puerto Rico School of Medicine , San Juan , Puerto Rico
| | - Angel Lopez-Candales
- a Cardiovascular Medicine Division , University of Puerto Rico School of Medicine , San Juan , Puerto Rico
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Inuzuka R, Kuwata S, Kurishima C, Liang F, Sughimoto K, Senzaki H. Influence of Cardiac Function and Loading Conditions on the Myocardial Performance Index - Theoretical Analysis Based on a Mathematical Model. Circ J 2015; 80:148-56. [PMID: 26558878 DOI: 10.1253/circj.cj-15-0598] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The myocardial performance index (MPI) has emerged as a Doppler-derived index for global ventricular function capable of estimating combined systolic and diastolic performance. While several studies have reported its load-dependency, responses of the MPI to various hemodynamic changes have not been fully characterized. METHODS AND RESULTS The response characteristics of the MPI were examined and compared with ejection fractions (EF) by changing hemodynamic parameters within the physiological range in a lumped parameter model of the cardiovascular system. At baseline, the MPI was 0.42 and the EF was 0.68. Heart rate increase resulted in a decrease in EF and an increase in the MPI. Reduction in end-systolic elastance decreased EF and increased the MPI. Volume overload and ventricular stiffening did not affect EF but paradoxically reduced the MPI. Increased afterload due to higher systemic resistance resulted in a decrease in EF and increase in the MPI, but afterload increase caused by reduced arterial compliance led to a decrease in both EF and MPI. These MPI characteristics caused paradoxical improvement of the MPI during disease progression of chronic heart failure in a simulation of mitral regurgitation. CONCLUSIONS The MPI is affected by a wider variety of hemodynamic parameters than EF. In addition, it is predicted to decrease paradoxically with volume overload, reduction in arterial compliance, or ventricular diastolic stiffening. These MPI characteristics should be considered when assessing cardiovascular dynamics using this index.
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Affiliation(s)
- Ryo Inuzuka
- Department of Pediatrics, The University of Tokyo
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110
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Nassr AA, Youssef AA, Zakherah MS, Ismail AM, Brost BC. Clinical application of fetal left modified myocardial performance index in the evaluation of fetal growth restriction. J Perinat Med 2015; 43:749-54. [PMID: 24706424 DOI: 10.1515/jpm-2014-0018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study aims to evaluate cardiac function in fetuses with intrauterine growth restriction (IUGR) compared with healthy fetuses, using the left modified myocardial performance index (MPI) and the association between MPI and perinatal outcome. METHODS Pregnant women between 34 and 39 weeks of gestation, who met the criteria for IUGR and were scheduled for delivery at an Egyptian tertiary medical center, were prospectively enrolled in the study. Women in the same gestational-age group with uncomplicated pregnancies were included as a control group. MPI was measured in all fetuses. The IUGR group was analyzed based on normal and abnormal umbilical artery (UA) Doppler. Perinatal outcomes were recorded. RESULTS The mean left MPI was significantly higher in IUGR fetuses with abnormal UA Doppler (mean 0.58±SD 0.093) compared with healthy fetuses (mean 0.45±SD 0.070) (P<0.001). IUGR fetuses with abnormal left MPI showed significantly worse perinatal outcome and increased morbidity compared with the control group. IUGR fetuses with abnormal left MPI also showed significantly worse perinatal outcome compared with IUGR fetuses with normal MPI (whether the UA Doppler was normal or abnormal). The fetal MPI was associated with the severity of fetal compromise in IUGR fetuses based on the perinatal outcome. CONCLUSION MPI is a potentially useful tool in evaluating fetuses with suspected IUGR, which is crucial in classifying IUGR pregnancies into critical and non-critical cases and in predicting neonatal outcome.
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Abstract
Aging results in progressive deteriorations in the structure and function of the heart and is a dominant risk factor for cardiovascular diseases, the leading cause of death in Western populations. Although the phenotypes of cardiac aging have been well characterized, the molecular mechanisms of cardiac aging are just beginning to be revealed. With the continuously growing elderly population, there is a great need for interventions in cardiac aging. This article will provide an overview of the phenotypic changes of cardiac aging, the molecular mechanisms underlying these changes, and will present some of the recent advances in the development of interventions to delay or reverse cardiac aging.
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Affiliation(s)
- Ying Ann Chiao
- Department of Pathology, University of Washington, Seattle, Washington 98195
| | - Peter S Rabinovitch
- Department of Pathology, University of Washington, Seattle, Washington 98195
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112
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AboHadeed HMA, Zolaly MA, Khoshhal SQ, El-Harbi KM, Tarawah AM, Al-Hawsawi ZM, Al-Mozainy I. Assessment of cardiac functions in children with sickle cell anemia: doppler tissue imaging study. Arch Med Res 2015; 46:462-9. [PMID: 26314226 DOI: 10.1016/j.arcmed.2015.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2015] [Accepted: 08/17/2015] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS The extent in which sickle cell anemia (SCA) impacts myocardial function in children is unclear. Doppler tissue imaging (DTI) was introduced as a new non-invasive echocardiographic method for assessment of ventricular systolic and diastolic functions. We undertook this study to assess subclinical impact of SCA on global myocardial performance in affected children using DTI and to correlate it with mean hemoglobin concentration. METHODS Eighty five children with SCA (mean age 11.82 ± 3.7 years) was included as the study group and 55 age- and sex-matched healthy children as the control group. Conventional two-dimensional echocardiography was performed in both groups and DTI was used to determine right ventricular (RV) and left ventricular (LV) Tei indexes. Mean Hb concentration was correlated to the cardiac functions of SCA children. RESULTS RV and LV Tei indexes were significantly higher in SCA group (mean ± SD: 0.54 ± 0.19 vs. 0.27 ± 0.01, p <0.0001 and 0.47 ± 0.09 vs. 0.30 ± 0.07, p <0.0001, respectively). Also, mean Hb concentration was correlated negatively with both LV Tei index (r = -0.611, p <0.0001) and with RV Tei index (r = -0.894, p <0.0001). On the contrary, fractional shortening (FS) did not correlate with mean Hb concentration (r = -0.044, p = 0.681). CONCLUSIONS DTI technique appears to be more sensitive than conventional echocardiography in the early detection of myocardial dysfunction in children with SCA. This provides insights into the value of early screening and the potential for preventive therapy in children to avert cardiac morbidity and mortality in adults with SCA.
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Affiliation(s)
- Hany M A AboHadeed
- Department of Pediatrics, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia.
| | - Mohamed A Zolaly
- Department of Pediatrics, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Saad Q Khoshhal
- Department of Pediatrics, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Khaled M El-Harbi
- Department of Pediatrics, Faculty of Medicine, Taibah University, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Ahmed M Tarawah
- Department of Pediatrics, Maternity and Child Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Zakaria M Al-Hawsawi
- Department of Pediatrics, Maternity and Child Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia
| | - Ibrahim Al-Mozainy
- Department of Pediatrics, Maternity and Child Hospital, Al-Madinah Al-Munawwarah, Saudi Arabia
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Abstract
This preliminary prospective study evaluated cardiac status in 15 treatment-resistant schizophrenia patients (aged 18-55 years) without evidence of cardiovascular disease. Patients underwent clinical assessment, blood tests, ECG, and echocardiography before and during clozapine treatment for 4 weeks as doses increased from 25 to 100 mg/day. Serum concentrations of high-sensitivity C-reactive protein, troponin-I, brain natriuretic peptide, and clozapine+norclozapine were assayed at week 3; ECG and echocardiography were repeated at week 4. At moderate serum drug concentrations (124 ng/ml), the heart rate increased by 10% and high-sensitivity C-reactive protein levels were slightly elevated, but troponin-I and brain natriuretic peptide levels were not elevated. Echocardiographic indices indicated declining left ventricular (LV) diastolic and systolic function in 60-80% of participants, with an increase in systolic pulmonary artery pressure, A-wave velocity, and LV myocardial performance index by 16-24% in 60-80% of participants and a decrease in the E/A ratio by 29% in 73% of participants - all uncorrelated with drug concentrations. Early treatment with moderate doses of clozapine was associated with subclinical but substantial decreases in LV functioning in surprisingly high proportions of participants. Studies with more participants, higher drug doses, and long-term follow-up are needed to confirm and determine the course of the observed abnormalities and to evaluate their relationship with rare clinical cardiotoxicity associated with clozapine.
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Sürücü H, Baytaroğlu C, Aksoy FA, Can N. Sürücü index and others. Indian Heart J 2015; 67:341-6. [PMID: 26304566 DOI: 10.1016/j.ihj.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Revised: 04/06/2015] [Accepted: 05/14/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In this study, we have aimed to evaluate the correlation between echocardiographic parameters that test systolic and diastolic function together. METHOD The study population was divided into two groups according to Vp. Group-1 (n = 103) represented the control group (Vp > 50 cm/s) and group-2 (n = 86) represented patients with systolic and diastolic dysfunctions together (Vp ≤ 50 cm/s). The echocardiographic parameters that evaluate systolic and diastolic function together, such as the Tei and the Sürücü indices, were compared between the groups. RESULTS In group-2, the Tei index was higher (p = 0.001) and the Sürücü index was lower (p < 0.001). We also showed that the Tei and Sürücü indices were significantly and negatively correlated. That is, as the Sürücü index decreases, the Tei index increases (p = 0.001). CONCLUSION Vp is an index more affected by diastolic parameters but rarely by systolic parameters because it is measured at diastolic period. The Tei index, on the other hand, is affected by preload variables and needs two different heart cycles for calculation. The Modified Tei index, however, has limited diagnostic value because of high inter-observer variability. In this study, the usability of the Sürücü index is shown in comparison with other indices used for this purpose. Considering that it is less affected by preload variables, can be calculated over a single heart cycle, and has the ability to test variables of both systolic and diastolic periods unlike Vp. We postulate that the Sürücü index is more usable and reliable.
