1501
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Zhou D, Huang Y, Fu M, Cai A, Tang S, Feng Y. Prognostic value of tissue Doppler E/e' ratio in hypertension patients with preserved left ventricular ejection fraction. Clin Exp Hypertens 2018; 40:554-559. [PMID: 29400582 DOI: 10.1080/10641963.2017.1407332] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aims to investigate the association of tissue Doppler E/e' with cardiac events in hypertension patients, independent of and incremental to clinical and left ventricular geometric patterns. METHODS We retrospectively enrolled 222 asymptomatic nonischemic patients with hypertension who had echocardiogram in 2012 to evaluate tissue Doppler E/e'. Patients were followed up for cardiac events (cardiac events were defined as myocardial infarction, coronary revascularization procedures, new-onset angina (stable or unstable), heart failure). A cox regression was used to assess the association of the ratio of transmitral Doppler early filling velocity to tissue Doppler early diastolic mitral annular velocity (E/e') with cardiac events. RESULTS A total of 222 patients were included in analysis. There were 10 primary cardiac events during 3.2 ± 0.4 years follow-up. The E/e' ratio was the strongest predictor of cardiac events in Cox-proportional hazards models. Following adjustment for covariates, a unit rise in the E/e' ratio was associated with a 26% increment in risk of a cardiac event (HR 1.26, CI 1.06-1.50, p = 0.008). When E/e' >14 the hazard ratio of cardiac event was significantly increased compared with E/e' ≤ 14 in Kaplan-Meier analysis (log-rank ratio, 16.26; p < 0.001). CONCLUSIONS E/e', a non-invasive estimate of left ventricular filling pressure, predicts cardiac events in hypertensive population with preserved left ventricular ejection fraction, independent of and incremental to clinical and left ventricular geometric patterns. E/e' represents an early, effective tool for cardiovascular risk stratification in hypertension population.
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Affiliation(s)
- Dan Zhou
- a Southern Medical University , Guangzhou , China.,b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Yuqing Huang
- b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Ming Fu
- b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Anping Cai
- b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
| | - Songtao Tang
- c Community Health Center of Liaobu County , Dongguan , China
| | - Yingqing Feng
- a Southern Medical University , Guangzhou , China.,b Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention , Guangdong General Hospital, Guangdong Academy of Medical Sciences, The First Affiliated Hospital of South China University of Technology , Guangzhou , China
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1502
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Krishnamoorthy V, Rowhani-Rahbar A, Gibbons EF, Chaikittisilpa N, Vavilala MS. The authors reply. Crit Care Med 2018; 46:e183-e184. [PMID: 29337822 PMCID: PMC5778896 DOI: 10.1097/ccm.0000000000002865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Vijay Krishnamoorthy
- Department of Anesthesiology, Duke University
- Harborview Injury Prevention and Research Center, University of
Washington
| | - Ali Rowhani-Rahbar
- Department of Epidemiology, University of Washington
- Harborview Injury Prevention and Research Center, University of
Washington
| | - Edward F. Gibbons
- Department of Medicine, Division of Cardiology, University of
Washington
- Harborview Injury Prevention and Research Center, University of
Washington
| | | | - Monica S. Vavilala
- Department of Anesthesiology and Pain Medicine, University of
Washington
- Harborview Injury Prevention and Research Center, University of
Washington
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1503
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Derumeaux G, Ernande L, Sawaki D. Weight loss to rejuvenate the heart. Eur Heart J Cardiovasc Imaging 2018; 19:143-144. [PMID: 29236999 DOI: 10.1093/ehjci/jex318] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Geneviève Derumeaux
- INSERM U955, Université Paris-Est Creteil (UPEC), 51 Av de Lattre de Tassigny, 94100 Créteil, France.,Department of Cardiology, Institut Mondor de Recherche Biomedicale, Unité Inserm 955-équipe 8, Faculté de médecine de Créteil, 8, rue du Général Sarrail, 94000 Créteil, France
| | - Laura Ernande
- INSERM U955, Université Paris-Est Creteil (UPEC), 51 Av de Lattre de Tassigny, 94100 Créteil, France.,Department of Cardiology, Institut Mondor de Recherche Biomedicale, Unité Inserm 955-équipe 8, Faculté de médecine de Créteil, 8, rue du Général Sarrail, 94000 Créteil, France
| | - Daigo Sawaki
- INSERM U955, Université Paris-Est Creteil (UPEC), 51 Av de Lattre de Tassigny, 94100 Créteil, France.,Department of Cardiology, Institut Mondor de Recherche Biomedicale, Unité Inserm 955-équipe 8, Faculté de médecine de Créteil, 8, rue du Général Sarrail, 94000 Créteil, France
