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Abstract
INTRODUCTION Limited transthoracic echocardiogram (LTTE) has been shown to be a useful tool in guiding resuscitation in adult trauma patients. Our hypothesis is that image-guided resuscitation in pediatric trauma patients with LTTE is feasible. METHODS A retrospective chart review was performed on highest level pediatric trauma alerts (age 18 years or younger) at our level I trauma center during a 6-month period. Patients were divided into 2 groups as follows: those who had LTTE performed (LTTE group) and those who did not have LTTE performed (non-LTTE group). RESULTS A total of 31 charts were reviewed; 4 patients were excluded because they died on arrival to the emergency department. Fourteen patients had LTTE performed (LTTE group); 13 patients did not have LTTE performed (non-LTTE group). There was no difference in mechanism of injury, age, injury severity score, weight, or intensive care unit admission between the groups. The LTTE group received significantly less intravenous fluid than the non-LTTE group (1.2 vs 2.3 L, P = 0.0013).Within the LTTE group, 8 patients had "full" inferior vena cava (IVC) and 6 patients had "empty" IVC. There was no difference in injury severity score between these subgroups (P = 0.1018). Less fluid was given in the group labeled with full IVC [1.1 L (0.8-1.2)] than the group with empty IVC [2.4 L (1.7-2.6)], P = 0.0005. Four of the 6 patients with "empty" IVC had a confirmed source of bleeding. CONCLUSIONS Limited transthoracic echocardiogram can limit the amount of unnecessary crystalloid resuscitation given to pediatric trauma patients who are not hypovolemic.
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102
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Chia PL, Chiang K, Snyder R, Dowling A. The utility of routine pre-chemotherapy screening with cardiac gated blood pool scan for patients at low risk of anthracycline toxicity. J Oncol Pharm Pract 2017; 24:264-271. [PMID: 29284360 DOI: 10.1177/1078155217697487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Anthracycline-based chemotherapy is used in many malignancies. Current recommendations by several groups suggest cardiac monitoring prior to and during anthracycline therapy. We aim to review the usefulness of baseline cardiac screening for left ventricular ejection fraction to assess if it had any impact on chemotherapy decisions in patients to be treated with anthracycline-based regimens or any beneficial effect upon outcomes. Methods We conducted a retrospective three-year audit of cancer patients who underwent GBPS prior to anthracycline (doxorubicin) chemotherapy. Subjects were identified via records from the Department of Nuclear Medicine. Pharmacy dispensing records identified those who received doxorubicin. Patient demographics, cancer type, cardiac risk factors, GBPS ejection fraction (EF), and cumulative anthracycline dose were collected. Results From 1 August 2009 to 31 July 2012, 179 patients underwent GBPS pre-doxorubicin chemotherapy. The mean age was 59 years (range 21-89 years), with 51% being males. Only two patients (1.1%) had an abnormal EF < 50%, while 33 patients (18%) had an EF 51-59% and 144 patients (80%) had EF ≥ 60%. The two patients with reduced baseline EF still received anthracycline-based chemotherapy. All 135 patients without any known cardiovascular risk factors had normal EFs. The total number of patients who received anthracycline chemotherapy during the same period was 207. Thus 28 patients (13%) commenced anthracycline without a prior GBPS. Conclusion Only 1.1% of the screened patients had EF < 50%. These two patients still received doxorubicin chemotherapy despite a compromised EF, as their treating clinicians believed that the benefits of chemotherapy outweighed the risk of potential cardiac toxicity. Our audit questions the practice of routine cardiac evaluation pre-anthracycline screening with GBPS. We propose that routine screening only be requested if cardiac risk factors are present.
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Affiliation(s)
- Puey Ling Chia
- 1 Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia.,2 Department of Medical Oncology, Olivia Newton-John Cancer Research Institute, Austin Health, Melbourne, Australia
| | - K Chiang
- 3 Department of Pharmacy, St Vincent's Hospital Melbourne, Australia
| | - R Snyder
- 1 Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia
| | - A Dowling
- 1 Department of Medical Oncology, St Vincent's Hospital Melbourne, Melbourne, Australia
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103
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Thyrotoxic Atrial Fibrillation: Factors Associated with Persistence and Risk of Ischemic Stroke. J Thyroid Res 2017; 2017:4259183. [PMID: 29379659 PMCID: PMC5742874 DOI: 10.1155/2017/4259183] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/21/2017] [Indexed: 01/02/2023] Open
Abstract
Background Atrial fibrillation (AF) is one of the commonest cardiovascular manifestations of thyrotoxicosis. A significant proportion of patients have persistent AF which may have long term consequences, for example, ischemic stroke. Methods We performed a retrospective cohort study in a regional hospital from January 2004 to June 2016 to examine the clinical characteristics and outcomes of thyrotoxic patients who presented with atrial fibrillation and to investigate possible factors associated with persistent atrial fibrillation and ischemic stoke. Results Among 1918 patients who had a diagnosis of thyrotoxicosis, 133 (6.9%) patients presented with AF. Spontaneous sinus conversion occurred in 89 (66.9%) patients in which 85 (94%) patients developed sinus conversion before or within 6 months after having achieved euthyroidism. The remaining 44 (33.1%) had persistent AF. The rate of ischemic stroke was numerically higher among patients who had persistent AF than those with spontaneous sinus conversion (15.9% versus 10.1%; log-rank 0.442, p = 0.506). Patients who sustained an ischemic stroke were older (71 ± 11 years versus 62 ± 16 years, p = 0.023) and had a trend towards higher CHA2DS2-VASc score (2.9 ± 1.7 versus 2.3 ± 1.7, p = 0.153). History of smoking (adjusted odds ratio 4.9, 95% CI [1.8,14.0], p = 0.002), a larger left atrial diameter (adjusted odd ratio 2.6, 95% CI [1.2,5.5], p = 0.014), and a relatively lower free thyroxine level at diagnosis (adjusted odd ratio 2.1, 95% CI [1.2,3.5], p = 0.008) were associated with persistence of AF on multivariate analysis. Conclusion Persistence of thyrotoxic AF occurred in one-third of patients and spontaneous sinus conversion was unlikely after six months of euthyroidism. High rate of ischemic stroke was observed among patients with persistent thyrotoxic AF and older age. Patients with factors associated with persistent AF, especially older people, should be closely monitored beyond 6 months so that anticoagulation can be initiated in a timely manner to reduce risk of ischemic stroke.
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104
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Presence of post-systolic shortening is an independent predictor of heart failure in patients following ST-segment elevation myocardial infarction. Int J Cardiovasc Imaging 2017; 34:751-760. [PMID: 29230597 DOI: 10.1007/s10554-017-1288-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
Following an ischemic event post systolic shortening (PSS) may occur. We investigated the association between PSS in patients with ST-segment elevation myocardial infarction (STEMI) following primary percutaneous coronary intervention (pPCI) and occurrence of cardiovascular events at follow-up. A total of 373 patients admitted with STEMI and treated with pPCI were prospectively included in the study cohort. All patients were examined by echocardiography a median of 2 days after admission (interquartile range, 1-3 days). PSS was measured by color tissue Doppler imaging (TDI) and speckle tracking echocardiography (STE) in six myocardial walls from all three apical projections. During a median follow-up period of 5.4 years (interquartile range, 4.1-6.0 years), 180 events occurred: 59 deaths, 70 heart failures (HF) and 51 new myocardial infarctions (MI). In multivariable analysis adjusting for: age, sex, peak troponin, left ventricle ejection fraction, TIMI flow grade, left ventricle mass index, hypertension and diabetes, presence of PSS by TDI in the culprit region was associated with a nearly twofold increased risk of HF (HR 1.90, 95% CI 1.02-3.53, P = 0.043) and the risk of HF increased incrementally with increasing numbers of walls displaying PSS. The increased risk of HF was confirmed when assessing the post-systolic index by STE (HR 1.29 95% CI 1.09-1.53, P = 0.003, per 1% increase). A regional analysis showed that PSS by TDI in the septal wall was the strongest predictor of HF (HR 1.77, 95% CI 1.08-2.92, P = 0.024). Presence of PSS was not associated with increased risk of death or MI. In patients with STEMI treated with pPCI, the presence of PSS examined by TDI and STE provides prognostic information on development of HF. Presence of PSS in the septal wall is the strongest predictor of HF.
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105
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Bobenko A, Bartels I, Münch M, Trippel T, Lindhorst R, Nolte K, Herrmann-Lingen C, Halle M, Duvinage A, Düngen HD, Gelbrich G, Tschöpe C, Hasenfuss G, Wachter R, Pieske B, Edelmann F. Amount or intensity? Potential targets of exercise interventions in patients with heart failure with preserved ejection fraction. ESC Heart Fail 2017; 5:53-62. [PMID: 29210202 PMCID: PMC5793976 DOI: 10.1002/ehf2.12227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/01/2017] [Indexed: 12/25/2022] Open
Abstract
AIMS Heart failure with preserved ejection fraction (HFpEF) remains a common condition with no pharmacological treatment. Physical activity (PA) improves symptoms and quality of life (QoL), but no clear recommendations exist on PA in HFpEF patients. We investigated the association of PA (amount/intensity) on clinical phenotype in HFpEF. METHODS AND RESULTS The Aldosterone in Diastolic Heart Failure trial investigated spironolactone vs. placebo in stable HFpEF patients. At baseline, all patients underwent detailed phenotypization including echocardiography, cardiopulmonary exercise testing, 6 minute walking test (6MWT), and QoL assessment (36-item Short-Form questionnaire). PA was assessed by a self-report questionnaire, classified in metabolic equivalents of task (MET) and analysed with regard to exercise capacity, diastolic function, and QoL. Four hundred twenty-two patients (52% women, age 67 ± 8 years, New York Heart Association II and III) were classified by weekly MET hours into a low (<70), middle (70-140), or high (>140) level of PA. Total PA correlated positively with 6MWT distance (r = 0.17; P = 0.002) and physical function of QoL (r = 0.10; P = 0.05), but not with peak oxygen uptake (peakVO2 ). In contrast, both 6MWT distance and peakVO2 were significantly higher in patients who performed high-intensity PA for >8 h/week (P < 0.001, P = 0.02, respectively). Time of high-intensity PA was related to higher 6MWT distance (r = 0.21, P < 0.001), peakVO2 , and better physical function of QoL (both r = 0.13, P = 0.01), whereas low-intensity PA did not show significant associations. Interestingly, PA was not related to any measure of diastolic function. CONCLUSIONS A higher amount of PA is related to higher submaximal exercise capacity and physical function of QoL. Regarding maximal exercise capacity, only high-intensity PA showed significant association in HFpEF patients.