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Affiliation(s)
- Hüseyin Sürücü
- Private Avcılar Hospital, Cardiology Department, İstanbul, Turkey.
| | - Corç Baytaroğlu
- Private Avcılar Hospital, Cardiology Department, İstanbul, Turkey
| | - Faik Alper Aksoy
- Private Medilife Hospital, Cardiology Department, İstanbul, Turkey
| | - Naser Can
- Private Avcılar Anadolu Hospital, Cardiology Department, İstanbul, Turkey
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115
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Ge HY, Li XM, Tang XJ, Zhang Y, Liu HJ, Li YH. Optimal noninvasive assessment of initial left ventricular dysfunction in children with ectopic atrial tachycardia. Eur J Pediatr 2015; 174:1015-22. [PMID: 25665973 DOI: 10.1007/s00431-015-2500-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 01/20/2015] [Accepted: 01/28/2015] [Indexed: 10/24/2022]
Abstract
UNLABELLED Tissue Doppler imaging (TDI) can identify cardiac dysfunction in adults. This study is aimed to improve early identification of initial left ventricular (LV) dysfunction secondary to ectopic atrial tachycardia (EAT) in children by TDI. A total of 70 children with EAT were included in the present study. Cardiac function was evaluated by conventional echocardiography, TDI, and plasma N-terminal pro-brain natriuretic peptide (NT-proBNP). Doppler signals obtained from the mitral inflow and TDI of the mitral annulus were the average values of three consecutive heartbeats. Left ventricular ejection fraction (LVEF), peak early diastolic transmitral velocity (E), peak systolic mitral annulus velocity (S'), early diastolic mitral annular velocity (E'), the ratio E/E', and TDI-derived myocardial performance index (TDI-MPI) were compared between two groups of children with normal or elevated plasma NT-proBNP concentrations. Of the children, 18.6% demonstrated tachycardia-induced cardiomyopathy (TIC). Compared with LVEF, the TDI-MPI and E/E' showed better correlations with elevated plasma NT-proBNP. Addition of TDI-MPI and E/E' to LVEF provided increased information to detect elevated plasma NT-proBNP (91.67% sensitivity). CONCLUSIONS TIC occurred in 18.6% of children with EAT. Initial LV dysfunction assessed by the TDI-MPI and E/E' is associated with elevated plasma NT-proBNP, even the LVEF is normal.
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Affiliation(s)
- Hai-Yan Ge
- Department of Pediatric Cardiology, Heart Center, the First Hospital of Tsinghua University, Medical Center, Tsinghua University, Beijing, 100016, China,
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Mahjoub Y, Malaquin S, Mourier G, Lorne E, Abou Arab O, Massy ZA, Dupont H, Ducancel F. Short- versus Long-Sarafotoxins: Two Structurally Related Snake Toxins with Very Different in vivo Haemodynamic Effects. PLoS One 2015; 10:e0132864. [PMID: 26176218 PMCID: PMC4503772 DOI: 10.1371/journal.pone.0132864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/19/2015] [Indexed: 11/24/2022] Open
Abstract
Sarafotoxin-m (24 amino acids) from the venom of Atractaspis microlepidota microlepidota was the first long-sarafotoxin to be identified, while sarafotoxin-b (21 aa) is a short-sarafotoxin from Atractaspis engaddensis. Despite the presence of three additional C-terminus residues in sarafotoxin-m, these two peptides display a high sequence homology and share similar three-dimensional structures. However, unlike sarafotoxin-b, sarafotoxin-m shows a very low in vitro affinity for endothelin receptors, but still has a very high in vivo toxicity in mammals, similar to that of sarafotoxin-b. We have previously demonstrated, in vitro, the crucial role of the C-terminus extension in terms of pharmacological profiles and receptor affinities of long- versus short-sarafotoxins. One possible hypothesis to explain the high in vivo toxicity of sarafotoxin-m could be that its C-terminus extension is processed in vivo, resulting in short-like sarafotoxin. To address this possibility, we investigated, in the present study, the in vivo cardiovascular effects of sarafotoxin-b, sarafotoxin-m and sarafotoxin-m−Cter (sarafotoxin-m without the C -terminus extension). Male Wistar rats were anaesthetised and mechanically ventilated. Invasive haemodynamic measurements and echocardiographic measurements of left and right ventricular function were performed. The rats were divided into four groups that respectively received intravenous injections of: saline, sarafotoxin-b (one LD50), sarafotoxin-m (one LD50) or sarafotoxin-m−Cter (one LD50). All measurements were performed at baseline, at 1 minute (+1) and at 6 minutes (+6) after injection. Results: Sarafotoxin-b and sarafotoxin-m-Cter decreased cardiac output and impaired left ventricle systolic and diastolic function, whilst sarafotoxin-m decreased cardiac output, increased airway pressures and led to acute right ventricular dilatation associated with a decreased tricuspid annulus peak systolic velocity. Sarafotoxin-b and sarafotoxin-m−Cter appear to exert toxic effects via impairment of left ventricular function, whilst sarafotoxin-m increases airway pressures and impairs right ventricular function. These results do not support the hypothesis of an in vivo processing of long sarafotoxins.
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Affiliation(s)
- Yazine Mahjoub
- Pôle d’anesthésie, réanimation et médecine d’urgence, CHU Amiens, Amiens, France
- Unité INSERM U1088, Amiens, France
- * E-mail:
| | - Stéphanie Malaquin
- Pôle d’anesthésie, réanimation et médecine d’urgence, CHU Amiens, Amiens, France
- Unité INSERM U1088, Amiens, France
| | - Gilles Mourier
- CEA, iBiTec-S, Service d’Ingénierie Moléculaire des Protéines (SIMOPRO), CEA Saclay, F-91191 Gif sur Yvette, France
| | - Emmanuel Lorne
- Pôle d’anesthésie, réanimation et médecine d’urgence, CHU Amiens, Amiens, France
- Unité INSERM U1088, Amiens, France
| | - Osama Abou Arab
- Pôle d’anesthésie, réanimation et médecine d’urgence, CHU Amiens, Amiens, France
- Unité INSERM U1088, Amiens, France
| | | | - Hervé Dupont
- Pôle d’anesthésie, réanimation et médecine d’urgence, CHU Amiens, Amiens, France
- Unité INSERM U1088, Amiens, France
| | - Frédéric Ducancel
- CEA, iMETI, Service d’Immuno Virologie (SIV), CEA Fontenay-aux-Roses, F-92265 Fontenay-aux-Roses, France
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117
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Chen Q, Sun XD, Cao H, Zhang GC, Chen LW, Hu YN. Echocardiographic Evaluation of Changes in Cardiac Hemodynamics and Loading Conditions after Transthoracic Minimally Invasive Device Closure of Atrial Septal Defect. PLoS One 2015; 10:e0128475. [PMID: 26147594 PMCID: PMC4493115 DOI: 10.1371/journal.pone.0128475] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 04/27/2015] [Indexed: 12/02/2022] Open
Abstract
Purpose To evaluate transthoracic minimally invasive device closure of atrial septal defects by performing transthoracic echocardiography to measure changes in cardiac hemodynamics and loading conditions. Methods Between January 2012 and December 2012, we performed transthoracic minimally invasive device closure of atrial septal defects in 95 patients with secundum atrial septal defects (ASD), and performed transthoracic echocardiography to measure blood flow velocities at the tricuspid valve orifice and at the pulmonary valve orifice, sizes of the left and right atria and ventricles, right ventricular fractional area change, right ventricular Tei index, three-dimensional right ventricular ejection fraction, tricuspid annular plane systolic excursion and left ventricular ejection fractions before the procedure and 1 week, 3 months, and 1 year post-procedure. Results Varying degrees of improvement were observed post-procedure at later time points. The maximum blood flow velocity at the pulmonary valve orifice, mean flow velocity, velocity-time integral, and A peak and E peak blood flow velocity at the tricuspid valve orifice decreased significantly post-procedure (P<0.05). In 3 months and 1 year’s follow-up, the inner diameter of the middle portion of the pulmonary artery, and diameters of the right atrium and right ventricle decreased significantly post-procedure (P<0.05). The diameters of the left atrium and left ventricle increased after the procedure (P<0.05). One week after the procedure, the right ventricular fractional area change, three-dimensional right ventricular ejection fraction, right ventricular Tei index and tricuspid annular plane systolic excursion had significantly reduced compared with the preoperative data (P<0.05). While these four parameters were still decreased at the 3 months and at 1 year’s follow-up, but the differences were not statistically significant compared with the 1 week’s postoperative data (P>0.05). One week post-procedure, left ventricular ejection fraction had not changed significantly, but at 3 months and at 1 year post-procedure, left ejection fraction had increased significantly compared with the preoperative data (P<0.05). Conclusion Echocardiographic evaluation has demonstrated that cardiac hemodynamics and loading conditions improved significantly after transthoracic minimally invasive device closure of atrial septal defects.