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1504
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Konerman MC, Greenberg JC, Kolias TJ, Corbett JR, Shah RV, Murthy VL, Hummel SL. Reduced Myocardial Flow Reserve Is Associated With Diastolic Dysfunction and Decreased Left Atrial Strain in Patients With Normal Ejection Fraction and Epicardial Perfusion. J Card Fail 2018; 24:90-100. [PMID: 29051079 PMCID: PMC5811315 DOI: 10.1016/j.cardfail.2017.10.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 09/16/2017] [Accepted: 10/10/2017] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Coronary microvascular dysfunction (MVD) may contribute to the pathogenesis of heart failure with preserved ejection fraction (HFpEF). Using myocardial flow reserve (MFR) measured by positron emission tomography (PET) as an assessment of microvascular function, we hypothesized that abnormal MFR is associated with LV diastolic dysfunction (DD) and reduced LV and LA strain in patients with risk factors for HFpEF and normal epicardial perfusion on cardiac PET. METHODS AND RESULTS Retrospective study of patients without heart failure who underwent cardiac rubidium-82 PET and echocardiography. Global MFR was calculated as the ratio of global stress to rest myocardial blood flow. Echocardiographic measures of diastolic function were recorded. Global longitudinal LA and LV strain were measured with a 2-dimensional speckle-tracking technique. Relationships among MFR and echocardiographic measures were assessed with linear regression, analysis of variance, and test for trend. Seventy-three patients (age 64 ± 11 years, 52% male) were identified with no epicardial perfusion defect on cardiac PET and an ejection fraction ≥50%. Decreased MFR was associated with LV DD (P = .02) and increased E/e', an estimation of LV filling pressure (low E/e' [<8] vs. high E/e' [>15], P < .001). MFR was associated with LA strain independent of age, gender, and common comorbidities (adjusted β = 2.6% per unit MFR, P = 0.046); however, MFR was only marginally related to LV strain. CONCLUSIONS In patients with risk factors for HFpEF, MVD assessed with MFR was associated with DD, increased estimated LV filling pressure, and abnormal LA strain.
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Affiliation(s)
- Matthew C Konerman
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
| | | | - Theodore J Kolias
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - James R Corbett
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Ravi V Shah
- Massachusetts General Hospital, Harvard University, Boston, Massachusetts
| | - Venkatesh L Murthy
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Scott L Hummel
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan; Ann Arbor Veterans Affairs Health System, Ann Arbor, Michigan
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1505
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Kupczynska K, Kasprzak JD, Michalski BW, Miskowiec DL, Lipiec P. The impact of the latest echocardiographic chamber quantification recommendations on the prediction of left atrial appendage thrombus presence by transthoracic echocardiography. Acta Cardiol 2018; 73:91-95. [PMID: 28799449 DOI: 10.1080/00015385.2017.1351241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION The latest recommendations for echocardiographic chamber quantification have implemented updated normal values for all cardiac chambers. PURPOSE To evaluate the incidence of normal and abnormal values of routine echocardiographic parameters such as left ventricular ejection fraction (LVEF) and left atrial volume indexed to body surface area (LAVi) in patients with non-valvular atrial fibrillation (AF) and to determine the influence of LVEF and LAVi reclassification on the prediction of LAAT by transthoracic echocardiography. METHODS We retrospectively analysed the database of 1674 transesophageal echocardiograms performed between 2012 and 2015 in our echo lab. The study involved patients (mean age 70 ± 7 years, 80% men) with paroxysmal or persistent AF (35 patients with left atrial appendage thrombus [LAAT] and 35 sex- and age-matched controls without LAAT). LVEF and LAVi were categorised in two ways: semi-quantitative using four-degree scale (normal or abnormal graded from mild and moderate to severe) and qualitative (normal vs. abnormal). RESULTS We reclassified 6 (9%) and 4 (6%) patients with regard to LVEF as well as 38 (54%) and 16 (23%) with regard to LAVi on semi-quantitative and qualitative scale, respectively. After adjustment for effective anticoagulation and approved risk factors in the multivariate models, we identified LVEF categorised in semi-quantitative manner according to both documents, LAVi categorised in a binary manner by new guidelines and semi-quantitative scale by both recommendations as independently associated with LAAT. CONCLUSIONS Differentiation between normal and abnormal value enhanced the diagnostic meaning of LAVi in the aspect of higher LAAT risk. LVEF reclassification had no significant influence.