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Affiliation(s)
- Anna Bobenko
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Inke Bartels
- Clinic for Cardiology and Pneumology, University of Göttingen Medical Centre, Göttingen, Germany
| | - Marlene Münch
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Centre, University Hospital Würzburg, Würzburg, Germany
| | - Tobias Trippel
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Ruhdja Lindhorst
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Kathleen Nolte
- Clinic for Cardiology and Pneumology, University of Göttingen Medical Centre, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Christoph Herrmann-Lingen
- DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany.,Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen Medical Centre, Göttingen, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation, and Sports Medicine, Technische Universität München, Munich, Germany.,DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
| | - André Duvinage
- Department of Prevention, Rehabilitation, and Sports Medicine, Technische Universität München, Munich, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany
| | - Götz Gelbrich
- Institute for Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany.,Clinical Trial Centre, University Hospital Würzburg, Würzburg, Germany
| | - Carsten Tschöpe
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,BCRT (Berlin-Brandenburg Center for Regenerative Therapies), Berlin, Germany
| | - Gerd Hasenfuss
- Clinic for Cardiology and Pneumology, University of Göttingen Medical Centre, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Rolf Wachter
- Clinic for Cardiology and Pneumology, University of Göttingen Medical Centre, Göttingen, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
| | - Burkert Pieske
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Berlin, Berlin, Germany.,Department of Cardiology, Deutsches Herzzentrum Berlin (DHZB), Berlin, Germany
| | - Frank Edelmann
- Department of Cardiology, Charité-Universitätsmedizin Berlin, Berlin, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Göttingen, Göttingen, Germany
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106
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Impact of Modified Transesophageal Echocardiography on Mortality and Stroke after Cardiac Surgery: A Large Cohort Study. Int J Vasc Med 2017; 2017:1857069. [PMID: 29085679 PMCID: PMC5611872 DOI: 10.1155/2017/1857069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 06/27/2017] [Accepted: 07/18/2017] [Indexed: 11/18/2022] Open
Abstract
The aim of this study was to investigate the impact of perioperative screening with modified transesophageal echocardiography (A-View method). We compared, in consecutive patients who underwent cardiac surgery between 2006 and 2014, 30-day mortality and in-hospital stroke incidence, operated either with perioperative modified TEE screening (intervention group) or only with conventional TEE screening (control group). Of the 8,605 study patients, modified TEE was applied in 1,391 patients (16.2%). Patients in the intervention group were on average older (71 versus 68 years, p < 0.001) and more often females (31.0% versus 28.0%, p < 0.001) and had a higher predicted mortality (EuroSCORE I: 5.9% versus 4.0%, p < 0.001). The observed 30-day mortality was 2.2% and 2.5% in both groups, respectively, with multivariable and propensity-score adjusted relative risks (RRs) of 0.70 (95% CI: 0.50–1.00, p = 0.05) and 0.67 (95% CI: 0.45–0.98, p = 0.04). In-hospital stroke was 2.9% and 2.1% in both groups, respectively, with adjusted RRs of 1.03 (95% CI: 0.73–1.45) and 1.01 (95% CI: 0.71–1.43). In patients undergoing cardiac surgery, use of perioperative screening for aortic atherosclerosis with modified TEE was associated with lower postoperative mortality, but not stroke, as compared to patients operated on without such screening.
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107
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McDiarmid AK, Pellicori P, Cleland JG, Plein S. Taxonomy of segmental myocardial systolic dysfunction. Eur Heart J 2017; 38:942-954. [PMID: 27147609 PMCID: PMC5381597 DOI: 10.1093/eurheartj/ehw140] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/10/2016] [Indexed: 12/13/2022] Open
Abstract
The terms used to describe different states of myocardial health and disease are poorly defined. Imprecision and inconsistency in nomenclature can lead to difficulty in interpreting and applying trial outcomes to clinical practice. In particular, the terms ‘viable’ and ‘hibernating’ are commonly applied interchangeably and incorrectly to myocardium that exhibits chronic contractile dysfunction in patients with ischaemic heart disease. The range of inherent differences amongst imaging modalities used to define myocardial health and disease add further challenges to consistent definitions. The results of several large trials have led to renewed discussion about the classification of dysfunctional myocardial segments. This article aims to describe the diverse myocardial pathologies that may affect the myocardium in ischaemic heart disease and cardiomyopathy, and how they may be assessed with non-invasive imaging techniques in order to provide a taxonomy of myocardial dysfunction.
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Affiliation(s)
- Adam K McDiarmid
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
| | - Pierpaolo Pellicori
- Academic Cardiology Unit, University of Hull, Castle Hill Hospital, Kingston upon Hull, UK
| | - John G Cleland
- Academic Cardiology Unit, University of Hull, Castle Hill Hospital, Kingston upon Hull, UK
| | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds LS2 9JT, UK
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108
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Haji K, Haji D, Canty DJ, Royse AG, Tharmaraj D, Azraee M, Hopkins L, Royse CF. The Feasibility and Impact of Routine Combined Limited Transthoracic Echocardiography and Lung Ultrasound on Diagnosis and Management of Patients Admitted to ICU: A Prospective Observational Study. J Cardiothorac Vasc Anesth 2017; 32:354-360. [PMID: 29126689 DOI: 10.1053/j.jvca.2017.08.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Limited transthoracic echocardiography (TTE) and lung ultrasound increasingly is performed in the intensive care unit (ICU), though used in a goal-directed rather than routine manner. DESIGN Prospective observational study. SETTINGS Tertiary ICU. PARTICIPANTS Ninety-three critically ill participants within 24 hours of admission to ICU. METHODS A treating intensivist documented a clinical diagnosis and management plan before and after combined limited TTE and lung ultrasound. Ultrasound was performed by an independent intensivist and checked for accuracy offline by a second reviewer. RESULTS Ultrasound images were interpretable in 99%, with good interobserver agreement. The hemodynamic diagnosis was altered in 66% of participants, including new (14%) or altered (25%) abnormal states or exclusion of clinically diagnosed abnormal state (27%). Valve pathology of at least moderate severity was diagnosed for mitral regurgitation (7%), aortic stenosis (1%), aortic stenosis and mitral regurgitation (1%), tricuspid regurgitation (3%), and 1 case of mitral regurgitation was excluded. Lung pathology diagnosis was changed in 58% of participants including consolidation (13%), interstitial syndrome (4%), and pleural effusion (23%), and exclusion of clinically diagnosed consolidation (6%), interstitial syndrome (3%), and pleural effusion (9%). Management changed in 65% of participants including increased (12%) or decreased (23%) fluid therapy, initiation (10%), changing (6%) or cessation (9%) of inotropic, vasoactive or diuretic drugs, non-invasive ventilation (3%), and pleural drainage (2%). CONCLUSION Routine screening of patients with combined limited TTE and lung ultrasound on admission to ICU is feasible and frequently alters diagnosis and management.
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Affiliation(s)
- Kavi Haji
- Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia; Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| | - Darsim Haji
- Frankston Hospital, Frankston, Victoria, Australia; Ultrasound Simulation, Department of Surgery, University of Melbourne, Melbourne, Australia
| | - David J Canty
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | - Alistair G Royse
- Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Dhaksha Tharmaraj
- Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia
| | - Meor Azraee
- Intensive Care Unit, Frankston Hospital, Frankston, Victoria, Australia
| | - Lynda Hopkins
- Frankston Hospital, Frankston, Victoria, Australia; Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - Collin F Royse
- Ultrasound Education Group, Department of Surgery, The University of Melbourne, Melbourne, Australia
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109
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Abstract
Aging is characterized by heterogeneity, both in health and illness. Older adults with heart failure often have preserved ejection fraction and atypical and delayed clinical manifestations. After diagnosis of heart failure is established, a cause should be sought. The patient's comorbidities may provide clues. An elevated jugular venous pressure is the most reliable clinical sign of fluid volume overload and should be carefully evaluated. Left ventricular ejection fraction must be determined to assess prognosis and guide therapy. These 5 steps, namely, diagnosis, etiologic factor, fluid volume, ejection fraction, and therapy for heart failure may be memorized by mnemonic: DEFEAT-HF.
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Affiliation(s)
- Gurusher Panjrath
- Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-416, Washington, DC 20037, USA; Inova Heart and Vascular Institute, Inova Fairfax Hospital, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Ali Ahmed
- Department of Medicine, George Washington University, 2150 Pennsylvania Avenue, NW, Suite 8-416, Washington, DC 20037, USA; Center for Health and Aging, Veterans Affairs Medical Center, 50 Irving Street NW, Washington, DC 20422, USA; Department of Medicine, University of Alabama at Birmingham, 933 19th Street South, CH19 201, Birmingham, AL 35294, USA.
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110
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Güçlü A, Knaapen P, Harms HJ, Parbhudayal RY, Michels M, Lammertsma AA, van Rossum AC, Germans T, van der Velden J. Disease Stage-Dependent Changes in Cardiac Contractile Performance and Oxygen Utilization Underlie Reduced Myocardial Efficiency in Human Inherited Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005604. [PMID: 28476777 DOI: 10.1161/circimaging.116.005604] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 02/03/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Reduced myocardial efficiency represents a target for therapy in hypertrophic cardiomyopathy although therapeutic benefit may depend on disease stage. Here, we determined disease stage-dependent changes in myocardial efficiency and effects of myectomy surgery. METHODS AND RESULTS Myocardial external efficiency (MEE) was determined in 27 asymptomatic mutation carriers (genotype positive/phenotype negative), 10 patients with hypertrophic obstructive cardiomyopathy (HOCM), 10 patients with aortic valve stenosis, and 14 healthy individuals using [11C]-acetate positron emission tomography and cardiovascular magnetic resonance imaging. Follow-up measurements were performed in HOCM and aortic valve stenosis patients 4 months after surgery. External work did not differ in HOCM compared with controls, whereas myocardial oxygen consumption was lower in HOCM. Because of a higher cardiac mass, total cardiac oxygen consumption was significantly higher in HOCM than in controls and genotype positive/phenotype negative. MEE was significantly lower in genotype positive/phenotype negative than in controls (28±6% versus 42±6%) and was further decreased in HOCM (22±5%). In contrast to patients with aortic valve stenosis, MEE was not improved in patients with HOCM after surgery, which was explained by opposite changes in the septum (decrease) and lateral (increase) wall. CONCLUSIONS Different mechanisms underlie reduced MEE at the early and advanced stage of hypertrophic cardiomyopathy. The initial increase and subsequent reduction in myocardial oxygen consumption during disease progression indicates that energy deficiency is a primary mutation-related event, whereas mechanisms secondary to disease remodeling underlie low MEE in HOCM. Our data highlight that the benefit of therapies to improve energetic status of the heart may vary depending on the disease stage and that treatment should be initiated before cardiac remodeling.
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Affiliation(s)
- Ahmet Güçlü
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.).
| | - Paul Knaapen
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
| | - Hendrik J Harms
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
| | - Rahana Y Parbhudayal
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
| | - Michelle Michels
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
| | - Adriaan A Lammertsma
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
| | - Albert C van Rossum
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
| | - Tjeerd Germans
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
| | - Jolanda van der Velden
- From the Department of Cardiology (A.G., P.K., R.Y.P., A.C.v.R., T.G.), Department of Physiology (A.G., R.Y.P., J.v.d.V.), Department of Radiology and Nuclear Medicine, Institute for Cardiovascular Research (ICaR-VU) (H.J.H., A.A.L.), VU University Medical Center, Amsterdam, The Netherlands; Department of Cardiology, Erasmus Medical Center Rotterdam, The Netherlands (M.M.); Department of Cardiology, Medical Center Alkmaar, The Netherlands (T.G.); and ICIN-The Netherlands Heart Institute, Utrecht (A.G., J.v.d.V.)