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Affiliation(s)
- Qiang Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
- * E-mail:
| | - Xu-Dong Sun
- Department of Cardiology, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Hua Cao
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Gui-Can Zhang
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Liang-Wan Chen
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
| | - Yun-Nan Hu
- Department of Cardiovascular Surgery, Union Hospital, Fujian Medical University, Fuzhou, P. R. China
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Besli F, Basar C, Ekinozu I, Turker Y. Relationship Between Tei Index and PEP-Derived Myocardial Performance Index in Sinus Rhythm. Medicine (Baltimore) 2015; 94:e1112. [PMID: 26200613 PMCID: PMC4602998 DOI: 10.1097/md.0000000000001112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The goal of this study was to evaluate the preejection time (PEP)-derived myocardial performance index (MPI) in hypertensive (HT) patients with sinus rhythm and its relationship to the classic Tei index. One hundred five patients were enrolled in the study (65 HT and 40 control subjects). The mean age of all patients was 50.5 ± 15 years and 60% were female. Echocardiography was performed on all patients. MPI was measured with the classic Tei method (MPI-Tei index) and the PEP-derived MPI method by using tissue Doppler echocardiography. Although the MPI-Tei index is defined as the ratio of isovolumetric contraction time (IVCT) along with isovolumetric relaxation time (IVRT) to ejection time (ET), PEP-derived MPI is defined as the ratio of PEP and IVRT to ET. We compared echocardiographic data between the HT group and the control group. MPI-Tei index and the PEP-derived MPI values were higher in the HT group compared with controls (0.52 ± 0.10 vs 0.39 ± 0.07, P < 0.001, and 0.51 ± 0.09 vs 0.39 ± 0.07). PEP-derived MPI was strongly correlated with the MPI-Tei index (r = 0.945, P < 0.001). Our study determined that the PEP-derived MPI might be used in the evaluation of left ventricular function in patients with HT, similar to the classic MPI-Tei index.
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Affiliation(s)
- Feyzullah Besli
- From the Department of Cardiology (FB), Sanliurfa Mehmet Akif Inan Training and Research Hospital, Sanliurfa; Department of Cardiology (CB), Duzce Ataturk State Hospital; and Department of Cardiology (IE, YT), Duzce University Faculty of Medicine Hospital, Duzce, Turkey
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Grattan MJ, Mertens L. Echocardiographic assessment of ventricular function in pediatric patients: a comprehensive guide. Future Cardiol 2015; 10:511-23. [PMID: 25301314 DOI: 10.2217/fca.14.41] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Assessment of ventricular function is an important part of every echocardiographic examination. Specific pediatric guidelines on quantification of ventricular function are available, but technology evolves quickly and it generally takes long before newer techniques are integrated into routine clinical practice and are adopted by the guidelines. In the current overview, we would like to present our experience with integrating newer echocardiographic techniques for assessing ventricular function in children using a comprehensive state-of-the-art echocardiographic functional protocol. This protocol is used for specific patient populations such as pediatric patients with cardiomyopathy, post-transplant patients and oncology patients. We present the practical aspects of the protocols, their rationale and how this can be applied in clinical practice.
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Affiliation(s)
- Michael J Grattan
- Labatt Family Heart Center, University of Toronto, Toronto, ON M5G 1X8, Canada
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120
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Gulati G, Zhang KW, Scherrer-Crosbie M, Ky B. Cancer and cardiovascular disease: the use of novel echocardiography measures to predict subsequent cardiotoxicity in breast cancer treated with anthracyclines and trastuzumab. Curr Heart Fail Rep 2015; 11:366-73. [PMID: 25079445 DOI: 10.1007/s11897-014-0214-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
As the population of breast cancer survivors grows, it has become evident that chemotherapy has significant cardiotoxic side effects. Echocardiography is a noninvasive, cost-effective, and widely available imaging tool that is well positioned to serve as a primary modality for monitoring chemotherapy-induced cardiotoxicity. Although left ventricular ejection fraction is a standard measurement by which to monitor chemotherapy-induced cardiotoxicity, its predictive value in identifying subsequent cardiotoxicity is limited. More sophisticated echocardiography modalities may offer improved sensitivity and specificity for detecting chemotherapy-induced cardiotoxicity. These include tissue Doppler imaging measures, newer techniques based upon two- and three-dimensional strain and torsion analysis, and three-dimensional measures of cardiac size. While these modalities are not all currently part of clinical practice, a body of data supporting their use is steadily building. More research remains to be performed, and noninvasively detecting cancer therapy-induced cardiac dysfunction at the earliest stages is of increasing interest.
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Affiliation(s)
- Gaurav Gulati
- Department of Medicine, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
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121
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Maheshwari P, Henry A, Welsh AW. The Fetal Modified Myocardial Performance Index: Is Automation the Future? BIOMED RESEARCH INTERNATIONAL 2015; 2015:215910. [PMID: 26185751 PMCID: PMC4491561 DOI: 10.1155/2015/215910] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Accepted: 09/28/2014] [Indexed: 11/30/2022]
Abstract
The fetal modified myocardial performance index (Mod-MPI) is a noninvasive, pulsed-wave Doppler-derived measure of global myocardial function. This review assesses the progress in technical refinements of its measurement and the potential for automation to be the crucial next step. The Mod-MPI is a ratio of isovolumetric to ejection time cardiac time intervals, and the potential for the left ventricular Mod-MPI as a tool to clinically assess fetal cardiac function is well-established. However, there are wide variations in published reference ranges, as (1) a standardised method of selecting cardiac time intervals used in Mod-MPI calculation has not been established; (2) cardiac time interval measurement currently requires manual, inherently subjective placement of callipers on Doppler ultrasound waveforms; and (3) ultrasound machine settings and ultrasound system type have been found to affect Mod-MPI measurement. Collectively these factors create potential for significant inter- and intraobserver measurement variability. Automated measurement of the Mod-MPI may be the next key development which propels the Mod-MPI into routine clinical use. A novel automated system of Mod-MPI measurement is briefly presented and its implications for the future of the Mod-MPI in fetal cardiology are discussed.
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Affiliation(s)
- Priya Maheshwari
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Amanda Henry
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Women's and Children's Health, St George Hospital, Kogarah, NSW 2217, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia
| | - Alec W. Welsh
- Faculty of Medicine, School of Women's & Children's Health, University of New South Wales, Sydney, NSW 2052, Australia
- Department of Maternal-Fetal Medicine, Royal Hospital for Women, Locked Bag 2000, Barker Street, Randwick, NSW 2031, Australia
- Australian Centre for Perinatal Science, University of New South Wales, Sydney, NSW 2052, Australia
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Kaypakli O, Gür M, Gözükara MY, Uçar H, Kivrak A, Şeker T, Şahin DY, Elbasan Z, Türkoğlu C, Çayli M. Association between high-sensitivity troponin T, left ventricular hypertrophy, and myocardial performance index. Herz 2015; 40:1004-10. [DOI: 10.1007/s00059-015-4322-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 03/21/2015] [Accepted: 04/16/2015] [Indexed: 12/01/2022]
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Fukuhara K, Okura H, Koyama T, Kume T, Neishi Y, Hayashida A, Yoshida K. Feasibility of a novel atrioventricular delay optimization method using transmitral and pulmonary venous flow in patients with sequential ventricular pacing or cardiac resynchronization therapy. J Echocardiogr 2015; 13:52-8. [PMID: 26069448 PMCID: PMC4454827 DOI: 10.1007/s12574-014-0237-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Revised: 11/07/2014] [Accepted: 11/25/2014] [Indexed: 11/28/2022]
Abstract
Background Although several echo-Doppler methods were proposed to optimize atrioventricular (AV) delay in patients with sequential ventricular pacing, “echo-guided” AV optimization has not been widely adopted clinically. A combination of trasmitral flow (TMF) and pulmonary venous flow (PVF) measurements may be beneficial to further optimize AV delay to achieve better cardiac function. The aim of this study was to assess the feasibility and usefulness of AV delay optimization by combined use of TMF and PVF. Methods A total of 32 patients after sequential ventricular pacemaker implantation were enrolled and studied. The optimal AV delay was defined as the timing to minimize the duration between PVF reversal (a) wave and the duration of the “A” wave of TMF. Stroke volume was measured at the “optimized” AV delay (AVDOPT) and was compared with that obtained at shorter (AVDOPT − 50 ms) and longer (AVDOPT + 50 ms) AV delays. Results AV optimization was feasible in 27 of 32 patients (87 %). Stroke volume at AVDOPT was significantly higher than that at shorter or longer AV delay (63 ± 18 ml vs. 57 ± 15 ml vs. 56 ± 16 ml, P = 0.001). Conclusions AV delay optimization using TMF and PV flow was feasible. Usefulness of this method requires further investigation with a larger study population.