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Affiliation(s)
- Karolina Kupczynska
- a Chair and Department of Cardiology , Medical University of Lodz , Lodz , Poland
| | - Jaroslaw D Kasprzak
- a Chair and Department of Cardiology , Medical University of Lodz , Lodz , Poland
| | - Blazej W Michalski
- a Chair and Department of Cardiology , Medical University of Lodz , Lodz , Poland
| | - Dawid L Miskowiec
- a Chair and Department of Cardiology , Medical University of Lodz , Lodz , Poland
| | - Piotr Lipiec
- a Chair and Department of Cardiology , Medical University of Lodz , Lodz , Poland
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1506
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Gillebert TC. Pulse pressure and blood pressure components:. Is the sum more than the parts? Eur J Prev Cardiol 2018; 25:457-459. [PMID: 29372648 DOI: 10.1177/2047487318755805] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Thierry C Gillebert
- Department of Cardiology, Ghent University and Ghent University Hospital, Belgium
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1507
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Del Rios M, Colla J, Kotini-Shah P, Briller J, Gerber B, Prendergast H. Emergency physician use of tissue Doppler bedside echocardiography in detecting diastolic dysfunction: an exploratory study. Crit Ultrasound J 2018; 10:4. [PMID: 29372430 PMCID: PMC5785451 DOI: 10.1186/s13089-018-0084-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 01/09/2018] [Indexed: 01/20/2023] Open
Abstract
Introduction This study evaluates the agreement between emergency physician (EP) assessment of diastolic dysfunction (DD) by a simplified approach using average peak mitral excursion velocity (eʹA) and an independent cardiologist’s diagnosis of DD by estimating left atrial (LA) pressure using American Society of Echocardiography (ASE) guidelines. Methods This was a secondary analysis of 48 limited bedside echocardiograms (LBE) performed as a part of a research study of patients presenting to the Emergency Department (ED) with elevated blood pressure but without decompensated heart failure. EPs diagnosed DD based on eʹA < 9 cm/s alone. A blinded board-certified cardiologist reviewed LBEs to estimate LA filling pressures following ASE guidelines. An unweighted kappa measure was calculated to determine agreement between EP and cardiologist. Results Six LBEs were deemed indeterminate by the cardiologist and excluded from the analysis. Agreement was reached in 41 out of 48 cases (85.4%). The unweighted kappa coefficient was 0.74 (95% CI 0.57–0.92). EPs identified 18 out of 20 LBEs diagnosed with diastolic dysfunction by the cardiologist. Conclusion There is a good agreement between (eʹA) by EP and cardiologist interpretation of LBEs. Future studies should investigate this simplified approach as a one-step method of screening for LV diastolic dysfunction in the ED.
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Affiliation(s)
- Marina Del Rios
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA.
| | - Joseph Colla
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Pavitra Kotini-Shah
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Joan Briller
- Department of Cardiology, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Ben Gerber
- Department of Internal Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Heather Prendergast
- Department of Emergency Medicine, University of Illinois at Chicago, Chicago, Illinois, USA
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1508
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Zhong Y, Almodares Q, Yang J, Wang F, Fu M, Johansson MC. Reduced stroke distance of the left ventricular outflow tract is independently associated with long-term mortality, in patients hospitalized due to heart failure. Clin Physiol Funct Imaging 2018; 38:881-888. [DOI: 10.1111/cpf.12500] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Affiliation(s)
- You Zhong
- Department of Molecular and Clinical Medicine/Cardiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
- Department of Cardiology; Beijing Hospital; National Center of Gerontology; Beijing China
| | - Qays Almodares
- Department of Molecular and Clinical Medicine/Clinical Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - JieFu Yang
- Department of Cardiology; Beijing Hospital; National Center of Gerontology; Beijing China
| | - Fang Wang