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111
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Early Detection and Serial Monitoring of Anthracycline-Induced Cardiotoxicity Using T1-mapping Cardiac Magnetic Resonance Imaging: An Animal Study. Sci Rep 2017; 7:2663. [PMID: 28572614 PMCID: PMC5453985 DOI: 10.1038/s41598-017-02627-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 04/13/2017] [Indexed: 11/26/2022] Open
Abstract
A reliable, non-invasive diagnostic method is needed for early detection and serial monitoring of cardiotoxicity, a well-known side effect of chemotherapy. This study aimed to assess the feasibility of T1-mapping cardiac magnetic resonance imaging (CMR) for evaluating subclinical myocardial changes in a doxorubicin-induced cardiotoxicity rabbit model. Adult male New Zealand White rabbits were injected twice-weekly with doxorubicin and subjected to CMR on a clinical 3T MR system before and every 2–4 weeks post-drug administration. Native T1 and extracellular volume (ECV) values were measured at six mid-left ventricle (LV) and specific LV lesions. Histological assessments evaluated myocardial injury and fibrosis. Three pre-model and 11 post-model animals were included. Myocardial injury was observed from 3 weeks. Mean LV myocardium ECV values increased significantly from week 3 before LV ejection fraction decreases (week 6), and ECVs of the RV upper/lower insertion sites and papillary muscle exceeded those of the LV. The mean native T1 value in the mid-LV increased significantly increased from week 6, and LV myocardium ECV correlated strongly with the degree of fibrosis (r = 0.979, p < 0.001). Myocardial T1 mapping, particularly ECV values, reliably and non-invasively detected early cardiotoxicity, allowing serial monitoring of chemotherapy-induced cardiotoxicity.
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112
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Ghany R, Tamariz L, Chen G, Ghany A, Forbes E, Tajiri T, Palacio A. Screening echocardiograms in a senior focused value based primary care improves systolic heart failure detection and clinical management. Cardiovasc Diagn Ther 2017; 7:236-243. [PMID: 28567349 DOI: 10.21037/cdt.2017.03.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Screening echocardiograms are not indicated. Our aim is to evaluate the impact of screening echocardiograms on improving clinical management among older adults. METHODS We performed screening echocardiograms for all consecutive patients and defined incident systolic heart failure (HF) as an ejection fraction of less than 50% among patients without a previous HF diagnosis. We reviewed medical record data to determine if the new cases where Stage B or C. We obtained prescribed medications and vital signs from the electronic health record to determine absolute changes before and after the echocardiogram. RESULTS We performed an echocardiogram in 6,417 patients with a mean age of 71.4±6. The echocardiogram identified 292 seniors with new cases of systolic HF (5.34%; 95% CI: 4.7-5.9) and 239 were stage B HF. The increase in the use of ace-inhibitor, beta blocker when comparing the pre and post echocardiogram periods was highest in those with Stage C and those with ejection fraction lower than 40%. Systolic blood pressure (SBP) decreased from 140±19 to 136±15 (P<0.01) and low density lipoprotein (LDL) from 105±36 to 97±33 (P<0.01). CONCLUSIONS Performing echocardiograms in senior-focused value-based primary care improves evidence-based cardiovascular treatment and short-term clinical outcomes, including lowering SBP and LDL.
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Affiliation(s)
- Reyan Ghany
- Chen Neighborhood Medical Centers, Miami, FL, USA
| | - Leonardo Tamariz
- Miller School of Medicine at the University of Miami, Miami, FL, USA.,Veterans Affairs Medical Center, Miami, FL, USA
| | - Gordon Chen
- Chen Neighborhood Medical Centers, Miami, FL, USA
| | - Alina Ghany
- Chen Neighborhood Medical Centers, Miami, FL, USA
| | | | | | - Ana Palacio
- Chen Neighborhood Medical Centers, Miami, FL, USA.,Miller School of Medicine at the University of Miami, Miami, FL, USA.,Veterans Affairs Medical Center, Miami, FL, USA
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113
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Jelavic MM, Babic Z, Pintaric H. The importance of two metabolic syndrome diagnostic criteria and body fat distribution in predicting clinical severity and prognosis of acute myocardial infarction. Arch Med Sci 2017; 13:795-806. [PMID: 28721147 PMCID: PMC5510506 DOI: 10.5114/aoms.2016.59703] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/15/2016] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION The interrelation between metabolic syndrome (MetS) (the revised National Cholesterol Education Program-Adult Treatment Panel III (NCEP-ATP III) and International Diabetes Federation (IDF)) and obesity indices in predicting clinical severity and prognosis of acute ST-elevation myocardial infarction (STEMI) is insufficiently known. MATERIAL AND METHODS This prospective study included 250 acute STEMI patients treated with primary percutaneous coronary intervention. The patients with/without MetS were analyzed by baseline (medical history, demography and obesity indices: overall - body mass index (BMI) vs.central - body adiposity index (BAI), conicity index (Cindex), visceral adiposity index (VAI), waist circumference (WC), waist-to-hip (WHR) and waist-to-height ratio (WHtR)), severity (clinical presentation, laboratory, echocardiography, coronary angiography and in-hospital complications) and prognostic parameters (major adverse cardiovascular events and sick leave duration during 12-month follow-up). RESULTS There were 136 (54.4%) and 147 (58.8%) patients with MetS (NCEP-ATP III) and MetS (IDF), respectively. MetS (NCEP-ATP III) increased the risk of > 1 significantly stenosed coronary artery (CA), very high BAI increased the risk of dyspnea, Cindex > 1.25/1.18 increased the risk of total in-hospital complications, increased VAI increased the risk of coronary segment 3 significant stenosis, WHR ≥ 0.90/0.85 increased the risk of proximal/middle coronary segments (especially of segment 1) significant stenosis, WHtR ≥ 63/58 increased the risk of heart failure, and the number of significantly stenosed CAs increased the risk of total MACE (p < 0.05). CONCLUSIONS MetS (NCEP-ATP III) and several central obesity indices are superior to BMI in predicting acute STEMI severity (clinical presentation, in-hospital complications, severity of coronary disease), while WC and MetS (IDF) have no influence on it. They all have no influence on prognosis.
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Affiliation(s)
- Marko Mornar Jelavic
- Department of Internal Medicine and Dialysis, Zagreb – East Health Center, Zagreb, Croatia
| | - Zdravko Babic
- Coronary Care Unit, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Hrvoje Pintaric
- Cardiac Catheterization Laboratory, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
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114
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Echocardiographic Determinants of One-Year All-Cause Mortality in Patients With Chronic Heart Failure Complicated by Significant Functional Tricuspid Regurgitation. J Card Fail 2017; 23:434-443. [DOI: 10.1016/j.cardfail.2016.11.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 11/21/2016] [Accepted: 11/23/2016] [Indexed: 11/18/2022]
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115
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Lüers C, Edelmann F, Wachter R, Pieske B, Mende M, Angermann C, Ertl G, Düngen HD, Störk S. Prognostic impact of diastolic dysfunction in systolic heart failure-A cross-project analysis from the German Competence Network Heart Failure. Clin Cardiol 2017; 40:667-673. [PMID: 28467622 DOI: 10.1002/clc.22710] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2016] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the modifying role and prognostic importance of diastolic dysfunction (DD) in patients with heart failure and systolic dysfunction (SD). HYPOTHESIS The echocardiographic evaluation of diastolic function in patients with SD provides further prognostic information. METHODS From the German Competence Network Heart Failure, 1046 heart failure patients with reduced left ventricular ejection fraction (LVEF; <50%) were echocardiographically studied and followed for a median of 5 years. SD was subdivided into nonsevere (LVEF 36%-49%) and severe (LVEF ≤35%); DD was subdivided into nonsevere (E/E' <15) and severe (E/E' ≥15). RESULTS In general, severe SD was associated with higher hazard ratios (HRs; 2-fold to 3.5-fold) for all endpoints (all-cause death, cardiac death, cardiovascular hospitalization, duration of hospitalization). Patients with severe SD had a 2.5-fold risk of death (95% confidence interval [CI]: 1.84-3.47, P < 0.001), and patients with severe DD showed a 1.8-fold risk (95% CI: 1.17-2.61, P = 0.004). Furthermore, we observed a strong interaction of SD and DD: concomitant severe DD in patients with moderate SD increased risk substantially (HR: 1.73, 95% CI: 1.16-2.6, P = 0.007); by contrast, in patients with severe SD, additional presence of severe DD added little or no risk (HR for interaction: 0.5-1.2). CONCLUSIONS In heart failure patients with reduced LVEF, the evaluation of diastolic function provides additional prognostic information. Although severe SD generally increased the risk for all endpoints, the degree of DD and its impact as a prognostic marker for overall and cardiovascular mortality appeared of particular relevance in subjects with nonsevere SD.
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Affiliation(s)
- Claus Lüers
- University of Oldenburg, European Medical School Oldenburg-Groningen, Germany
| | - Frank Edelmann
- Department of Cardiology and Pneumology, University of Göttingen, Germany.,Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Rolf Wachter
- Department of Cardiology and Pneumology, University of Göttingen, Germany
| | - Burkert Pieske
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | | | - Christiane Angermann
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Georg Ertl
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
| | - Hans-Dirk Düngen
- Department of Cardiology, Campus Virchow, Charité University, Berlin, Germany
| | - Stefan Störk
- Comprehensive Heart Failure Center, University of Würzburg, and Department of Internal Medicine Cardiology, University Hospital Würzburg, Germany
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116
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Lüers C, Trippel TD, Seeländer S, Wachter R, Hasenfuss G, Lindhorst R, Bobenko A, Nolte K, Pieske B, Edelmann F. Arterial stiffness and elevated left ventricular filling pressure in patients at risk for the development or a previous diagnosis of HF—A subgroup analysis from the DIAST-CHF study. ACTA ACUST UNITED AC 2017; 11:303-313. [DOI: 10.1016/j.jash.2017.03.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 03/10/2017] [Accepted: 03/18/2017] [Indexed: 12/28/2022]
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117
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Batalli A, Ibrahimi P, Bytyçi I, Ahmeti A, Haliti E, Elezi S, Henein MY, Bajraktari G. Different determinants of exercise capacity in HFpEF compared to HFrEF. Cardiovasc Ultrasound 2017; 15:12. [PMID: 28446199 PMCID: PMC5405480 DOI: 10.1186/s12947-017-0103-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/20/2017] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Quality of life is as important as survival in heart failure (HF) patients. Controversies exist with regards to echocardiographic determinants of exercise capacity in HF, particularly in patients with preserved ejection fraction (HFpEF). The aim of this study was to prospectively examine echocardiographic parameters that correlate and predict functional exercise capacity assessed by 6 min walk test (6-MWT) in patients with HFpEF. METHODS In 111 HF patients (mean age 63 ± 10 years, 47% female), an echo-Doppler study and a 6-MWT were performed in the same day. Patients were divided into two groups based on the 6-MWT distance (Group I: ≤ 300 m and Group II: >300 m). RESULTS Group I were older (p = 0.008), had higher prevalence of diabetes (p = 0.027), higher baseline heart rate (p = 0.004), larger left atrium - LA (p = 0.001), longer LV filling time - FT (p = 0.019), shorter isovolumic relaxation time (p = 0.037), shorter pulmonary artery acceleration time - PA acceleration time (p = 0.006), lower left atrial lateral wall myocardial velocity (a') (p = 0.018) and lower septal systolic myocardial velocity (s') (p = 0.023), compared with Group II. Patients with HF and reduced EF (HFrEF) had lower hemoglobin (p = 0.007), higher baseline heart rate (p = 0.005), higher NT-ProBNP (p = 0.001), larger LA (p = 0.004), lower septal s', e', a' waves, and septal mitral annular plane systolic excursion (MAPSE), shorter PA acceleration time (p < 0.001 for all), lower lateral MAPSE, higher E/A & E/e', and shorter LVFT (p = 0.001 for all), lower lateral e' (p = 0.009), s' (p = 0.006), right ventricular e' and LA emptying fraction (p = 0.012 for both), compared with HFpEF patients. In multivariate analysis, only LA diameter [2.676 (1.242-5.766), p = 0.012], and diabetes [0.274 (0.084-0.898), p = 0.033] independently predicted poor 6-MWT performance in the group as a whole. In HFrEF, age [1.073 (1.012-1.137), p = 0.018] and LA diameter [3.685 (1.348-10.071), p = 0.011], but in HFpEF, lateral s' [0.295 (0.099-0.882), p = 0.029], and hemoglobin level [0.497 (0.248-0.998), p = 0.049] independently predicted poor 6-MWT performance. CONCLUSIONS In HF patients determinants of exercise capacity differ according to severity of overall LV systolic function, with left atrial enlargement in HFrEF and longitudinal systolic shortening in HFpEF as the the main determinants.