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Affiliation(s)
- Kenzo Fukuhara
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Hiroyuki Okura
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Terumasa Koyama
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Teruyoshi Kume
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | - Yoji Neishi
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
| | | | - Kiyoshi Yoshida
- Division of Cardiology, Kawasaki Medical School, Kurashiki, Japan
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ElMarsafawy H, Matter M, Sarhan M, El-Ashry R, Al-Tonbary Y. Assessment of Myocardial Function in Children before and after Autologous Peripheral Blood Stem Cell Transplantation. Echocardiography 2015; 33:82-9. [PMID: 26059008 DOI: 10.1111/echo.12988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Increased interest is focused on the long-term adverse effects of bone marrow transplantation. Subclinical cardiac involvement appears common in adults, but only a few reports have examined pediatric patients. MATERIALS AND METHODS A prospective case-control study of 19 children with normal cardiac function undergoing autologous hematopoietic stem cell transplantation (HSCT) was performed. Tissue Doppler imaging (TDI) and echocardiographic measurements were obtained according to the guidelines of the American Society of Echocardiography before and 3 months after HSCT. RESULTS Lateral mitral annulus before HSCT showed significant reduced mitral systolic annular velocity (P < 0.0001), early diastolic annular velocity (P < 0.0001), late diastolic annular velocity (P = 0.02) and prolonged isovolumetric relaxation time (IRT) (P < 0.0001) compared with control. Significant reduced mitral systolic annular velocity (P < 0.0001), early diastolic annular velocity (P = 0.0005) and Em/Am ratio (P = 0.004), with higher late diastolic annular velocity (P = 0.02) and prolonged isovolumetric contraction time (ICT) (P = 0.003) and IRT (P = 0.002) after HSCT, were observed. Investigation of lateral tricuspid annulus showed nearly similar results as the lateral mitral annulus. LV and RV Tei indices were higher before HSCT compared with control and remained high after HSCT. CONCLUSION TDI detected subtle abnormalities in systolic and diastolic functions before and after HSCT, which suggests that a conditioning regimen may affect cardiac function.
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Affiliation(s)
- Hala ElMarsafawy
- Cardiology Unit, Mansoura University Children Hospital, Mansoura, Egypt
| | - Mohamed Matter
- Cardiology Unit, Mansoura University Children Hospital, Mansoura, Egypt
| | - Mohamed Sarhan
- Hematology/Oncology/BMT Unit, Mansoura University Children Hospital, Mansoura, Egypt
| | - Rasha El-Ashry
- Hematology/Oncology/BMT Unit, Mansoura University Children Hospital, Mansoura, Egypt
| | - Youssef Al-Tonbary
- Hematology/Oncology/BMT Unit, Mansoura University Children Hospital, Mansoura, Egypt
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Axt-Fliedner R, Graupner O, Kawecki A, Degenhardt J, Herrmann J, Tenzer A, Doelle A, Willruth A, Steinhard J, Gembruch U, Bahlmann F, Enzensberger C. Evaluation of right ventricular function in fetuses with hypoplastic left heart syndrome using tissue Doppler techniques. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2015; 45:670-677. [PMID: 25418127 DOI: 10.1002/uog.14736] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 09/24/2014] [Accepted: 11/17/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVE The outcome of patients with hypoplastic left heart syndrome (HLHS) is influenced by right ventricular function. This study aimed to investigate whether differences in right ventricular function of fetuses with HLHS are present during gestation. METHODS This was a prospective study comprising 14 fetuses with HLHS (28 measurements obtained in total) and 28 normal control fetuses (31 measurements obtained in total). The two groups were matched for gestational age. Ultrasound M-mode was used to assess displacement of the tricuspid annulus. Spectral Doppler and myocardial tissue Doppler-derived inflow and outflow velocities were assessed. Tricuspid valve peak early wave to peak active wave (E/A) ratio, the early wave to early diastolic annular relaxation velocity (E/E') ratio and the tissue Doppler-derived myocardial performance index (MPI') were calculated. RESULTS E-wave velocity was significantly higher in fetuses with HLHS than in control fetuses (mean, 40.14 cm/s vs 35.47 cm/s; P < 0.05, respectively), and A-wave velocity in fetuses with HLHS showed a tendency for higher values in the right ventricle compared with normal control fetuses, but this did not reach statistical significance (61.16 cm/s vs 54.64 cm/s; P = 0.08). The E/A ratio increased during gestation in controls, but this increase was not seen in HLHS fetuses. Peak annular velocity during atrial contraction (A') and the E/E' ratio were significantly lower in controls than in HLHS fetuses: 9.50 cm/s vs 10.39 cm/s (P < 0.05) and 5.77 vs 7.37 (P < 0.05), respectively. There were no differences for right-ventricular MPI' or tricuspid annular plane systolic excursion between HLHS fetuses and controls. CONCLUSION The results of this study show that altered right ventricular function in HLHS infants may develop antenatally. It is hoped that confirmation of these findings using Doppler-independent techniques will lead to further exploration of ventricular function in HLHS fetuses. Consequently, parental counseling and postnatal management strategies could be influenced.
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Affiliation(s)
- R Axt-Fliedner
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - O Graupner
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - A Kawecki
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - J Degenhardt
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - J Herrmann
- IT Service Center, Statistical Consulting Service Unit, Justus-Liebig-University Giessen, Giessen, Germany
| | - A Tenzer
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - A Doelle
- Toshiba Medical Systems Europe BV, Zoetermeer, The Netherlands
| | - A Willruth
- Department of Obstetrics and Prenatal Medicine, University of Bonn, Bonn, Germany
| | - J Steinhard
- Praxis Dr. Rosenberg, Dr. Steinhard und Kollegen, Münster, Germany
| | - U Gembruch
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
| | - F Bahlmann
- Department of Obstetrics and Gynecology, Bürgerhospital, Frankfurt, Germany
| | - C Enzensberger
- Division of Prenatal Medicine, Department of Obstetrics & Gynecology, Justus-Liebig-University, Giessen, Germany
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Sivanna U, Joshi S, Babu B, Jagadeesh AM. A comparative study of pharmacological myocardial protection between sevoflurane and desflurane at anaesthestic doses in patients undergoing off pump coronary artery bypass grafting surgery. Indian J Anaesth 2015; 59:282-6. [PMID: 26019352 PMCID: PMC4445149 DOI: 10.4103/0019-5049.156867] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND AND AIMS Perioperative myocardial ischaemia (PMI) is one of the known complications during off pump coronary artery bypass (OPCAB) surgeries. The length of hospital stay is considerably prolonged in patients with PMI. Myocardial protection is an area which is being widely researched currently to prevent or reduce the incidence of PMI. Over the last decade it has become clear that volatile anaesthetic agents are protective in the setting of PMI and reperfusion. Hence, we planned to study the effect of two different volatile anaesthetics as myocardial protective agents in OPCAB surgery. METHODS A total of 40 patients were enrolled for the study; Group A (sevoflurane, n = 20) and Group B (desflurane, n = 20). All patients had a baseline measurement of Trop-T, creatine phosphokinase-MB (CPKMB) and myocardial performance index (MPI) pre-operatively, which was repeated 4 h after the surgery. Chi-square/Fisher test was used to find the significance of the differences between the two agents. RESULTS Patients were comparable in demographic, baseline, biochemical and echo criteria. Post-operative CPKMB levels (desflurane - 30.85 ± 2.69 u/L; sevoflurane - 29.05 ± 5.26 u/L, P = 0.7) and number of Trop-T positive patients (Sevoflurane - 9; desflurane - 6, P ≥ 0.05) were comparable. Post-operative MPI indicated decreased left ventricular function in sevoflurane group as compared to desflurane group (P ≤ 0.03). CONCLUSION Desflurane exerts better cardioprotective effect than sevoflurane as indicated by better MPI in OPCAB surgeries.
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Affiliation(s)
- Umesh Sivanna
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Shreedhar Joshi
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - Balaji Babu
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
| | - A M Jagadeesh
- Department of Cardiac Anaesthesiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bengaluru, Karnataka, India
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Abstract
BACKGROUND The functionally single fetal right ventricle demonstrates reduced longitudinal relative to circumferential contraction velocities and deformation, a pattern similar to the normal fetal left ventricle. Altered diastolic properties are also present, with greater reliance on atrial contraction for right ventricular filling. It is unknown whether the functionally single left ventricle (SLV) demonstrates similar altered deformation patterns and diastolic properties. METHODS Echocardiograms from 29 fetuses with SLVs were retrospectively compared with those from 48 controls with appropriately grown left ventricles. Ventricular function was assessed using Velocity Vector Imaging velocity, tissue deformation, two-dimensional, and Doppler flow parameters. RESULTS Fetuses with functionally SLVs showed no difference in peak global left ventricular longitudinal velocity or displacement or strain, while global radial displacement was increased (P < .001). The ratio of longitudinal to circumferential deformation was also no different from that in controls. The SLVs showed increased diameters (P < .001) with normal lengths. Mitral inflow peak E-wave (P < .05) and A-wave (P < .0001) velocities were increased, with a reduced E/A ratio (P < .001). A-wave inflow fraction was also increased (P < .05), with no change in A duration. Although ejection time was no different, inflow duration was increased (P < .01) and there was a trend toward reduction of the Tei index (P = .07). CONCLUSIONS The functionally single fetal left ventricle shows comparable changes to the single right ventricle, with a more spherical morphology and greater reliance on atrial contraction for ventricular filling than in controls. However, in contrast to the single right ventricle, the SLV had a normal longitudinal to circumferential deformation ratio with enhanced early diastolic filling.