- Department of Cardiology; Beijing Hospital; National Center of Gerontology; Beijing China
| | - Michael Fu
- Department of Molecular and Clinical Medicine/Cardiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - Magnus C. Johansson
- Department of Molecular and Clinical Medicine/Clinical Physiology; Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
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1509
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Oliveras A, Armario P, Sans L, Clarà A, Vázquez S, Molina L, Pareja J, de la Sierra A, Pascual J. Organ damage changes in patients with resistant hypertension randomized to renal denervation or spironolactone: The DENERVHTA (Denervación en Hipertensión Arterial) study. J Clin Hypertens (Greenwich) 2018; 20:69-75. [DOI: 10.1111/jch.13156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Revised: 08/02/2017] [Accepted: 08/14/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Anna Oliveras
- Nephrology Department; Hospital del Mar; Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
| | - Pedro Armario
- Internal Medicine Department; Vascular Risk Area; Hospital Moisés Broggi; Consorci Sanitari Integral; University of Barcelona; Barcelona Spain
| | - Laia Sans
- Nephrology Department; Hospital del Mar; Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
| | - Albert Clarà
- IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
- Vascular Surgery Department; Hospital del Mar; Barcelona Spain
| | - Susana Vázquez
- Nephrology Department; Hospital del Mar; Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
| | - Luis Molina
- IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
- Cardiology Department; Hospital del Mar; Barcelona Spain
| | - Júlia Pareja
- Internal Medicine Department; Hospital de l'Esperit Sant; Santa Coloma de Gramenet Spain
| | - Alejandro de la Sierra
- Internal Medicine Department; Hospital Mútua Terrassa; University of Barcelona; Barcelona Spain
| | - Julio Pascual
- Nephrology Department; Hospital del Mar; Barcelona Spain
- IMIM (Hospital del Mar Medical Research Institute); Barcelona Spain
- Universitat Autònoma de Barcelona; Barcelona Spain
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1510
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D'Andrea A, Vriz O, Ferrara F, Cocchia R, Conte M, Di Maio M, Driussi C, Scarafile R, Martone F, Sperlongano S, Tocci G, Citro R, Caso P, Bossone E, Golino P. Reference Ranges and Physiologic Variations of Left E/e' Ratio in Healthy Adults: Clinical and Echocardiographic Correlates. J Cardiovasc Echogr 2018; 28:101-108. [PMID: 29911006 PMCID: PMC5989540 DOI: 10.4103/jcecho.jcecho_57_17] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background: Transthoracic Doppler echocardiographic examination is commonly performed to define the diastolic ventricular function since it is widely available, noninvasive, and inexpensive with respect to other diagnostic imaging modalities. However, data regarding age- and gender-matched reference values are scanty and sometimes conflicting. This study aims to explore the physiologic variations of left ventricular (LV) E/e' ratio as assessed in a large cohort of healthy adults and to investigate clinical and echocardiographic correlates. Methods: From June 2007 to February 2014, 1168 healthy Caucasian adults (mean age 45.1 ± 15.6 years) performed standard echocardiographic examination (transthoracic echocardiogram). Results: E/e' constantly increases across all the age classes (P < 0.0001, analyses of variance both for males and females) with a strong statistically significant linear positive correlation with age. Stepwise multiple linear regression analysis identified age (P < 0.0001), LV mass (P < 0.001), LV end-diastolic volume (P < 0.01), and left atrial volume (P < 0.001) as the only independent determinants of E/e' ratio (model R2 = 0.54, P < 0.0001). Conclusions: In healthy subjects, transmitral E velocity to e' ratio changes in relation to the age: it increased with a statistically significant correlation in individuals older than 60 years. Hence, differences related to demographic and anthropometric measurements may potentially develop a misclassification of otherwise normal individuals when established on dichotomically suggested normal reference values. Our study can demonstrate that it is indispensable to apply specific cutoff related to the age and gender to properly assess LV diastolic function.