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Affiliation(s)
- Arlind Batalli
- 0000 0004 4647 7277grid.412416.4Clinic of Cardiology, University Clinical Centre of Kosova, “Rrethi i Spitalit”, p.n., Prishtina, Kosovo
- grid.449627.aMedical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Pranvera Ibrahimi
- 0000 0004 4647 7277grid.412416.4Clinic of Cardiology, University Clinical Centre of Kosova, “Rrethi i Spitalit”, p.n., Prishtina, Kosovo
- 0000 0001 1034 3451grid.12650.30Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Ibadete Bytyçi
- 0000 0004 4647 7277grid.412416.4Clinic of Cardiology, University Clinical Centre of Kosova, “Rrethi i Spitalit”, p.n., Prishtina, Kosovo
| | - Artan Ahmeti
- 0000 0004 4647 7277grid.412416.4Clinic of Cardiology, University Clinical Centre of Kosova, “Rrethi i Spitalit”, p.n., Prishtina, Kosovo
- grid.449627.aMedical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Edmond Haliti
- 0000 0004 4647 7277grid.412416.4Clinic of Cardiology, University Clinical Centre of Kosova, “Rrethi i Spitalit”, p.n., Prishtina, Kosovo
- grid.449627.aMedical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Shpend Elezi
- grid.449627.aMedical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Michael Y. Henein
- 0000 0001 1034 3451grid.12650.30Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
- grid.264200.2Molecular and Clinical Sciences Research Institute, St George University London, London, United Kingdom
| | - Gani Bajraktari
- 0000 0004 4647 7277grid.412416.4Clinic of Cardiology, University Clinical Centre of Kosova, “Rrethi i Spitalit”, p.n., Prishtina, Kosovo
- grid.449627.aMedical Faculty, University of Prishtina, Prishtina, Kosovo
- 0000 0001 1034 3451grid.12650.30Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
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118
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Akashi N, Sakakura K, Yamamoto K, Taniguchi Y, Wada H, Momomura SI, Fujita H. Minimization of door-to-balloon time for ST-elevation acute myocardial infarction: a case report. Clin Case Rep 2017; 5:787-791. [PMID: 28588811 PMCID: PMC5457994 DOI: 10.1002/ccr3.939] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 03/07/2017] [Accepted: 03/09/2017] [Indexed: 11/24/2022] Open
Abstract
It is of utmost importance to minimize the door‐to‐balloon time for the initial treatment of ST‐elevation acute myocardial infarction. In this case report, we made all kinds of efforts to minimize procedures in the emergency department (ED minimization) as well as in the catheter laboratory without sacrificing safety.
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Affiliation(s)
- Naoyuki Akashi
- Division of Cardiovascular Medicine Saitama Medical Center Jichi Medical University Omiya-ku Saitama Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine Saitama Medical Center Jichi Medical University Omiya-ku Saitama Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine Saitama Medical Center Jichi Medical University Omiya-ku Saitama Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine Saitama Medical Center Jichi Medical University Omiya-ku Saitama Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine Saitama Medical Center Jichi Medical University Omiya-ku Saitama Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine Saitama Medical Center Jichi Medical University Omiya-ku Saitama Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine Saitama Medical Center Jichi Medical University Omiya-ku Saitama Japan
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119
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Iskandar R, Liu S, Xiang F, Chen W, Li L, Qin W, Huang F, Chen X. Expression of pericardial fluid T-cells and related inflammatory cytokines in patients with chronic heart failure. Exp Ther Med 2017; 13:1850-1858. [PMID: 28565777 PMCID: PMC5443183 DOI: 10.3892/etm.2017.4202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2015] [Accepted: 12/19/2016] [Indexed: 12/12/2022] Open
Abstract
Pericardial fluid, as a biochemical indicator of heart status, directly indicates pathological alteration to the heart. The accumulation of pericardial fluid can be attributed to an underlying systemic or local inflammatory process. However, the pericardial fluid expression of cellular surface markers, as well as several cytokines in chronic heart failure (CHF), remain unclear. In order to evaluate these issues further the pericardial fluid expression of several cytokines and the surface expression of activity markers between CHF patients and non-heart failure (NHF) patients were analyzed. The pericardial fluid expression of cytokines was measured by immunofluorescence and biomarker of plasma N-terminal propeptide of B-type natriuretic peptide (NT-proBNP), while pericardial fluid levels of soluble glycoprotein 130 (sgp130) were analyzed by ELISA in 50 CHF and 24 NHF patients. In addition, the surface expression of activation markers for T-cells was measured by immunohistochemistry. Patients with CHF demonstrated increased levels of plasma NT-proBNP and pericardial fluid sgp130. Surface expression of cellular activation markers CD25 and Foxp3 in the pericardial fluid was increased in patients with CHF. Moreover, the pro- and anti-inflammatory cytokines interferon (IFN)-γ, interleukin (IL)-6 and IL-10 in patients with CHF also demonstrated an increased expression within its pericardial fluid. In addition, there was infiltration of inflammatory cells and enhanced expression of inflammatory cytokines in the pericardial fluid of patients with CHF, which may reflect T cell activation, suggesting that systemic inflammation is important in the progression of CHF. This evidence could indicate a possible novel target for future therapeutics and prevention of CHF.
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Affiliation(s)
- Reinard Iskandar
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Shengchen Liu
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Fei Xiang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Wen Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Liangpeng Li
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Wei Qin
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Fuhua Huang
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
| | - Xin Chen
- Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu 210006, P.R. China
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Sachdeva R, Travers CD, McCracken CE, Samai C, Campbell RM, Slesnick TC, Border WL. Temporal Trends in Utilization of Transthoracic Echocardiography for Common Outpatient Pediatric Cardiology Diagnoses over the Past 15 Years. J Am Soc Echocardiogr 2017; 30:201-208. [DOI: 10.1016/j.echo.2016.12.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Indexed: 10/20/2022]
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121
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Al-Khatib SM, Yancy CW, Solis P, Becker L, Benjamin EJ, Carrillo RG, Ezekowitz JA, Fonarow GC, Kantharia BK, Kleinman M, Nichol G, Varosy PD. 2016 AHA/ACC Clinical Performance and Quality Measures for Prevention of Sudden Cardiac Death: A Report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circ Cardiovasc Qual Outcomes 2017; 10:e000022. [DOI: 10.1161/hcq.0000000000000022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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122
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Dimitriadis Z, Scholtz S, Ensminger S, Wiemer M, Fischbach T, Scholtz W, Piper C, Börgermann J, Bitter T, Horstkotte D, Faber L. Left ventricular adaptation after TAVI evaluated by conventional and speckle-tracking echocardiography. Int J Cardiol 2017; 228:633-637. [DOI: 10.1016/j.ijcard.2016.11.035] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 08/16/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022]
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123
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Bambul Heck P, Eicken A, Kasnar-Samprec J, Ewert P, Hager A. Early pulmonary arterial hypertension immediately after closure of a ventricular or complete atrioventricular septal defect beyond 6 months of age. Int J Cardiol 2017; 228:313-318. [DOI: 10.1016/j.ijcard.2016.11.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 09/21/2016] [Accepted: 11/05/2016] [Indexed: 11/28/2022]
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124
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Gouriet F, Levy PY. Management of Pericardial Effusion. Infect Dis (Lond) 2017. [DOI: 10.1016/b978-0-7020-6285-8.00209-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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125
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Aydin Sunbul E, Sunbul M, Gulec H. The impact of major depression on heart rate variability and endothelial dysfunction in patients with stable coronary artery disease. Gen Hosp Psychiatry 2017; 44:4-9. [PMID: 28041575 DOI: 10.1016/j.genhosppsych.2016.10.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 10/17/2016] [Accepted: 10/24/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Depression is an independent risk factor in cardiovascular diseases. Changes in the cardiac autonomic functions and pro-inflammatory processes are potential biological factors. Endothelial dysfunction plays an important role in the etiopathogenesis of atherosclerosis. Our objective was to evaluate the impact of major depression on heart rate variability and endothelial dysfunction in patients with stable CAD. METHODS The study group included 65 CAD patients with a diagnosis of major depression and 54 CAD patients without major depression. All study population underwent transthoracic echocardiography, measurement of flow mediated dilatation (FMD) and 24-h holter recording for heart rate variability (HRV). Blood samples were drawn to determine the inflammatory parameters. Severity of depressive episode was assessed by Montgomery-Asberg Depression Scale (MADRS). RESULTS The distribution of age and sex was similar in the patient and control groups (P=0.715, 0.354, respectively). There was no significant difference in medications used between the groups. Echocardiographic parameters were similar between the groups. Inflammatory parameters were also similar between the groups. HRV parameters were significantly lower in the patient group than controls. The absolute FMD value and percentage FMD were significantly lower in the patient group than controls (P<0.001). The MADRS score correlated with pNN50 in both groups (P<0.05), and with FMD in the control group (P<0.001), even after adjusting for age and gender (P<0.001). CONCLUSIONS MADRS score was an independent predictor of pNN50 level, percentage and absolute FMD values regardless of age and gender. Clinician should pay more attention for evaluation of depressive patients with CAD.