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129
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Gürdal A, Kasikcioglu E, Yakal S, Bugra Z. Impact of diabetes and diastolic dysfunction on exercise capacity in normotensive patients without coronary artery disease. Diab Vasc Dis Res 2015; 12:181-8. [PMID: 25670849 DOI: 10.1177/1479164114565631] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE The aim of this study was to determine the impact of diabetes and diastolic dysfunction on exercise capacity in asymptomatic, normotensive patients with type 2 diabetes without coronary artery disease. METHODS A total of 43 type 2 diabetes patients (age: 50 ± 5 years) and 20 healthy controls (age: 48 ± 4 years) were enrolled. Diastolic function was investigated by conventional pulsed-wave (PW) Doppler and tissue Doppler imaging (TDI). Exercise capacity was evaluated with cardiopulmonary exercise testing (CPET). RESULTS In patients with type 2 diabetes, increase in resting heart rate (HR-rest) (p = 0.013), decrease in maximum heart rate during exercise (HR-max) (p < 0.001) and exercise time (p < 0.001) compared with controls were significant. Patients had significantly increased minute ventilation volume (VE)/maximum carbon dioxide discharge (VCO2) ratio (p < 0.001), decreased maximum oxygen consumption (VO2-max) (p < 0.001), oxygen consumption at anaerobic threshold (VO2-an) (p < 0.001) and maximum carbon dioxide discharge (VCO2) (p < 0.001) compared to controls indicating significantly reduced exercise capacity. HbA1c was inversely correlated with VO2-max (r = -0.456, p < 0.01) independent of the absence or presence of mild diastolic dysfunction. CONCLUSION Exercise capacity was found to be significantly decreased in normotensive patients with type 2 diabetes without coronary artery disease, and this decrease was independent of diastolic dysfunction.
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Affiliation(s)
- Ahmet Gürdal
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Erdem Kasikcioglu
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sertac Yakal
- Department of Sports Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Zehra Bugra
- Department of Cardiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey
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Mahajan A, Henry A, Meriki N, Hernandez-Andrade E, Crispi F, Wu L, Welsh AW. The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research. Fetal Diagn Ther 2015; 38:1-13. [DOI: 10.1159/000363181] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Accepted: 04/24/2014] [Indexed: 11/19/2022]
Abstract
Functional cardiovascular assessment is becoming an increasingly important tool in the study of fetal pathology. The myocardial performance index (MPI) is a parameter measuring global myocardial function. Since its introduction, several studies have proposed methods to improve its reproducibility and have constructed normative reference ranges. Fetal heart evaluation using the MPI is technically challenging, requiring specific training and expertise, and a consensus has yet to be reached on the method of delineating the time periods used to calculate the index. Despite these limitations, it has been shown to be a useful and highly sensitive parameter of dysfunction in a number of fetal pathologies. Further research is warranted into the effect of pathology on MPI, parameters of unilateral cardiac strain that utilise MPI, and automation of the MPI to encourage incorporation of the MPI as a useful tool in clinical practice.
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131
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Sivanandam S, Wey A, Louis JS. Intraoperative transesophageal echocardiographic assessment of left ventricular Tei index in congenital heart disease. Ann Card Anaesth 2015; 18:198-201. [PMID: 25849689 PMCID: PMC4406256 DOI: 10.4103/0971-9784.154474] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 03/10/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Use of the Tei index has not been described to assess myocardial function before or after surgery in pediatric patients. This study was designed to evaluate the left ventricular (LV) function using the Tei index pre- and post-cardiopulmonary bypass in patients with lesion that result in a volume loaded right ventricle (RV). METHODS Retrospective data on 55 patients who underwent repair of a cardiac defect were analyzed. Patients with volume overload RV (n = 15) were compared to patients without volume overload but with other cardiac defects (n = 40). We reviewed pre- and post-operative LV myocardial performance index (Tei index). Tei index was obtained from transesophageal Doppler echocardiogram. RESULTS Patients with right heart volume overload, the mean preoperative Tei index was 0.6, with a postoperative mean decrease of 0.207 (P = 0.014). Patients without right heart volume overload, the mean preoperative Tei was 0.48 with no significant postoperative change (P = 0.82). CONCLUSION Pre- and post-operative transesophageal echocardiogram assessment provides an easy and quick way of evaluating LV function intra-operatively using LV Tei index. Preoperative LV Tei index was greater in the RV volume overload defects indicating diminished LV global function. This normalized in the immediate postoperative period, implying an immediate improvement in LV function. In patients without right heart volume load, consist of other cardiac defects, demonstrated no changes in the pre- and post-operative LV Tei. This implies that LV function was similar after the surgery.
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Affiliation(s)
- Shanthi Sivanandam
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew Wey
- Department of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - James St. Louis
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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Weidemann F, Liu D, Niemann M, Herrmann S, Hu H, Gaudron P, Ertl G, Hu K. Abschätzung der linksventrikulären systolischen Funktion bei Patienten mit schlechter Bildqualität. Herz 2015; 40:240-9. [DOI: 10.1007/s00059-013-3924-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 11/28/2022]
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133
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Hashima JN, Rogers V, Langley SM, Ashraf M, Sahn DJ, Ohtonen P, Davis LE, Hohimer AR, Rasanen J. Fetal ventricular interactions and wall mechanics during ductus arteriosus occlusion in a sheep model. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:1020-1028. [PMID: 25701524 PMCID: PMC4407698 DOI: 10.1016/j.ultrasmedbio.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 11/04/2014] [Accepted: 11/06/2014] [Indexed: 06/04/2023]
Abstract
We investigated the effect of fetal sheep ductus arteriosus occlusion (DO) on the distribution of cardiac output and left and right ventricular function by tissue and pulsed Doppler at baseline; after 15 and 60 min of DO induced with a vascular occluder; and 15 min after release of DO. Ductal occlusion decreased fetal pO2. Mean left ventricular output increased (p < 0.001) from 725 to 1013 mL/min, and right ventricular (1185 mL/min vs. 552 mL/min) and systemic (1757 mL/min vs. 1013 mL/min) cardiac outputs fell (p < 0.001) after 15 min of DO, compared with baseline. Pulmonary vascular impedance decreased and volume blood flow increased more than threefold during DO, whereas foramen ovale volume blood flow remained unchanged. Left ventricular systolic function was unaffected, whereas isovolumic relaxation velocity deceleration decreased. Right ventricular functional indices remained unchanged. We conclude that DO increased pulmonary volume blood flow, not foramen ovale volume blood flow. Left ventricular output increased, although not as much as right ventricular output fell, resulting in decreased systemic cardiac output. During DO, left ventricular function exhibited diminished relaxation.
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Affiliation(s)
- Jason N Hashima
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Vanessa Rogers
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Stephen M Langley
- Division of Cardiothoracic Surgery, Department of Surgery, Oregon Health & Science University, Portland, Oregon, USA
| | - Muhammed Ashraf
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - David J Sahn
- Division of Pediatric Cardiology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, USA
| | - Pasi Ohtonen
- Department of Anesthesiology and Surgery, Oulu University Hospital, Oulu, Finland
| | - Lowell E Davis
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - A Roger Hohimer
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Juha Rasanen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA; Department of Obstetrics and Gynecology, Oulu University Hospital, Oulu, Finland; Department of Obstetrics and Gynecology, Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland.
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134
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CERCENELLI L, MARCELLI E. CARDIAC APEX ROTATION ASSESSED BY AN IMPLANTABLE GYRO SENSOR: CORRELATION WITH A LV PRESSURE-DERIVED MYOCARDIAL PERFORMANCE INDEX IN EXPERIMENTALLY INDUCED ISCHEMIA. J MECH MED BIOL 2015. [DOI: 10.1142/s0219519415400138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite many investigators have focused attention on cardiac apex rotation (CAR) as a sensitive marker of left ventricle (LV) function, no studies have been specifically aimed to evaluate the correlation of CAR with myocardial performance index (MPI), a well-known index of both systolic and diastolic performance. In four sheep, we measured CAR using a miniature gyro sensor epicardically positioned at LV apex and we evaluated the beat-to-beat correlation between CAR and a myocardial performance index calculated from LV-pressure (LVP) measurements (MPILVP). We also compared CAR with hemodynamic parameters (LVdP/dtMAX, LVdP/dtMIN). A strong negative correlation was observed between CAR and MPILVP during the experimental cardiac conditions (baseline, acute ischemia induced by coronary ligation and release of ligation). At 30 s after ligation a marked decrease of CAR was observed, while LVdP/dtMAX showed minor changes. CAR has good potential to reflect changes of global myocardial performance and to predict hemodynamic changes in acute impairment of cardiac function.