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Affiliation(s)
- Antonello D'Andrea
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Olga Vriz
- Department of Cardiology and Emergency Medicine, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Francesco Ferrara
- Department of Cardiology and Cardiac Surgery, University Hospital, San Giovanni di Dio, Salern, Italy
| | - Rosangela Cocchia
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Marianna Conte
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Marco Di Maio
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Caterina Driussi
- Department of Cardiology and Emergency Medicine, San Antonio Hospital, San Daniele del Friuli, Udine, Italy
| | - Raffaella Scarafile
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Francesca Martone
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Simona Sperlongano
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Giampaolo Tocci
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Rodolfo Citro
- Department of Cardiology and Cardiac Surgery, University Hospital, San Giovanni di Dio, Salern, Italy
| | - Pio Caso
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
| | - Eduardo Bossone
- Department of Cardiology and Cardiac Surgery, University Hospital, San Giovanni di Dio, Salern, Italy
| | - Paolo Golino
- Department of Cardiology, Luigi Vanvitelli University, Monaldi Hospital, AORN Ospedali dei Colli, Naples, Italy
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1511
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Ha JW. Diastolic Stress Echocardiography to Quantify the Response of Diastolic Functional Indices to Dynamic Exercise in Abnormal Relaxation: Unmasking Diastolic Abnormalities is Getting Ready for Prime Time. Korean Circ J 2018; 48:755-759. [PMID: 30073815 PMCID: PMC6072660 DOI: 10.4070/kcj.2018.0164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Accepted: 06/04/2018] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jong-Won Ha
- Division of Cardiology, Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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1512
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Horn R. [Sonographic Evaluation Algorithm for Acute Dyspnea]. PRAXIS 2018; 107:1201-1210. [PMID: 30376779 DOI: 10.1024/1661-8157/a003093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The goal in emergency medicine is to provide a patient with dyspnea with the optimal therapy without delay, even when the definitive diagnosis has not yet been ascertained. The focused lung and heart ultrasound is a diagnostic resource that can be deployed immediately and repeatedly, and which rapidly provides the treating physician with essential information for providing therapy. Certain diagnoses (pneumothorax, pleural effusion, pericardial effusion) can be identified based on ultrasound. Other findings, including patient interview and physical exam, must also be considered in order to assess the clinical relevance. Further diagnoses can be made only after combining all findings (lung embolism, cardiac insufficiency with lung edema).
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1513
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Mehta S, Khoury PR, Madsen NL, Dolan LM, Kimball TR, Urbina EM. Arterial Thickness and Stiffness Are Independently Associated with Left Ventricular Strain. J Am Soc Echocardiogr 2018; 31:99-104. [PMID: 29174337 PMCID: PMC5756686 DOI: 10.1016/j.echo.2017.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Indexed: 01/15/2023]
Abstract
BACKGROUND The aim of this study was to examine the association between myocardial strain and arterial thickness and stiffness in young adults. Increased common carotid artery intima media thickness and peripheral arterial stiffness are known to precede coronary artery disease and cardiovascular (CV) events such as myocardial infarction and congestive heart failure. However, subclinical cardiac dysfunction can be detected in high-risk adults by myocardial strain echocardiography. The authors hypothesized that increased carotid artery intima media thickness would be associated with abnormal myocardial strain in young subjects who had obesity and type 2 diabetes mellitus. METHODS CV risk factors were collected in 338 young adults participating in a prospective, cross-sectional study. The CV parameters collected included intima-media thickness, peripheral arterial stiffness by brachial distensibility, and myocardial strain and strain rate. General linear models were constructed to determine if vascular structure and function measures were independently associated with myocardial strain and strain rate. RESULTS A linear relationship was found between global longitudinal strain obtained from the four-chamber view and global strain rate in systole and carotid intima-media thickness (four-chamber global longitudinal strain: β = 3.0, CV risk factor-adjusted R2 = 0.34; global strain rate in systole: β = 0.0053, R2 = 0.21; P ≤ .0001) and between four-chamber global longitudinal strain and lower brachial distensibility (β = -0.42, R2 = 0.22; P < .001). CONCLUSIONS Adverse changes in vascular structure and function are simultaneously present with reduced myocardial systolic function.
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Affiliation(s)
- Smita Mehta
- Preventive Cardiology, Dayton Children's Hospital, Dayton, Ohio
| | - Philip R Khoury
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Nicolas L Madsen
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Lawrence M Dolan
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Thomas R Kimball
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Elaine M Urbina
- Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
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1514
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Dini FL, Bajraktari G, Zara C, Mumoli N, Rosa GM. Optimizing Management of Heart Failure by Using Echo and Natriuretic Peptides in the Outpatient Unit. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1067:145-159. [PMID: 29374825 DOI: 10.1007/5584_2017_137] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Chronic heart failure (HF) is an important public health problem and is associated with high morbidity, high mortality, and considerable healthcare costs. More than 90% of hospitalizations due to worsening HF result from elevations of left ventricular (LV) filling pressures and fluid overload, which are often accompanied by the increased synthesis and secretion of natriuretic peptides (NPs). Furthermore, persistently abnormal LV filling pressures and a rise in NP circulating levels are well known indicators of poor prognosis. Frequent office visits with the resulting evaluation and management are most often needed. The growing pressure from hospital readmissions in HF patients is shifting the focus of interest from traditionally symptom-guided care to a more specific patient-centered follow-up care based on clinical findings, BNP and echo. Recent studies supported the value of serial NP measurements and Doppler echocardiographic biomarkers of elevated LV filling pressures as tools to scrutinize patients with impending clinically overt HF. Therefore, combination of echo and pulsed-wave blood-flow and tissue Doppler with NPs appears valuable in guiding ambulatory HF management, since they are potentially useful to distinguish stable patients from those at high risk of decompensation.