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Affiliation(s)
- Esra Aydin Sunbul
- Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul, Turkey
| | - Murat Sunbul
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey.
| | - Huseyin Gulec
- Erenkoy Training and Research Hospital for Psychiatric and Neurological Disorders, Psychiatry Clinic, Istanbul, Turkey
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Arodiwe I, Ikefuna A, Obidike E, Arodiwe E, Anisuba B, Ibeziako N, Omokoidion S, Okoroma C. Left ventricular systolic function in Nigerian children infected with HIV/AIDS: a cross-sectional study. Cardiovasc J Afr 2016; 27:25-9. [PMID: 26956496 PMCID: PMC4816967 DOI: 10.5830/cvja-2015-066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Accepted: 08/25/2015] [Indexed: 11/30/2022] Open
Abstract
Background Cardiac complications contribute significantly to morbidity and mortality in children with HIV/AIDS. These rates have been under-reported in sub-Saharan African children. Methods This was an observational, cross-sectional Doppler echocardiographic study of ventricular systolic function, performed at a tertiary clinic on children with HIV/AIDS. Results Left ventricular systolic dysfunction was present in 27.0% of the children with HIV infection and 81.2% of those with AIDS. The mean fractional shortening in the AIDS group (31.6 ± 9.5%) was significantly lower than in the HIV-infected group (35.3 ± 10.5%, p = 0.001). A significant correlation was found with CD4+ cell count and age, and these were the best predictors of left ventricular systolic dysfunction in the stepwise multiple regression analysis (r = 0.396, p = 0.038; r = –0.212, p = 0.025, respectively). Conclusion Left ventricular systolic dysfunction is common in Nigerian children with HIV/AIDS.
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Affiliation(s)
- Ijeoma Arodiwe
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.
| | - Anthony Ikefuna
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Egbuna Obidike
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Ejikeme Arodiwe
- Department of Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Bennedict Anisuba
- Department of Medicine, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Ngozi Ibeziako
- Department of Paediatrics, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria
| | - Sunday Omokoidion
- Department of Paediatrics, University College Hospital, Ibadan, Nigeria
| | - Christy Okoroma
- Department of Paediatrics, College of Medicine, University of Lagos, Lagos, Nigeria
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Verde E, Pérez de Prado A, López-Gómez JM, Quiroga B, Goicoechea M, García-Prieto A, Torres E, Reque J, Luño J. Asymptomatic Intradialytic Supraventricular Arrhythmias and Adverse Outcomes in Patients on Hemodialysis. Clin J Am Soc Nephrol 2016; 11:2210-2217. [PMID: 27697781 PMCID: PMC5142067 DOI: 10.2215/cjn.04310416] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2016] [Accepted: 08/01/2016] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES Supraventricular arrhythmias are associated with high morbidity and mortality. Nevertheless, this condition has received little attention in patients on hemodialysis. The objective of this study was to analyze the incidence of intradialysis supraventricular arrhythmia and its long-term prognostic value. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We designed an observational and prospective study in a cohort of patients on hemodialysis with a 10-year follow-up period. All patients were recruited for study participation and were not recruited for clinical indications. The study population comprised 77 patients (42 men and 35 women; mean age =58±15 years old) with sinus rhythm monitored using a Holter electrocardiogram over six consecutive hemodialysis sessions at recruitment. RESULTS Hypertension was present in 68.8% of patients, and diabetes was present in 29.9% of patients. Supraventricular arrhythmias were recorded in 38 patients (49.3%); all of these were short, asymptomatic, and self-limiting. Age (hazard ratio, 1.04 per year; 95% confidence interval, 1.00 to 1.08) and right atrial enlargement (hazard ratio, 4.29; 95% confidence interval, 1.30 to 14.09) were associated with supraventricular arrhythmia in the multivariate analysis. During a median follow-up of 40 months, 57 patients died, and cardiovascular disease was the main cause of death (52.6%). The variables associated with all-cause mortality in the Cox model were age (hazard ratio, 1.04 per year; 95% confidence interval, 1.00 to 1.08), C-reactive protein (hazard ratio, 1.04 per 1 mg/L; 95% confidence interval, 1.00 to 1.08), and supraventricular arrhythmia (hazard ratio, 3.21; 95% confidence interval, 1.29 to 7.96). Patients with supraventricular arrhythmia also had a higher risk of nonfatal cardiovascular events (hazard ratio, 4.32; 95% confidence interval, 2.11 to 8.83) and symptomatic atrial fibrillation during follow-up (hazard ratio, 17.19; 95% confidence interval, 2.03 to 145.15). CONCLUSIONS The incidence of intradialysis supraventricular arrhythmia was high in our hemodialysis study population. Supraventricular arrhythmias were short, asymptomatic, and self-limiting, and although silent, these arrhythmias were independently associated with mortality and cardiovascular events.
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Affiliation(s)
- Eduardo Verde
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | | | - Juan M. López-Gómez
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Borja Quiroga
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Marian Goicoechea
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ana García-Prieto
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Esther Torres
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Javier Reque
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - José Luño
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Dalia AA, Khan H, Flores AS. Intraoperative Diagnosis of Intracardiac Thrombus During Orthotopic Liver Transplantation With Transesophageal Echocardiography: A Case Series and Literature Review. Semin Cardiothorac Vasc Anesth 2016; 21:245-251. [DOI: 10.1177/1089253216677966] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Anesthesia for orthotopic liver transplantation (OLT) is challenging for any anesthesiologist as the patients undergoing this procedure are among the most critically ill. Adding to the underlying complexity of OLT management is the rare complication of an intracardiac thrombus (ICT). Intracardiac thrombi can present following liver allograft reperfusion resulting in high morbidity and mortality. Currently there is no consensus treatment for ICT, and the gold standard for diagnosis is intraoperative transesophageal echocardiography (TEE); these 2 factors lead to a dangerous amalgam of the difficulty in diagnosing and treating the disease. We describe 2 separate cases in detail of ICT formation during OLT that were recognized and diagnosed with intraoperative TEE. These 2 cases highlight the important role of TEE in the management of ICT. A thorough literature review that follows analyzes our current understanding of ICT during OLT and the vital function of TEE by every anesthesiologists regardless of formal TEE training. Broader use of TEE during all OLTs can help narrow the anesthesiologist’s differential diagnosis during the acute phases of transplantation and should be considered in all liver transplant surgeries.
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Affiliation(s)
- Adam A. Dalia
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Hisham Khan
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Guo L, Chughtai AR, Jiang H, Gao L, Yang Y, Yang Y, Liu Y, Xie Z, Li W. Relationship between polycythemia and in-hospital mortality in chronic obstructive pulmonary disease patients with low-risk pulmonary embolism. J Thorac Dis 2016; 8:3119-3131. [PMID: 28066591 DOI: 10.21037/jtd.2016.11.31] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUNDS Pulmonary embolism (PE) is frequent in subjects with chronic obstructive pulmonary disease (COPD) and associated with high mortality. This multi-center retrospective study was performed to investigate if secondary polycythemia is associated with in-hospital mortality in COPD patients with low-risk PE. METHODS We identified COPD patients with proven PE between October, 2005 and October, 2015. Patients in risk classes III-V on the basis of the PESI score were excluded. We extracted demographic, clinical and laboratory information at the time of admission from medical records. All subjects were followed until hospital discharge to identify all-cause mortality. RESULTS We enrolled 629 consecutive patients with COPD and PE at low risk: 132 of them (21.0%) with and 497 (79.0%) without secondary polycythemia. Compared with those without polycythemia, the polycythemia group had significantly lower forced expiratory volume in one second (FEV1) level (0.9±0.3 vs. 1.4±0.5, P=0.000), lower PaO2 and SpO2 as well as higher PaCO2 (P=0.03, P=0.03 and P=0.000, respectively). COPD patients with polycythemia had a higher proportion of arrhythmia in electrocardiogram (ECG) (49.5% vs. 35.7%, P=0.02), a longer hospital duration time (15.3±10.1 vs. 9.7±9.1, P=0.001), a higher mechanical ventilation rate (noninvasive and invasive, 51.7% vs. 30.3%, P=0.04 and 31.0% vs. 7.9%, P=0.04, respectively), and a higher in-hospital mortality (12.1% vs. 6.6%, P=0.04). Multivariate logistic regression analysis revealed that polycythemia was associated with mortality in COPD patients with low-risk PE (adjusted OR 1.11; 95% CI, 1.04-1.66). CONCLUSIONS Polycythemia is an independent risk factor for all-cause in-hospital mortality in COPD patients with PE at low risk.
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Affiliation(s)
- Lu Guo
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China;; Department of Respiratory Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu 610072, China
| | | | - Hongli Jiang
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Lingyun Gao
- Department of Respiratory Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu 610072, China
| | - Yan Yang
- Department of Respiratory Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu 610072, China
| | - Yang Yang
- Department of Respiratory Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu 610072, China
| | - Yuejian Liu
- Department of Respiratory Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu 610072, China
| | - Zhenliang Xie
- Department of Respiratory Medicine, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, University Hospital of Electronic Science & Technology of China, Chengdu 610072, China
| | - Weimin Li
- Department of Respiratory Medicine, West China Hospital of Sichuan University, Chengdu 610041, China
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ANGPTL2 activity in cardiac pathologies accelerates heart failure by perturbing cardiac function and energy metabolism. Nat Commun 2016; 7:13016. [PMID: 27677409 PMCID: PMC5052800 DOI: 10.1038/ncomms13016] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 08/25/2016] [Indexed: 12/21/2022] Open
Abstract
A cardioprotective response that alters ventricular contractility or promotes cardiomyocyte enlargement occurs with increased workload in conditions such as hypertension. When that response is excessive, pathological cardiac remodelling occurs, which can progress to heart failure, a leading cause of death worldwide. Mechanisms underlying this response are not fully understood. Here, we report that expression of angiopoietin-like protein 2 (ANGPTL2) increases in pathologically-remodeled hearts of mice and humans, while decreased cardiac ANGPTL2 expression occurs in physiological cardiac remodelling induced by endurance training in mice. Mice overexpressing ANGPTL2 in heart show cardiac dysfunction caused by both inactivation of AKT and sarco(endo)plasmic reticulum Ca2+-ATPase (SERCA)2a signalling and decreased myocardial energy metabolism. Conversely, Angptl2 knockout mice exhibit increased left ventricular contractility and upregulated AKT-SERCA2a signalling and energy metabolism. Finally, ANGPTL2-knockdown in mice subjected to pressure overload ameliorates cardiac dysfunction. Overall, these studies suggest that therapeutic ANGPTL2 suppression could antagonize development of heart failure. Heart responds to increased workload by enlarging cardiomyocytes to preserve function, but in pathologies hypertrophy leads to heart failure. Here the authors show that ANGPTL2 activity in the heart is critical for determining beneficial vs. pathological hypertrophy via its effect on AKT-SERCA2a signaling and myocardial energy.