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Affiliation(s)
- L. CERCENELLI
- Experimental Diagnostic and Specialty Medicine Department, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
| | - E. MARCELLI
- Experimental Diagnostic and Specialty Medicine Department, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy
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135
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Lu W, Zheng J, Pan X, Sun L. Diagnostic performance of echocardiography for the detection of acute cardiac allograft rejection: a systematic review and meta-analysis. PLoS One 2015; 10:e0121228. [PMID: 25822627 PMCID: PMC4378940 DOI: 10.1371/journal.pone.0121228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 01/29/2015] [Indexed: 11/22/2022] Open
Abstract
Objective Many studies have addressed the diagnostic performance of echocardiography to evaluate acute cardiac allograft rejection compared with endomyocardial biopsy. But the existence of heterogeneity limited its clinical application. Thus, we conducted a comprehensive, systematic literature review and meta-analysis for the purpose. Methods Studies prior to September 1, 2014 identified by Medline/PubMed, EMBASE and Cochrance were examined by two independent reviews. We conducted meta-analysis by using Meta-DiSc 1.4 software. An assessment tool of QUADAS-2 was applied to evaluate the risk of bias and applicability of the studies. Results Thirty studies met the inclusion criteria of meta-analysis. The four parameters of pressure half time, isovolumic relaxation time, index of myocardial performance and late diastolic mitral annular motion velocity were included in the meta-analysis, with a pooled diagnostic odds ratio of 10.43, 6.89, 15.95 and 5.68 respectively, and the area under the summary receiver operating characteristic curves value of 0.829, 0.599, 0.871 and 0.685 respectively. Conclusion The meta-analysis and systematic review demonstrate that no single parameter of echocardiography showed a reliable diagnostic performance for acute cardiac allograft rejection. A result of echocardiography for ACAR should be comprehensively considered by physicians in the context of clinical presentations and imaging feature.
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Affiliation(s)
- Wei Lu
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
- Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, 100029, China
| | - Jun Zheng
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Xudong Pan
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Lizhong Sun
- Department of Cardiac surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
- * E-mail:
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136
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Biventricular function and glycemic load in type 1 diabetic children: Doppler tissue-imaging study. Pediatr Cardiol 2015; 36:423-31. [PMID: 25304244 DOI: 10.1007/s00246-014-1030-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
To assess right- and left-ventricular function in children with type 1 diabetes mellitus (DM) as well as correlate cardiac function with diabetes duration and state of metabolic control. The present study included 30 patients with type 1 DM (group 1) and 20 apparently normal children with comparable age and sex as controls (group 2). All children were subjected to detailed history, clinical examination, and routine laboratory investigations, including glycated hemoglobin, as well as conventional echocardiographic and tissue Doppler examination. Children with type 1 DM have impaired diastolic function in both left and right ventricles before the development of systolic dysfunction when assessed with either conventional or tissue Doppler echocardiography. Resting heart rate in diabetic patients showed a significant positive correlation with mitral A flow velocity and a significant negative correlation with mitral and tricuspid E/A ratio. Regarding morphological parameters of the left ventricle, all dimensions and volumes were comparable between diabetic patients and controls; however, a significant positive correlation was found between interventricular septal thickness at diastole (IVSd), interventricular septal thickness at systole (IVSs), and left ventricular posterior wall at systole (LVPWs) and the duration of diabetes. Children with type 1 DM have impaired diastolic function in both left and right ventricles with normal systolic function when assessed with either conventional or tissue Doppler echocardiography.
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137
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Noori S, McNamara P, Jain A, Lavoie PM, Wickremasinghe A, Merritt TA, Solomon T, Sekar K, Attridge JT, Swanson JR, Gillam-Krakauer M, Reese J, Poindexter BB, Brook M, Auchus RJ, Clyman RI. Catecholamine-resistant hypotension and myocardial performance following patent ductus arteriosus ligation. J Perinatol 2015; 35:123-7. [PMID: 25118721 PMCID: PMC4310792 DOI: 10.1038/jp.2014.151] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/05/2014] [Accepted: 06/16/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE We performed a multicenter study of preterm infants, who were about to undergo patent ductus arteriosus ligation, to determine whether echocardiographic indices of impaired myocardial performance were associated with subsequent development of catecholamine-resistant hypotension following ligation. STUDY DESIGN A standardized treatment approach for hypotension was followed at each center. Infants were considered to have catecholamine-resistant hypotension if their dopamine infusion was > 15 μg kg(-1)min(-1). Echocardiograms and cortisol measurements were obtained between 6 and 14 h after the ligation (prior to the presence of catecholamine-resistant hypotension). RESULT Forty-five infants were enrolled, 10 received catecholamines (6 were catecholamine-responsive and 4 developed catecholamine-resistant hypotension). Catecholamine-resistant hypotension was not associated with decreased preload, shortening fraction or ventricular output. Infants with catecholamine-resistant hypotension had significantly lower levels of systemic vascular resistance and postoperative cortisol concentration. CONCLUSION We speculate that low cortisol levels and impaired vascular tone may have a more important role than impaired cardiac performance in post-ligation catecholamine-resistant hypotension.
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Affiliation(s)
- Shahab Noori
- Departments of Pediatrics of Children's Hospital of Los Angeles and University of Southern California, Los Angeles, CA,Departments of Pediatrics of University of Oklahoma, Oklahoma City, OK
| | - Patrick McNamara
- Departments of Pediatrics of Hospital for Sick Children, Toronto, Canada
| | - Amish Jain
- Departments of Pediatrics of Hospital for Sick Children, Toronto, Canada,Departments of Pediatrics of Mount Sinai Hospital, University of Toronto, Canada
| | - Pascal M. Lavoie
- Departments of Pediatrics of Children’s & Women’s Health Centre of British Columbia, Vancouver, Canada
| | - Andrea Wickremasinghe
- Departments of Pediatrics and Cardiovascular Research Institute, University of California San Francisco
| | - T. Allen Merritt
- Departments of Pediatrics of Loma Linda University, Loma Linda, CA
| | - Tabitha Solomon
- Departments of Pediatrics of Loma Linda University, Loma Linda, CA
| | | | - Joshua T. Attridge
- Departments of Pediatrics of University of Virginia, Charlottesville, VA
| | | | | | - Jeff Reese
- Departments of Pediatrics of Vanderbilt University, Nashville, TN
| | | | - Michael Brook
- Departments of Pediatrics and Cardiovascular Research Institute, University of California San Francisco
| | | | - Ronald I. Clyman
- Departments of Pediatrics and Cardiovascular Research Institute, University of California San Francisco
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138
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Besli F, Basar C, Kecebas M, Turker Y. Improvement of the myocardial performance index in atrial fibrilation patients treated with amiodarone after cardioversion. J Interv Card Electrophysiol 2015; 42:107-15. [PMID: 25591725 DOI: 10.1007/s10840-014-9965-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2014] [Accepted: 12/10/2014] [Indexed: 11/24/2022]
Abstract
PURPOSE This study evaluated the response to electrical cardioversion (EC) and the effect on the myocardial performance index (MPI) in patients with persistent and long-standing persistent atrial fibrillation (AF). METHODS We enrolled 103 patients (mean age 69.6 ± 8.9 years, 40.7% males) with a diagnosis of persistent and long-standing persistent AF. EC was applied to all patients after one g of amiodarone administration. Echocardiographic findings before EC were compared in patients with successful versus unsuccessful cardioversions and in patients with maintained sinus rhythm (SR) versus those with AF recurrence at the end of the first month. We also compared echocardiographic data before EC versus at the end of the first month in the same patients with maintained SR. RESULTS SR was achieved in 72.8% of patients and was continued at the end of the first month in 69.3% of the patients. The MPI value of all patients was found to be 0.73 ± 0.21. The size of the left atrium was determined to be an independent predictor of the maintenance of SR at 1 month. In subgroup analyses, when we compared echocardiographic findings before EC and at the end of the first month in patients with maintained SR, the MPI (0.66 ± 0.14 vs 0.56 ± 0.09, p < 0.001) values were significantly decreased. CONCLUSIONS Our study is the first to show impairment of the MPI, which is an indicator of systolic and diastolic function, in patients with persistent and long-standing persistent AF and improvement of the MPI after successful EC.