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Affiliation(s)
- Frank Lloyd Dini
- Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy. .,Unità Operativa Malattie Cardiovascolari 1, Dipartimento Cardio, Toracico e Vascolare, Azienda Ospedaliera-Universitaria Pisana, Pisa, Italy.
| | - Gani Bajraktari
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.,Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Cornelia Zara
- Cardiovascular and Thoracic Department, University of Pisa, Pisa, Italy
| | - Nicola Mumoli
- Department of Internal Medicine, Livorno Hospital, Livorno, Italy
| | - Gian Marco Rosa
- Department of Internal Medicine and Medical Specialities, University of Genoa, Genoa, Italy
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1515
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Nazário Leão R, Marques Silva P, Branco L, Fonseca H, Bento B, Alves M, Virella D, Palma Reis R. Systolic time ratio measured by impedance cardiography accurately screens left ventricular diastolic dysfunction in patients with arterial hypertension. Clin Hypertens 2017; 23:28. [PMID: 29299336 PMCID: PMC5744395 DOI: 10.1186/s40885-017-0084-y] [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] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 11/30/2017] [Indexed: 11/12/2022] Open
Abstract
Background The use of impedance cardiography (ICG) may play a role in the assessment of cardiac effects of hypertension (HT), especially its hemodynamic features. Hypertensive heart disease involves structural changes and alterations in left ventricular geometry that end up causing systolic and/or diastolic dysfunction. The IMPEDDANS study aims to assess the usefulness of ICG for the screening of left ventricular diastolic dysfunction (LVDD) in patients with HT. Methods Patients with HT were assessed by echocardiography and ICG. Receiver-operating characteristic curve and the area under the curve were used to assess the discriminative ability of the parameters obtained by ICG to identify LVDD, as diagnosed by echocardiography. Results ICG derived pre-ejection period (PEP), left ventricle ejection time (LVET), systolic time ratio (STR) and D wave were associated (p < 0.001) with LVDD diagnosis, with good discriminative ability: PEP (AUC 0.81; 95% CI 0.74–0.89), LVET (AUC 0.82; 95% CI 0.75–0.88), STR (AUC 0.97; 95% CI 0.94–1.00) and presence of D wave (AUC = 0.87; 95% CI 0.82–0.93). STR ≥ 0.30 outperformed the other parameters (sensitivity of 98.0%, specificity of 90.2%, positive predictive value of 95.2%, and negative predictive value of 96.1%). Conclusion The ICG derived value of STR allows the accurate screening of LVDD in patients with HT. It might as well be used for follow up assessment. Trial registration The study protocol was retrospectively registered as IMPEDDANS on ClinicalTrials.gov (ID: NCT03209141) on July 6, 2017.