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Mornar Jelavic M, Babic Z, Perencevic A, Doko S, Sikic A, Pintaric H. The correlation of several kidney function parameters with clinical severity and prognosis of acute myocardial infarction. Am J Emerg Med 2016; 34:1904-7. [DOI: 10.1016/j.ajem.2016.06.110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 11/30/2022] Open
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Sinha SK, Goel A, Madaan A, Thakur R, Krishna V, Singh K, Sachan M, Pandey U, Varma CM. Prevalence of Metabolic Syndrome and Its Clinical and Angiographic Profile in Patients With Naive Acute Coronary Syndrome in North Indian Population. J Clin Med Res 2016; 8:667-73. [PMID: 27540441 PMCID: PMC4974837 DOI: 10.14740/jocmr2655w] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Data of isolated metabolic syndrome as risk factor in patients presenting with acute coronary syndrome (ACS) especially in context to Indian subcontinent are sparse. Therefore, we studied the prevalence of metabolic syndrome (MetS), and its clinical and angiographic profile in naive ACS patients in North Indian population. METHODS A single-center, prospective, observational study of 324 patients was conducted at LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, India with newly diagnosed ACS patients with MetS, as per modified NCEP-ATP III criteria. They were divided into two groups with and without MetS, and their clinical and angiographic profiles were studied. RESULTS Prevalence of MetS in our study was 37.65%. Patients with MetS were significantly older than without MetS (60.3 ± 8.4 vs. 57.6 ± 7.9), and had females preponderance (35.24% vs. 24.25%), less tobacco abuse (30.32% vs. 42.57%), more non-ST-segment elevation ACS (58.19% vs. 36.14%), less ST-segment elevation myocardial infarction (STEMI) (41.80% vs. 63.86%), more cardiogenic shock (27.04% vs. 17.32%), recurrent ischemia (14.75% vs. 7.42%) and on angiogram, lesser single vessel disease (21.13% vs. 53.96%), more double vessel disease (39.34 vs. 24.26%), triple vessel disease (19.67% vs. 10.39%), left main (13.11% vs. 4.45%) and complex coronary lesions (tubular 40.98% vs. 31.68%; diffuse 26.23% vs. 18.32%). However, there was a trend of lower but insignificant mortality with MetS (5.44% vs. 6.55%). CONCLUSION There was high prevalence of MetS among patients with ACS in North Indian population with more advanced coronary artery disease. To the best of our knowledge, this is the first study from North India documenting clinical and angiographic profile of patients with MetS and ACS.
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Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Amit Goel
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Amit Madaan
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G.S.V.M. Medical College, Kanpur, Uttar Pradesh 208002, India
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Ebert M, Jander N, Minners J, Blum T, Doering M, Bollmann A, Hindricks G, Arentz T, Kalusche D, Richter S. Long-Term Impact of Right Ventricular Pacing on Left Ventricular Systolic Function in Pacemaker Recipients With Preserved Ejection Fraction: Results From a Large Single-Center Registry. J Am Heart Assoc 2016; 5:JAHA.116.003485. [PMID: 27444509 PMCID: PMC5015385 DOI: 10.1161/jaha.116.003485] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background There is limited evidence of long‐term impact of right ventricular pacing on left ventricular (LV) systolic function in pacemaker recipients with preserved LV ejection fraction (LVEF). The objective of the study was to evaluate the outcome and echocardiographic course of baseline preserved LVEF in a large cohort of pacemaker recipients with respect to pacing indication and degree of right ventricular pacing. Methods and Results We enrolled 991 patients (73±10 years, 54% male) with baseline normal (>55%) LVEF (n=791) or mildly reduced (41–55%) LVEF (n=200) who had paired echocardiographic data on LV systolic function recorded at implantation and last follow‐up. According to pacing indication, patients were divided into atrioventricular block group A (n=500) and sinus node disease group B (n=491). Main outcome measures were all‐cause mortality and deterioration of LV function ≥2 LVEF categories at last follow‐up. Patients were followed for an average of 44 months. Death from any cause occurred in 166 (17%), and deterioration of LV function ≥2 LVEF categories in 56 (6%) patients. There was no significant difference in outcome between group A and group B either in patients with normal LVEF or in those with mildly reduced LVEF. Mean percentage of right ventricular pacing was not predictive of outcome. Conclusions In a large cohort of pacemaker recipients with predominantly normal LVEF, clinically relevant LV dysfunction develops rather infrequently. No significant difference in all‐cause mortality and development of severe LV dysfunction is observed between patients with atrioventricular block and sinus node disease. Accordingly, de novo biventricular pacing cannot be recommended for patients with preserved LVEF.
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Affiliation(s)
- Micaela Ebert
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Nikolaus Jander
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Jan Minners
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Thomas Blum
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Michael Doering
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
| | - Andreas Bollmann
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
| | - Gerhard Hindricks
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
| | - Thomas Arentz
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Dietrich Kalusche
- Department of Electrophysiology, University Heart Center Freiburg-Bad Krozingen, Germany
| | - Sergio Richter
- Department of Electrophysiology, Heart Center-University of Leipzig, Germany
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Konomi I, Tasoulis A, Kaltsi I, Karatzanos E, Vasileiadis I, Temperikidis P, Nanas S, Routsi CI. Left Ventricular Diastolic Dysfunction—An Independent Risk Factor for Weaning Failure from Mechanical Ventilation. Anaesth Intensive Care 2016; 44:466-73. [DOI: 10.1177/0310057x1604400408] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The objective of this study was to investigate the contribution of left ventricular (LV) diastolic dysfunction to weaning failure, along with the levels of the currently used cardiac biomarkers. Forty-two mechanically ventilated patients, who fulfilled criteria for weaning from mechanical ventilation (MV), underwent a two-hour spontaneous breathing trial (SBT). Transthoracic echocardiography (TTE) was performed before the start of the SBT. The grade of LV diastolic dysfunction was assessed by pulsed-wave Doppler and tissue Doppler imaging at the level of the mitral valve. Haemodynamic and respiratory parameters were recorded. Blood levels of B-type natriuretic peptide (BNP), troponin I, creatine kinase–MB, and myoglobin were measured on MV and at the end of the SBT. Weaning success was defined as the patient's ability to tolerate spontaneous breathing for more than 48 hours. Fifteen patients failed to wean. LV diastolic dysfunction was significantly associated with weaning failure ( P <0.001). The grade of diastolic dysfunction was significantly correlated with BNP levels both on MV and at the end of the SBT ( P <0.001, r = 0.703 and P <0.001, r = 0.709, respectively). BNP levels on MV were lower in patients who successfully weaned compared to those who did not (361 ± 523 ng/l versus 643 ± 382 ng/l respectively, P=0.008). The presence of diastolic dysfunction was independently associated with weaning failure (odds ratio [OR] 11.23, confidence interval [CI] 1.16–109.1, P=0.037) followed by respiratory frequency/tidal volume (OR 1.05, CI 1.00–1.10, P=0.048). Therefore, assessment of LV diastolic function before the start of weaning could be useful to identify patients at risk of weaning failure.
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Affiliation(s)
- I. Konomi
- Department of Intensive Care, Evangelismos Hospital, Athens, Greece
| | - A. Tasoulis
- Department of Intensive Care, Evangelismos Hospital, Athens, Greece
| | - I. Kaltsi
- Department of Intensive Care, Evangelismos Hospital, Athens, Greece
| | - E. Karatzanos
- Department of Intensive Care, Evangelismos Hospital, Athens, Greece
| | - I. Vasileiadis
- Department of Intensive Care, Evangelismos Hospital, Athens, Greece
| | - P. Temperikidis
- Department of Intensive Care, Evangelismos Hospital, Athens, Greece
| | - S. Nanas
- Department of Intensive Care and Cardiopulmonary Exercise Testing and Rehabilitation Laboratory, National and Kapodistrian University of Athens, Evangelismos Hospital, Athens, Greece
| | - C. I. Routsi
- Intensivist, National and Kapodistrian University of Athens, Department of Intensive Care, Evangelismos Hospital, Athens, Greece
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Heiberg J, El-Ansary D, Royse CF, Royse AG, Alsaddique AA, Canty DJ. Transthoracic and transoesophageal echocardiography: a systematic review of feasibility and impact on diagnosis, management and outcome after cardiac surgery. Anaesthesia 2016; 71:1210-21. [PMID: 27341788 DOI: 10.1111/anae.13545] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 11/29/2022]
Abstract
Transthoracic and transoesophageal echocardiography are increasingly used as tools to improve clinical assessment following cardiac surgery. However, most physicians are not trained in echocardiography, and there is no widespread agreement on the feasibility, indications or effect on outcome of transthoracic or transoesophageal echocardiography for patients after cardiac surgery. We performed a systematic review of electronic databases for focused transthoracic and transoesophageal echocardiography after cardiac surgery which revealed 15 full-text articles. They consistently reported that echocardiography is feasible, whether performed by a novice or expert, and frequently resulted in important changes in diagnosis of cardiac abnormalities and their management. However, most were observational studies and there were no well-designed trials investigating the impact of echocardiography on outcome. We conclude that both transthoracic and transoesophageal echocardiography are useful following cardiac surgery.
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Affiliation(s)
- J Heiberg
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
| | - D El-Ansary
- Department of Physiotherapy, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - C F Royse
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - A G Royse
- Department of Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - A A Alsaddique
- Department of Cardiothoracic Surgery, King Fahad Cardiac Centre, Riyadh, Saudi Arabia
| | - D J Canty
- Department of Anaesthesia and Pain Management, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Bloom MW, Hamo CE, Cardinale D, Ky B, Nohria A, Baer L, Skopicki H, Lenihan DJ, Gheorghiade M, Lyon AR, Butler J. Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 1: Definitions, Pathophysiology, Risk Factors, and Imaging. Circ Heart Fail 2016; 9:e002661. [PMID: 26747861 DOI: 10.1161/circheartfailure.115.002661] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Advances in cancer therapy have resulted in significant improvement in long-term survival for many types of cancer but have also resulted in untoward side effects associated with treatment. One such complication that has become increasingly recognized is the development of cardiomyopathy and heart failure. Whether a previously healthy person from a cardiovascular perspective develops cancer therapy-related cardiac dysfunction or a high-risk cardiovascular patient requires cancer therapy, the team of oncologists and cardiologists must be better equipped with an evidence-based approach to care for these patients across the spectrum. Although the toxicities associated with various cancer therapies are well recognized, limitations to our understanding of the appropriate course of action remain. In this first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy-related cardiac dysfunction and heart failure. In a subsequent second part, we discuss the prevention and treatment aspects, concluding with a section on evidence gap and future directions. We focus on adult patients in all stages of cancer therapy from pretreatment surveillance, to ongoing therapy, and long-term follow-up.
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Affiliation(s)
- Michelle W Bloom
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Carine E Hamo
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Daniela Cardinale
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Bonnie Ky
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Anju Nohria
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Lea Baer
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Hal Skopicki
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Daniel J Lenihan
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Mihai Gheorghiade
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Alexander R Lyon
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Javed Butler
- From the Cardiology Division (M.W.B., C.E.H., H.S., J.B.) and Oncology Division (L.B.), Stony Brook University, NY; Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiovascular Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
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Jiang YX, Jing LD, Jia YH. Clinical Characteristics and Risk Factors of Left Ventricular Thrombus after Acute Myocardial Infarction: A Matched Case-control Study. Chin Med J (Engl) 2016; 128:2415-9. [PMID: 26365955 PMCID: PMC4725552 DOI: 10.4103/0366-6999.164869] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Left ventricular thrombus (LVT) is reported to be a common complication in acute myocardial infarction (AMI) patients. And it has the potential to cause systemic embolism. This retrospective study was to present the current situation of LVT in clinical practice, as well as to evaluate the clinical characteristics and the risk factors of LVT after AMI. Methods: LVT cases (n = 96) were identified from 13,732 AMI (non-ST elevation myocardial infarction was excluded) patients in Fuwai Hospital's electronic medical records system from January 2003 to January 2013. The controls (n = 192) were gender- and age-matched AMI patients without LVT during this period. A conditional logistic regression (fitted by the Cox model) was performed to identify the independent risk factors. Results: The incidence of LVT after AMI was 0.7%. Univariate analysis indicated that the anterior myocardial infarction (especially extensive anterior myocardial infarction), lower left ventricular ejection fraction (LVEF), LVEF ≤40%, severe regional wall motion abnormalities (RWMA), pericardial effusion, and left ventricular aneurysm were all related to LVT after AMI. The independent risk factors obtained from the conditional logistic regression analysis were lower LVEF (odds ratio (OR) = 0.891, 95% confidence interval (CI): 0.828–0.960), extensive anterior myocardial infarction (OR = 6.403, 95% CI: 1.769–23.169), severe RWMA (OR = 7.348, 95% CI: 1.323–40.819), and left ventricular aneurysm (OR = 6.955, 95% CI: 1.673–28.921). Conclusions: This study indicated that lower LVEF, extensive anterior myocardial infarction, severe RWMA, and left ventricular aneurysm were independent risk factors of LVT after AMI. It also suggested that further efforts are needed for the LVT diagnosis after AMI in clinical practice.