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Affiliation(s)
- Feyzullah Besli
- Department of Cardiology, Duzce Ataturk State Hospital, Duzce, Turkey,
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139
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Gerede DM, Turhan S, Kaya CT, Ozcan OU, Goksuluk H, Vurgun VK, Dincer I, Kutlay S, Erturk S, Erol C. Effects of Hemodialysis on Tei Index: Comparison between Flow Doppler and Tissue Doppler Imaging. Echocardiography 2015; 32:1520-6. [DOI: 10.1111/echo.12895] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Sibel Turhan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Cansin Tulunay Kaya
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Ozgur Ulas Ozcan
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Huseyin Goksuluk
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Veysel Kutay Vurgun
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Irem Dincer
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
| | - Sim Kutlay
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Sehsuvar Erturk
- Department of Nephrology; Ankara University School of Medicine; Ankara Turkey
| | - Cetin Erol
- Department of Cardiology; Ankara University School of Medicine; Ankara Turkey
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140
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Wang J, Henry A, Welsh AW, Redmond SJ. Automated fetal cardiac valve movement detection for modified myocardial performance index calculation. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:1063-6. [PMID: 25570145 DOI: 10.1109/embc.2014.6943777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The Modified Myocardial Performance Index (Mod-MPI) is becoming an important index in fetal cardiac function evaluation. However, the current method for Mod-MPI calculation can be time-consuming and demonstrates poor inter-operator repeatability. This paper presents an automated method for detecting the opening and closing events of fetal cardiac valves with the aim of automating the Mod-MPI calculation. Fifty-four Doppler ultrasound images, showing blood inflow and outflow for the left ventricle, are analyzed to attempt to automatically detect the timings of a total of 905 opening and closing events for both aortic and mitral valves. Timings are found according to the morphological characteristics of waveforms as well as intensity information of images. The proposed method can detect the four valve movement events with high sensitivity (95.60-98.64%) and precision (96.85-100.00%). Results are verified by comparison with manual annotation of same images from an expert.
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141
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Di Maria MV, Hsu HH, Al-Naami G, Gruenwald J, Kirby KS, Kirkham FJ, Cox SE, Younoszai AK. Left ventricular rotational mechanics in Tanzanian children with sickle cell disease. J Am Soc Echocardiogr 2015; 28:340-6. [PMID: 25555520 PMCID: PMC4346279 DOI: 10.1016/j.echo.2014.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Indexed: 02/02/2023]
Abstract
Background Sickle cell disease (SCD) is a common inherited hemoglobinopathy. Adults with SCD manifest both systolic and diastolic cardiac dysfunction, though the age of onset of dysfunction has not been defined. Left ventricular (LV) rotational mechanics have not been studied in children with SCD. The aim of this study was to investigate whether cardiac rotational mechanics differed between children with SCD and age-matched controls. Methods Basal and apical LV short-axis images were acquired prospectively in 213 patients with SCD (mean age, 14.1 ± 2.6 years) and 49 controls (mean age, 13.3 ± 2.8 years) from the Muhimbili Sickle Cohort in Dar es Salaam, Tanzania. The magnitude of basal and apical rotation, net twist angle, torsion, and untwist rate were obtained by two-dimensional speckle-tracking. The timing of events was normalized to aortic valve closure. Results Mean basal rotation was significantly lower in patients with SCD compared with controls (P = .012), although no difference was observed in apical rotation (P = .37). No statistically significant differences in torsion or net twist angle were detected. Rotation rate at the apex (P = .001) and base (P = .0004) were significantly slower in subjects with SCD compared with controls. Mean peak untwisting rate was also significantly slower in patients with SCD (P = .006). No associations were found between hemoglobin concentration and apical rotation, basal rotation, net twist, and torsion. Conclusion This study demonstrates alterations in LV rotational mechanics in children with SCD, including lower basal rotation, peak differential twist, and untwist rate. These abnormalities denote subclinical changes in LV systolic and diastolic performance in children with SCD. Future work may reveal an association between rotational metrics and long-term patient outcomes.
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Affiliation(s)
- Michael V Di Maria
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado.
| | - Hao H Hsu
- Division of Pediatric Cardiology, Children's Hospital & Medical Center, University of Nebraska Medical Center, Omaha, Nebraska
| | | | - Jeanine Gruenwald
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - K Scott Kirby
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
| | - Fenella J Kirkham
- Department of Neurosciences, UCL Institute of Child Health, London, United Kingdom
| | - Sharon E Cox
- Muhimbili Wellcome Programme, Muhimbili University of Health & Allied Sciences, Dar es Salaam, Tanzania; The London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Adel K Younoszai
- University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
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142
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Echocardiography in sickle cell anaemia patients under 20 years of age: a descriptive study in the Brazilian Western Amazon. Cardiol Young 2015; 25:63-9. [PMID: 24153103 DOI: 10.1017/s104795111300156x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Cardiac abnormalities in sickle cell anaemia are frequent and early, despite being more evident in adulthood. The study on cardiac abnormalities is essential in the current context, as, owing to improved health, children are increasingly able to reach adulthood and suffering the consequences of chronic cardiac injury. OBJECTIVE The aim of this study was to determine the prevalence of echocardiographic changes in patients under 20, suffering from sickle cell disease in Rio Branco, Brazilian Western Amazon. METHODS The descriptive epidemiological study compare two sets of children and adolescents, one including sickle cell anaemia patients (n=45), and other one (n=109) without sickle cell anaemia or heart disease. The echocardiographic measurements were indexed according to body surface using z-scores, and the prevalence of echocardiographic changes in both groups, with their respective 95% confidence intervals, ascertained and compared. RESULTS Compared with the non-sickle cell anaemia series, the sickle cell anaemia group showed z-scores 13.1-fold higher for the diastolic diameter of the left ventricle, 5.2 times higher for the thickness of the posterior wall, 4.9 higher for the left atrium, 2.5 times higher for the right ventricle and 2.0 times higher for the septum thickness. Also the rate of left ventricular mass, systolic pressure of the right ventricle and the relative wall thickness were significantly higher in sickle cell anaemia set. CONCLUSIONS Cardiac abnormalities were observed in 93.5% of patients. Early detection of cardiac abnormalities and quantifying them using the indexation of echocardiographic measurements according to body surface will allow proper identification and attendance of these children.
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143
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Bravo-Valenzuela NJM, Zielinsky P, Huhta JC, Acacio GL, Nicoloso LH, Piccoli A, Busato S, Klein C. Dynamics of pulmonary venous flow in fetuses with intrauterine growth restriction. Prenat Diagn 2014; 35:249-53. [DOI: 10.1002/pd.4529] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 11/06/2014] [Accepted: 11/06/2014] [Indexed: 01/21/2023]
Affiliation(s)
| | - Paulo Zielinsky
- Fetal Cardiology Unit; Institute of Cardiology; Porto Alegre RS Brazil
| | - James C. Huhta
- All Children's Hospital; Johns Hopkins University; St. Petersburg FL United States
| | | | - Luiz H. Nicoloso
- Fetal Cardiology Unit; Institute of Cardiology; Porto Alegre RS Brazil
| | - Antonio Piccoli
- Fetal Cardiology Unit; Institute of Cardiology; Porto Alegre RS Brazil
| | - Stefano Busato
- Fetal Cardiology Unit; Institute of Cardiology; Porto Alegre RS Brazil
| | - Caroline Klein
- Fetal Cardiology Unit; Institute of Cardiology; Porto Alegre RS Brazil
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144
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Kaderli B, Kaderli AA, Gullulu S, Inan UU, Senturk T, Aydinlar A, Yucel AA, Avci R. Myocardial performance is impaired in patients with branch retinal vein occlusion. J Int Med Res 2014; 43:33-41. [PMID: 25395502 DOI: 10.1177/0300060514543038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate whether the Tei index, which is an indicator of global myocardial function and an independent predictor of cardiac death, is increased in patients with branch retinal vein occlusion (BRVO). METHODS The Tei index was used to evaluate myocardial performance, in addition to conventional echocardiographic evaluation of myocardial structural and functional changes, in patients with BRVO, patients with hypertension and healthy controls. RESULTS Out of 36 patients with BRVO (18 female, 18 male; 17 hypertensive, 19 normotensive), 29 patients with hypertension (15 female, 14 male) and 28 healthy controls (15 female, 13 male), there were no significant between-group differences in age and sex. The mitral A wave was higher and mitral E/A ratio, mitral E wave and ejection time were lower, in patients with BRVO than in healthy controls. Mean Tei index was significantly higher in the BRVO group than in patients with hypertension or healthy controls. Compared with healthy controls, the Tei index was significantly higher in hypertensive and normotensive patients with BRVO. CONCLUSION Myocardial performance is decreased in patients with BRVO, independent of whether or not they have hypertension.
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Affiliation(s)
- Berkant Kaderli
- Department of Ophthalmology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Aysel Aydin Kaderli
- Department of Cardiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Sumeyye Gullulu
- Department of Cardiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Umit Ubeyt Inan
- Department of Ophthalmology, Faculty of Medicine, Afyon Kocatepe University, Afyonkarahisar, Turkey
| | - Tunay Senturk
- Department of Cardiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ali Aydinlar
- Department of Cardiology, Faculty of Medicine, Uludag University, Bursa, Turkey
| | - Ahmet Ali Yucel
- Department of Ophthalmology, Faculty of Medicine, Uludag University, Bursa, Turkey
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145
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Effect of increasing age on the haemodynamic response to thoracic epidural anaesthesia. Eur J Anaesthesiol 2014; 31:597-605. [DOI: 10.1097/eja.0000000000000125] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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146
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Morgan KY, Black LD. It's all in the timing: modeling isovolumic contraction through development and disease with a dynamic dual electromechanical bioreactor system. Organogenesis 2014; 10:317-22. [PMID: 25482314 DOI: 10.4161/org.29207] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
This commentary discusses the rationale behind our recently reported work entitled "Mimicking isovolumic contraction with combined electromechanical stimulation improves the development of engineered cardiac constructs," introduces new data supporting our hypothesis, and discusses future applications of our bioreactor system. The ability to stimulate engineered cardiac tissue in a bioreactor system that combines both electrical and mechanical stimulation offers a unique opportunity to simulate the appropriate dynamics between stretch and contraction and model isovolumic contraction in vitro. Our previous study demonstrated that combined electromechanical stimulation that simulated the timing of isovolumic contraction in healthy tissue improved force generation via increased contractile and calcium handling protein expression and improved hypertrophic pathway activation. In new data presented here, we further demonstrate that modification of the timing between electrical and mechanical stimulation to mimic a non-physiological process negatively impacts the functionality of the engineered constructs. We close by exploring the various disease states that have altered timing between the electrical and mechanical stimulation signals as potential future directions for the use of this system.