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Affiliation(s)
- Rodrigo Nazário Leão
- Unidade Funcional Medicina 1.2, Hospital de São José, Centro Hospitalar Lisboa Central-EPE, Rua José António Serrano, 1150-199 Lisboa, Portugal.,NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Pedro Marques Silva
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal.,Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal
| | - Luísa Branco
- Laboratório de Ecocardiografia, Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central-EPE, Lisboa, Portugal
| | - Helena Fonseca
- Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal
| | - Bruno Bento
- Unidade de Cardiologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte-EPE, Lisboa, Portugal
| | - Marta Alves
- Gabinete de Análise Epidemiológica e Estatística, Centro de Investigação, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal
| | - Daniel Virella
- Gabinete de Análise Epidemiológica e Estatística, Centro de Investigação, Centro Hospitalar Lisboa Central-EPE, Lisboa, Portugal
| | - Roberto Palma Reis
- NOVA Medical School, Universidade NOVA de Lisboa, Lisboa, Portugal.,Unidade de Cardiologia, Hospital Pulido Valente, Centro Hospitalar Lisboa Norte-EPE, Lisboa, Portugal
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1516
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Ladeiras-Lopes R, Fontes-Carvalho R, Vilela EM, Bettencourt P, Leite-Moreira A, Azevedo A. Diastolic Function Is Impaired in Patients With Prehypertension: Data From the EPIPorto Study. ACTA ACUST UNITED AC 2017; 71:926-934. [PMID: 29258737 DOI: 10.1016/j.rec.2017.11.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 11/02/2017] [Indexed: 12/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES Hypertension causes subclinical changes in left ventricular structure and function, namely diastolic dysfunction. Diastolic dysfunction is a predictor of heart failure, being involved in the association between hypertension and heart failure with preserved ejection fraction. We aimed to determine whether patients with prehypertension have early changes in diastolic function in a large community-based cohort of asymptomatic adults. METHODS A cross-sectional evaluation was performed of a community-based cohort consisting of 925 adults, aged 45 years or older, without known cardiovascular disease. All participants underwent detailed clinical and echocardiographic examination. The participants were categorized according to the European guidelines for the classification of office blood pressure (BP) levels as optimal, prehypertensive (normal and high-normal categories), and hypertensive. Diastolic function was evaluated by echocardiography using e' velocities and E/e' ratio. Diastolic dysfunction was defined using the 2016 ASE/EACVI Joint Recommendations and a 2017 clinically-oriented algorithm. RESULTS In this cohort (61.5 ± 10.5 years; 37% men), prehypertension was present in 30.4% and hypertension in 51.0%. Using optimal BP as the reference, there was a progressive decrease of e' velocity in prehypertensive and hypertensive individuals (12.2 ± 3.5 vs 11.3 ± 3.1 vs 9.6 ± 2.9cm/s, respectively; P for trend < .001). After multivariable adjustment, both BP categories were independent predictors of a lower e' velocity (β = -0.56, P = .035 for prehypertension and β = -1.08, P < .001 for hypertension). CONCLUSIONS In this large community-based cohort, adults with prehypertension already showed impaired cardiac relaxation before the onset of hypertension.
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Affiliation(s)
- Ricardo Ladeiras-Lopes
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Departamento de Cardiologia, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Investigação Cardiovascular, Universidade do Porto, Porto, Portugal.
| | - Ricardo Fontes-Carvalho
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Departamento de Cardiologia, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal; Unidade de Investigação Cardiovascular, Universidade do Porto, Porto, Portugal
| | - Eduardo M Vilela
- Departamento de Cardiologia, Centro Hospitalar de Gaia/Espinho, Vila Nova de Gaia, Portugal
| | - Paulo Bettencourt
- Unidade de Investigação Cardiovascular, Universidade do Porto, Porto, Portugal; Departamento de Medicina, Faculdade de Medicina, Universidade do Porto, Porto, Portugal
| | - Adelino Leite-Moreira
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Unidade de Investigação Cardiovascular, Universidade do Porto, Porto, Portugal; Departamento de Cirurgia Cardiotorácica, Centro Hospitalar São João, Porto, Portugal
| | - Ana Azevedo
- Departamento de Cirurgia e Fisiologia, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Departamento de Epidemiologia Clínica, Medicina Preditiva e Saúde Publica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal; Epidemiology Research Unit (EPIUnit) - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
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1517
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Johansson B, Lundin F, Tegerback R, Bojö L. E/a´ ratio a simple detector of left ventricular dysfunction in patients with decreased ejection fraction. SCAND CARDIOVASC J 2017; 52:20-27. [PMID: 29237305 DOI: 10.1080/14017431.2017.1414954] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Could a diastolic dysfunction and an increased LV-filling pressure according to ASE/EACVI guidelines be detected or ruled out by the E/a´ratio in patients with decreased ejection fraction. DESIGN We retrospectively evaluated the diastolic function of 113 unselected in-hospital patients, aged 40-84 years, in sinus rhythm and with no or mild valve disease, having a decreased systolic function (EF ≤50%) using the new ASE/EACVI guidelines and compared these results with the E/a´ratio derived from the E wave in the mitral flow and the a´velocity in the tissue Doppler. RESULTS The average E/a´ ratio is a strong predictor of a grade II-III diastolic dysfunction and an elevated left atrial pressure according to ASE/EACVI guidelines with an AUC of 0.92. An average E/a´ ratio with a cut-off >10 had a sensitivity of 97.6% and a negative predictive value of 98.2% in detecting or ruling out a grade II-III diastolic dysfunction and an elevated left atrial pressure according to the current guidelines. CONCLUSION The average E/a´ ratio might be useful as a fast screening tool of a left ventricular dysfunction and an increased left ventricular filling pressure in patients with a decreased ejection fraction.