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Affiliation(s)
| | | | - You-Hong Jia
- Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, State Key Laboratory of Cardiovascular Diseases, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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Breuckmann F, Hochadel M, Voigtländer T, Haude M, Schmitt C, Münzel T, Giannitsis E, Mudra H, Heusch G, Schumacher B, Barth S, Schuler G, Hailer B, Walther D, Senges J. The Use of Echocardiography in Certified Chest Pain Units: Results from the German Chest Pain Unit Registry. Cardiology 2016; 134:75-83. [PMID: 26910053 DOI: 10.1159/000443475] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/16/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To analyze the current usage of transthoracic echocardiography (TTE) as a rapid, noninvasive tool in the early stratification of acute chest pain in certified German chest pain units (CPUs). METHODS A total of 23,997 patients were enrolled. Analyses comprised TTE evaluation rates in relation to clinical presentation, risk profile, left ventricular impairment, final diagnosis and invasive management. Critical times were assessed. Multivariable analyses for independent determinants for the use of TTE were performed. RESULTS TTE evaluation was available in CPUs in 70.1% of cases. It was associated with lower rates of invasive management in unstable angina pectoris (UAP) and with higher rates in patients with initially suspected non-cardiac origin of symptoms and/or reduced systolic function (p < 0.05). Non-ST-segment elevation acute coronary syndrome (NSTE-ACS) was an independent determinant favoring TTE evaluation [NSTE-myocardial infarction: odds ratio (OR) 1.62; UAP: OR 1.34; p < 0.001 for both]. Clinical signs of heart failure (OR 1.31; p < 0.001), referral by emergency medical service (OR 1.18; p < 0.001) and kidney failure (OR 1.16; p < 0.05) were independently associated with higher TTE rates. TTE did not delay door-to-balloon times. CONCLUSIONS About two thirds of the patients admitted to certified CPUs received TTE evaluation, with the highest rates being in ACS patients, and thereby providing diagnostic information supporting or refuting further invasive management.
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Affiliation(s)
- Frank Breuckmann
- Department of Cardiology, Arnsberg Medical Center, Arnsberg, Germany
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Essandoh M, Otey AJ, Dalia A, Dewhirst E, Springer A, Henry M. Refractory Hypotension after Liver Allograft Reperfusion: A Case of Dynamic Left Ventricular Outflow Tract Obstruction. Front Med (Lausanne) 2016; 3:3. [PMID: 26909349 PMCID: PMC4754394 DOI: 10.3389/fmed.2016.00003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/14/2016] [Indexed: 12/14/2022] Open
Abstract
Hypotension after reperfusion is a common occurrence during liver transplantation following the systemic release of cold, hyperkalemic, and acidic contents of the liver allograft. Moreover, the release of vasoactive metabolites such as inflammatory cytokines and free radicals from the liver and mesentery, compounded by the hepatic uptake of blood, may also cause a decrement in systemic perfusion pressures. Thus, the postreperfusion syndrome (PRS) can materialize if hypotension and fibrinolysis occur concomitantly within 5 min of reperfusion. Treatment of the PRS may require the administration of inotropes, vasopressors, and intravenous fluids to maintain hemodynamic stability. However, the occurrence of the PRS and its treatment with inotropes and calcium chloride may lead to dynamic left ventricular outflow tract obstruction (DLVOTO) precipitating refractory hypotension. Expedient diagnosis of DLVOTO with transesophageal echocardiography is extremely vital in order to avoid potential cardiovascular collapse during this critical period.
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Affiliation(s)
- Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Andrew Joseph Otey
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Adam Dalia
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Elisabeth Dewhirst
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Andrew Springer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Mitchell Henry
- Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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140
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Imaging Techniques for Diagnosis of Thoracic Aortic Atherosclerosis. Int J Vasc Med 2016; 2016:4726094. [PMID: 26966580 PMCID: PMC4757718 DOI: 10.1155/2016/4726094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/13/2016] [Indexed: 12/22/2022] Open
Abstract
The most severe complications after cardiac surgery are neurological complications including stroke which is often caused by emboli merging from atherosclerosis in the ascending aorta to the brain. Information about the thoracic aorta is crucial in reducing the embolization risk for both surgical open and closed chest procedures such as transaortic heart valve implantation. Several techniques are available to screen the ascending aorta, for example, transesophageal echocardiography (TEE), epiaortic ultrasound, TEE A-view method, manual palpation, computed tomography, and magnetic resonance imaging. This paper provides a description of the advantages and disadvantages of these imaging techniques.
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141
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Hamo CE, Bloom MW, Cardinale D, Ky B, Nohria A, Baer L, Skopicki H, Lenihan DJ, Gheorghiade M, Lyon AR, Butler J. Cancer Therapy-Related Cardiac Dysfunction and Heart Failure: Part 2: Prevention, Treatment, Guidelines, and Future Directions. Circ Heart Fail 2016; 9:e002843. [PMID: 26839395 PMCID: PMC4743885 DOI: 10.1161/circheartfailure.115.002843] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Success with oncologic treatment has allowed cancer patients to experience longer cancer-free survival gains. Unfortunately, this success has been tempered by unintended and often devastating cardiac complications affecting overall patient outcomes. Cardiac toxicity, specifically the association of several cancer therapy agents with the development of left ventricular dysfunction and cardiomyopathy, is an issue of growing concern. Although the pathophysiologic mechanisms behind cardiac toxicity have been characterized, there is currently no evidence-based approach for monitoring and management of these patients. In the first of a 2-part review, we discuss the epidemiologic, pathophysiologic, risk factors, and imaging aspects of cancer therapy-related cardiac dysfunction and heart failure. In this second part, we discuss the prevention and treatment aspects in these patients and conclude with highlighting the evidence gaps and future directions for research in this area.
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Affiliation(s)
- Carine E Hamo
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Michelle W Bloom
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Daniela Cardinale
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Bonnie Ky
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Anju Nohria
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Lea Baer
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Hal Skopicki
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Daniel J Lenihan
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Mihai Gheorghiade
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Alexander R Lyon
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.)
| | - Javed Butler
- From the Cardiology Division (C.E.H., M.W.B, H.S., J.B.) and Oncology Division, Stony Brook University, NY (L.B.); Oncology Division, European Institute of Oncology, Milan, Italy (D.C.); Cardiology Division, University of Pennsylvania, Philadelphia (B.K.); Cardiology Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (A.N.); Cardiology Division, Vanderbilt University, Nashville, TN (D.J.L.); Cardiology Division, Center for Cardiovascular Innovation, Northwestern Feinberg School of Medicine, Chicago, IL (M.G.); and Cardiovascular Division, NIHR Cardiovascular Biomedical Research Unit, Royal Brompton Hospital and Imperial College London, London, United Kingdom (A.R.L.).
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Singh D, Thakur A, Tang WHW. Utilizing cardiac biomarkers to detect and prevent chemotherapy-induced cardiomyopathy. Curr Heart Fail Rep 2016; 12:255-62. [PMID: 25869733 DOI: 10.1007/s11897-015-0258-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The success achieved in advances in cancer therapy has been marred by development of cardiotoxicity, which causes significant morbidity and mortality. This has led to the development of surveillance protocols for cardiotoxicity utilizing multimodality imaging techniques and investigation of various drugs to treat and prevent cardiotoxicity in this subset of patients. Cardiac biomarkers hold important diagnostic and prognostic value in various cardiac diseases. In this review, we discuss the use of biomarkers in patients receiving chemotherapy, highlighting data behind the use of troponin, B-type natriuretic peptide, and myeloperoxidase. We also discuss the use of dexrazoxane, angiotensin-converting enzyme inhibitors, and beta blockers in the treatment and prevention of chemotherapy-induced cardiotoxicity. Cardiac biomarkers may serve an important role in selecting patients that are at high risk of cardiotoxicity and can potentially be used to guide the administration of drugs to treat and prevent cardiotoxicity.
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Affiliation(s)
- Dhssraj Singh
- Kaufman Center for Heart Failure, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, J3-4, Cleveland, OH, 44195, USA
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143
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Lee DW, Ha JH, Kim JH, Park KB, Lee JJ, Choi HI, Kim JH. Major Trauma induced Left Ventricular Thrombus after Acute Myocardial Infarction. J Lipid Atheroscler 2016. [DOI: 10.12997/jla.2016.5.2.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Dong Wook Lee
- Department of Internal Medicine, Busan Medical Center, Busan, Korea
| | - Ju Hee Ha
- Department of Internal Medicine, Busan Medical Center, Busan, Korea
| | - Jun Ho Kim
- Department of Internal Medicine, Busan Medical Center, Busan, Korea
| | - Ki Beom Park
- Department of Internal Medicine, Busan Medical Center, Busan, Korea
| | - Jae Joon Lee
- Department of Internal Medicine, Busan Medical Center, Busan, Korea
| | - Han Il Choi
- Department of Internal Medicine, Busan Medical Center, Busan, Korea
| | - Jin Hee Kim
- Department of Internal Medicine, Busan Medical Center, Busan, Korea
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Domercant J, Polin N, Jahangir E. Cardio-Oncology: A Focused Review of Anthracycline-, Human Epidermal Growth Factor Receptor 2 Inhibitor-, and Radiation-Induced Cardiotoxicity and Management. Ochsner J 2016; 16:250-256. [PMID: 27660573 PMCID: PMC5024806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
BACKGROUND Cardio-oncology is a collaborative approach between cardiologists and oncologists in the treatment of patients with cancer and heart disease. Radiation and chemotherapy have played a major role in the decreased cancer-related mortality achieved in the past 2 decades. However, anthracycline-, tyrosine kinase-, and radiation-based therapies are each associated with independent cardiovascular (CV) risks, and these risks are cumulative when these therapies are used in combination. METHODS We analyzed several published articles, studies, and guidelines to provide a focused review of cardiotoxicity associated with anthracyclines, human epidermal growth factor receptor 2 inhibitors, and radiation therapy and its management. RESULTS The focus on CV risk among individuals being treated with cardiotoxic agents is important because once the cancer is cured, CV disease becomes the number 1 cause of death among cancer survivors. Cardio-oncology focuses on assessing CV risk prior to starting therapy, optimizing modifiable risk factors, and providing surveillance and treatment for any early signs of cardiotoxicity in patients undergoing radiation and chemotherapy. A collaborative approach between oncologists and cardiologists is integral to the optimal care of patients with cancer. Although radiation and chemotherapy treatments have evolved with the aim of targeting cancer cells while having minimal effect on the heart, the increased risk of cardiomyopathy in patients receiving these treatments remains significant. CONCLUSION Proper screening and treatment of cardiotoxicity are essential for patients with cancer. As cardiac diseases and cancer remain the first and second causes of mortality in developed nations, respectively, cardio-oncology is the answer to this group of individuals who are especially vulnerable to both causes of mortality.