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Affiliation(s)
- Kathy Ye Morgan
- a Department of Biomedical Engineering ; Tufts University ; Medford , MA USA
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147
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Abstract
Chronic obstructive pulmonary disorder (COPD) is a systemic disease that affects the cardiovascular system through multiple pathways. Pulmonary hypertension, ventricular dysfunction, and atherosclerosis are associated with smoking and COPD, causing significant morbidity and poor prognosis. Coupling between the pulmonary and cardiovascular system involves mechanical interdependence and inflammatory pathways that potentially affect the entire circulation. Although treatments specific for COPD-related cardiovascular and pulmonary vascular disease are limited, early diagnosis, study of pathophysiology, and monitoring the effects of treatment are enhanced with improved imaging techniques. In this article, we review recent advancements in the imaging of the vasculature and the heart in patients with COPD. We also explore the potential mechanism of coupling between the progression of COPD and vascular disease. Imaging methods reviewed include specific implementations of computed tomography, magnetic resonance imaging, dual-energy computed tomography, positron emission tomography, and echocardiography. Specific applications to the proximal and distal pulmonary vasculature, as well as to the heart and systemic circulation, are also discussed.
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148
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Maizel J, Xavier S, Chen J, Lin CHS, Vasko R, Goligorsky MS. Sirtuin 1 ablation in endothelial cells is associated with impaired angiogenesis and diastolic dysfunction. Am J Physiol Heart Circ Physiol 2014; 307:H1691-704. [PMID: 25239805 DOI: 10.1152/ajpheart.00281.2014] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Discordant myocardial growth and angiogenesis can explain left ventricular (LV) hypertrophy progressing toward heart failure with aging. Sirtuin 1 expression declines with age; therefore we explored the role played by angiogenesis and Sirtuin 1 in the development of cardiomyopathy. We compared the cardiac function of 10- to 15-wk-old (wo), 30-40 wo, and 61-70 wo endothelial Sirtuin 1-deleted (Sirt1(endo-/-)) mice and their corresponding knockout controls (Sirt1(Flox/Flox)). After 30-40 wk, Sirt1(endo-/-) animals exhibited diastolic dysfunction (DD), decreased mRNA expression of Serca2a in the LV, and decreased capillary density compared with control animals despite a similar VEGFa mRNA expression. However, LV fibrosis and hypoxia-inducible factor (HIF)1α expression were not different. The creation of a transverse aortic constriction (TAC) provoked more severe DD and LV fibrosis in Sirt1(endo-/-) compared with control TAC animals. Although the VEGFa mRNA expression was not different and the protein expression of HIF1α was higher in the Sirt1(endo-/-) TAC animals, capillary density remained reduced. In cultured endothelial cells administration of Sirtuin 1 inhibitor decreased mRNA expression of VEGF receptors FLT 1 and FLK 1. Ex vivo capillary sprouting from aortic explants showed impaired angiogenic response to VEGF in the Sirt1(endo-/-) mice. In conclusion, the data demonstrate 1) a defect in angiogenesis preceding development of DD; 2) dispensability of endothelial Sirtuin 1 under unstressed conditions and during normal aging; and 3) impaired angiogenic adaptation and aggravated DD in Sirt1(endo-/-) mice challenged with LV overload.
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Affiliation(s)
- Julien Maizel
- Medical Intensive Care Unit, Department of Nephrology and INSERM U-1088, University of Picardie, Amiens, France; Department of Medicine, Renal Research Institute, New York Medical College, Valhalla, New York
| | - Sandhya Xavier
- Department of Medicine, Renal Research Institute, New York Medical College, Valhalla, New York
| | - Jun Chen
- Department of Medicine, Renal Research Institute, New York Medical College, Valhalla, New York
| | - Chi Hua Sarah Lin
- Department of Medicine, Renal Research Institute, New York Medical College, Valhalla, New York
| | - Radovan Vasko
- Medical Intensive Care Unit, Department of Nephrology and INSERM U-1088, University of Picardie, Amiens, France; Department of Nephrology and Rheumatology, University Medical Center, Gottingen, Germany; and
| | - Michael S Goligorsky
- Department of Medicine, Renal Research Institute, New York Medical College, Valhalla, New York
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Boueiz A, Hassoun PM. Saudi Guidelines on the Diagnosis and Treatment of Pulmonary Hypertension: Pulmonary arterial hypertension associated with connective tissue diseases. Ann Thorac Med 2014; 9:S26-37. [PMID: 25076994 PMCID: PMC4114266 DOI: 10.4103/1817-1737.134016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/05/2014] [Indexed: 12/22/2022] Open
Abstract
The explosive growth of medical literature on pulmonary hypertension (PH) has led to a steady increase in awareness of this disease within the medical community during the past decade. The recent revision of the classification of PH is presented in in the main guidelines. Group 1 PH or pulmonary arterial hypertension (PAH) is a heterogeneous group and includes PH due to inheritable, drug-induced, and toxin-induced causes and to such underlying systemic causes as connective tissue diseases, human immunodeficiency viral infection, portal hypertension, congenital heart disease, and schistosomiasis. Systemic sclerosis (SSc) is an autoimmune multisystem disorder, which affects over 240 persons per million in the United States.[1] Its manifestations are not confined to the skin but may also involve the lungs, kidneys, peripheral circulation, musculoskeletal system, gastrointestinal tract, and heart. The outcome of PAH associated with SSc is worse when compared to other subtypes of PAH. In this review, we summarize available information about the pulmonary vascular and cardiac manifestations of SSc with special emphasis on their prognostic implications as well as the peculiarity of their detection.
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Affiliation(s)
- Adel Boueiz
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Paul M Hassoun
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, USA
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150
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Ciurzyński M, Bienias P, Irzyk K, Kostrubiec M, Szewczyk A, Demkow U, Siwicka M, Kurnicka K, Lichodziejewska B, Pruszczyk P. Heart diastolic dysfunction in patients with systemic sclerosis. Arch Med Sci 2014; 10:445-54. [PMID: 25097573 PMCID: PMC4107251 DOI: 10.5114/aoms.2014.43739] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/24/2013] [Accepted: 10/14/2013] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION There are limited data on left (LV) and right ventricular (RV) diastolic function in systemic sclerosis (SSc) patients especially in relation to biomarkers of matrix remodeling. The aim of the study was to analyze LV and RV myocardial diastolic function in SSc patients at baseline and after at least 1 year of follow-up and its relation to serum tissue inhibitors of metalloproteinase 1 (TIMP-1) level. MATERIAL AND METHODS We prospectively studied 111 SSc patients (101 female, 10 male, age 54.2 ±13.8 years) and 21 age-matched controls (18 female, 3 male, age 49.3 ±10.5 years). After at least 1 year of observation (3.0 ±1.1 years) we reevaluated 69 of the SSc patients. Transthoracic echocardiography (Philips, iE33) for assessment of LV and RV diastolic function was performed and TIMP-1 serum level was measured. RESULTS Impaired LV relaxation was observed in 38 (34%) SSc patients and in 1 (5%) of the controls (p < 0.001). The mean E/A ratio was lower in patients with SSc than in controls (p = 0.002) and significantly decreased after the follow-up period (p = 0.02). Impaired RV relaxation was detected in 25 (22.5%) SSc patients and in 1 (5%) control subject (p < 0.001) but did not deteriorate after follow-up. Mean serum level of TIMP-1 was significantly elevated in the follow-up group compared to baseline examination (p = 0.0001). Serum TIMP-1 level correlated positively with E/E', both septal and lateral (r = 0.4, p = 0.002 and r = 0.32, p = 0.01). CONCLUSIONS The LV and RV relaxation is impaired in SSc patients. Moreover, left ventricular diastolic function deteriorated after the follow-up period. The TIMP-1 serum levels correlate with echocardiographic parameters, providing a potent link for LV diastolic function and matrix remodeling in patients with SSc.
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Affiliation(s)
- Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Bienias
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Irzyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | | | - Urszula Demkow
- Department of Laboratory Diagnostics and Clinical Immunology of Developmental Age, Medical University of Warsaw, Warsaw, Poland
| | - Maria Siwicka
- Department of Dermatology, Medical University of Warsaw, Warsaw, Poland
| | - Katarzyna Kurnicka
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Barbara Lichodziejewska
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw, Poland
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