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Affiliation(s)
- Jean Domercant
- Department of Internal Medicine, Leonard J. Chabert Medical Center, Houma, LA
| | - Nichole Polin
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
- The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA
| | - Eiman Jahangir
- Department of Cardiology, Ochsner Clinic Foundation, New Orleans, LA
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Güçlü A, Happé C, Eren S, Korkmaz IH, Niessen HWM, Klein P, van Slegtenhorst M, Schinkel AF, Michels M, van Rossum AC, Germans T, van der Velden J. Left ventricular outflow tract gradient is associated with reduced capillary density in hypertrophic cardiomyopathy irrespective of genotype. Eur J Clin Invest 2015; 45:1252-9. [PMID: 26444145 DOI: 10.1111/eci.12544] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 10/01/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) is an important feature of hypertrophic cardiomyopathy (HCM), which contributes negatively to symptoms and long-term outcome. Previous in vivo imaging studies in HCM suggest that left ventricular outflow tract (LVOT) gradient and genetic status are important contributors to CMD. CMD may be caused by reduced capillary density. Here, we investigated whether a reduction in capillary density is related to genetic status or LVOT gradient severity in an in vitro study of HCM cardiac samples. METHODS Using immunofluorescence microscopy, we analysed capillaries (Cap) and cardiomyocytes (CM) in myectomy specimens from 18 HCM patients with maximum left ventricular (LV) wall thickness ≥15 mm. All subjects exhibited significant LVOT obstruction, necessitating septal myectomy. In addition, control myocardium from the LV septal wall was collected at autopsy of 6 individuals that suffered a noncardiac death. RESULTS CM area was higher in patients with HCM compared to controls. Capillary density was significantly lower in patients with HCM compared with controls (1425 ± 262 vs. 2543 ± 509 Cap/mm(2) , P < 0·001), as was the number of Cap per CM corrected for CM area (2·2 ± 0·5 vs. 4·2 ± 0·9 Cap/CM area, P < 0·001). Capillary density did not differ between genotype-negative and genotype-positive HCM patients at similar resting LVOT gradients. A significant correlation was present between resting LVOT gradient and CM area (r = 0·73, P < 0·001), capillary density (r = -0·74, P < 0·001) and the number of Cap per CM corrected for CM area (r = -0·82, P < 0·001). CONCLUSIONS Our data indicate that LVOT gradient, rather than genetic status, is associated with reduced capillary density in HCM.
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Affiliation(s)
- Ahmet Güçlü
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands.,ICIN-The Netherlands Heart Institute, Utrecht, The Netherlands
| | - Chris Happé
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands.,Department of Pulmonology, Institute for Cardiovascular Research (ICaR-VU), VU University Medical Center, Amsterdam, The Netherlands
| | - Seyma Eren
- Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
| | - Ibrahim H Korkmaz
- Department of Pathology and Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Hans W M Niessen
- Department of Pathology and Cardiac Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Patrick Klein
- Department of Cardiothoracic Surgery, Sint Antonius Hospital, Nieuwegein, The Netherlands
| | | | - Arend F Schinkel
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michelle Michels
- Thorax Center, Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert C van Rossum
- Department of Cardiology, VU University Medical Center, Amsterdam, The Netherlands
| | | | - Jolanda van der Velden
- ICIN-The Netherlands Heart Institute, Utrecht, The Netherlands.,Department of Physiology, VU University Medical Center, Amsterdam, The Netherlands
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147
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Plasma mid-regional pro-adrenomedullin levels are inversely associated with anxiety but unrelated to depression: Results from the observational DIAST-CHF study in patients with cardiovascular risk factors. Psychoneuroendocrinology 2015; 62:227-32. [PMID: 26342564 DOI: 10.1016/j.psyneuen.2015.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Revised: 07/22/2015] [Accepted: 08/05/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES It has been postulated that patients with heart failure have a high risk of ventricular arrhythmias and sudden cardiac death resulting from anxiety-induced autonomic arousal. In the prospective and multicenter DIAST-CHF (Diagnostic Trial on Prevalence and Clinical Course of Diastolic Dysfunction and Heart Failure) study, we therefore, tested the hypothesis that adrenomedullin (ADM), a well-established predictor for cardiovascular outcome, is associated with self-rated anxiety symptoms in patients at risk of suffering from or actually with overt heart failure. PARTICIPANTS AND MEASURES Study participants with risk factors for diastolic dysfunction were requested to complete the Hospital Anxiety and Depression Scale (HADS), and plasma mid-regional pro-adrenomedullin (MR-proADM) concentrations were measured. RESULTS In bivariate analysis, we found significantly lower plasma MR-proADM levels in patients with elevated HADS-anxiety scores above the clinically relevant cut-off level of ≥11 (n=118, 536pmol/l, interquartile range [IQR] 449-626) as compared to non-anxious study participants (n=1,292, 573pmol/l, IQR 486-702, p=0.001). A set of multivariate models adjusted for potential confounders confirmed the negative association between self-rated anxiety symptoms and plasma MR-proADM. In similar models, no significant association was detected between HADS-depression scores and MR-proADM. CONCLUSIONS The inverse relationship between plasma MR-proADM and anxiety observed in patients with cardiovascular risk factors supports a previous experimental study using a mutant mouse line with a brain-specific loss of ADM expression which displayed hyperactive and over-anxious behavior. Further experimental and clinical studies are warranted to test the hypothesis that also in humans ADM acts as a neuromodulator with anxiolytic properties.
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148
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Myocardial Injury in Children with Unoperated Congenital Heart Diseases. Cardiol Res Pract 2015; 2015:104818. [PMID: 26649223 PMCID: PMC4663296 DOI: 10.1155/2015/104818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 10/30/2015] [Accepted: 11/02/2015] [Indexed: 11/18/2022] Open
Abstract
Background. Children with congenital heart diseases (CHDs) may have a risk of developing myocardial injury caused by volume and pressure overload. Objective. To evaluate the incidence of myocardial injury in children with cyanotic and acyanotic CHDs using cTnI assay and to correlate it with different hemodynamic parameters. Methods. This study included 80 children with CHDs (40 acyanotic and 40 cyanotic) as well as 40 healthy children (control group). Serum cTnI levels were measured for patients and control. Pulmonary to systemic blood flow (Qp/Qs) and pulmonary to systemic arterial pressure (Pp/Ps) ratios were measured for children with CHDs during cardiac catheterization. Results. Sixty-four out of 80 patients with CHDs had myocardial injury as evidenced by increased cTnI. Serum cTnI was significantly higher in both cyanotic and acyanotic groups compared to control group (p < 0.05). Serum cTnI level significantly correlated with oxygen saturation (SpO2), ejection fraction (EF), Qp/Qs, and Pp/Ps ratios. Conclusion. The incidence of myocardial injury was high in children with CHDs. The use of cTnI for follow-up of children with CHDs may help early detection of myocardial injury and help early management of these cases.
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149
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Huang J, Han SS, Qin DD, Wu LH, Song Y, Yu F, Wang SX, Liu G, Zhao MH. Renal Interstitial Arteriosclerotic Lesions in Lupus Nephritis Patients: A Cohort Study from China. PLoS One 2015; 10:e0141547. [PMID: 26544865 PMCID: PMC4636159 DOI: 10.1371/journal.pone.0141547] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 10/10/2015] [Indexed: 12/01/2022] Open
Abstract
Objective The aim of this study was to evaluate renal arteriosclerotic lesions in patients with lupus nephritis and investigate their associations with clinical and pathological characteristics, especially cardio-vascular features. Design A retrospective cohort study. Participants Seventy-nine patients with renal biopsy-proven lupus nephritis, diagnosed between January 2000 and June 2008 from Peking University First Hospital. Results In clinico-pathological data, patients with arteriosclerosis had higher ratio of hypertension and more severe renal injury indices compared with patients with no renal vascular lesions. More importantly, patients with renal arteriosclerosis had worse cardiac structure and function under transthoracic echocardiographic examination. Patients with renal arteriosclerosis tend to have higher ratios of combined endpoints compared with those of no renal vascular lesions, although the difference didn’t reach statistical meanings (P = 0.104). Conclusion Renal arteriosclerotic lesion was common and associated with vascular immune complex deposits in lupus nephritis. It might have a certain degree of association with poor outcomes and cardiovascular events, which needs further explorations.
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Affiliation(s)
- Jing Huang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Sha-sha Han
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Dan-dan Qin
- Department of Nephrology, The 2nd Affiliated Hospital, Harbin Medical University, Harbin, Heilongjiang, 150000, PR China
| | - Li-hua Wu
- Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, PR China
| | - Yan Song
- Department of Nephrology, the First Affiliated Hospital of Chinese PLA General Hospital, 51 Fucheng Road, Beijing, 100048, PR China
- * E-mail: (YS); (FY)
| | - Feng Yu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
- * E-mail: (YS); (FY)
| | - Su-xia Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Gang Liu
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
| | - Ming-hui Zhao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, 100034 PR China
- Institute of Nephrology, Peking University, Beijing, 100034, PR China
- Key Laboratory of Renal Disease, Ministry of Health of China, Beijing, 100034, PR China
- Key Laboratory of CKD Prevention and Treatment, Ministry of Education of China, Beijing, 100034, PR China
- Peking-Tsinghua Center for Life Sciences, Beijing, PR China
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150
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Özyörük D, Kibar AE, Sürücü M, Azak E, Emir S, Çetin İİ, Tunç B, Özbek NY. Pulmonary arterial hypertension in a child with stage-IV neuroblastoma after autologous hematopoietic stem cell transplantation and review of the literature. Pediatr Transplant 2015; 19:E185-8. [PMID: 26282574 DOI: 10.1111/petr.12576] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 12/15/2022]
Abstract
PH is a rare condition with high mortality rate after pediatric HSCT. As clinical presentation is non-specific and may mimic other conditions, a high degree of suspicion is required for diagnosis. Here, we present a patient with stage-IV neuroblastoma who developed PAH after autologous HSCT. After exclusion of other causes of PH, we regarded that this condition was secondary to HSCT.
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Affiliation(s)
- Derya Özyörük
- Division of Pediatric Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Ayşe Esin Kibar
- Division of Pediatric Cardiology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Murat Sürücü
- Division of Pediatric Cardiology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Emine Azak
- Division of Pediatric Cardiology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Suna Emir
- Division of Pediatric Oncology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - İbrahim İlker Çetin
- Division of Pediatric Cardiology, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Bahattin Tunç
- Division of Bone Marrow Transplantation Unit, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
| | - Namık Yaşar Özbek
- Division of Bone Marrow Transplantation Unit, Ankara Children's Hematology and Oncology Education and Research Hospital, Ankara, Turkey
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