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Affiliation(s)
- Benny Johansson
- a Department of Clinical Physiology , Örebro University Hospital , Örebro , Sweden
| | - Fredrik Lundin
- b Centre for statistical Clinical Research , County Council of Värmland , Karlstad , Sweden
| | - Rolf Tegerback
- c Department of Clinical Physiology , Central Hospital , Sundsvall , Sweden
| | - Leif Bojö
- d Department of Clinical Physiology , Central Hospital , Karlstad , Sweden
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1518
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Association of Active and Passive Components of LV Diastolic Filling With Exercise Intolerance in Heart Failure With Preserved Ejection Fraction: Mechanistic Insights From Spironolactone Response. JACC Cardiovasc Imaging 2017; 12:784-794. [PMID: 29248640 DOI: 10.1016/j.jcmg.2017.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 10/03/2017] [Accepted: 10/04/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to investigate the association of left ventricular (LV) untwisting rate (UT) and E/e' ratio with the response of exercise capacity to spironolactone in heart failure with preserved ejection fraction (HFpEF). BACKGROUND In most patients with HFpEF, LV filling abnormalities represent a central component in the development of dyspnea. LV diastolic filling is determined by the interplay of passive (LV stiffness and myocardial collagen content, reflected by E/e' ratio) and active myocardial properties (UT, a precursor to isovolumic pressure decay and contributor to diastolic suction). METHODS In 194 patients with HFpEF (64 ± 8 years), a complete echocardiogram (including assessment of myocardial deformation and rotational mechanics) was performed. Echocardiography following maximal exercise was undertaken to assess LV systolic and diastolic responses to stress. A subset of 105 patients with an exercise-induced increase in estimated LV filling pressure were randomly assigned to spironolactone 25 mg (n = 51) or placebo (n = 54) for 6 months. RESULTS Baseline peak Vo2 was associated with UT (β = 0.19; p = 0.01) and E/e' (β = -0.16; p = 0.03), independent of clinical data and exercise reserve in longitudinal deformation and ventricular-arterial coupling. An increase in peak Vo2 with treatment was independently associated with changes in UT (β = 0.28; p = 0.003) and exertional increase in E/e' (β = -0.23; p = 0.01) from baseline to follow-up. A significant interaction with the use of spironolactone on peak Vo2 was found for E/e' (p = 0.02) but not for UT (p = 0.62). CONCLUSIONS Both active and passive determinants of LV filling, as reflected by UT and E/e', contribute to reduced exercise capacity in HFpEF. Improvement in functional capacity with a 6-month therapy with spironolactone is associated with improvements in both indices. However, the possible mediating effect of this medication is observed only on E/e'.
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1519
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Billar RJ, Leening MJG, Merkus D, Brusselle GGO, Hofman A, Stricker BHC, Ghofrani HA, Franco OH, Gall H, Felix JF. Measures of subclinical cardiac dysfunction and increased filling pressures associate with pulmonary arterial pressure in the general population: results from the population-based Rotterdam Study. Eur J Epidemiol 2017; 33:403-413. [PMID: 29236195 PMCID: PMC5945799 DOI: 10.1007/s10654-017-0341-0] [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: 03/14/2017] [Accepted: 12/06/2017] [Indexed: 01/13/2023]
Abstract
Pulmonary hypertension is associated with increased mortality and morbidity in the elderly population. Heart failure is a common cause of pulmonary hypertension. Yet, the relation between left heart parameters reflective of subclinical cardiac dysfunction and increased filling pressures, and pulmonary arterial pressures in the elderly population remains elusive. Within the population-based Rotterdam Study, 2592 unselected participants with a mean age of 72.6 years (61.4% women) had complete echocardiography data available. We studied the cross-sectional associations of left heart structure and systolic and diastolic function with echocardiographically measured pulmonary artery systolic pressure. Mean pulmonary artery systolic pressure was 25.4 mmHg. After multivariable-adjustment measures of both structure and function were independently associated with pulmonary artery systolic pressure: E/A ratio [0.63 mmHg (95% CI 0.35–0.91) per 1-SD increase], left atrial diameter [0.79 mmHg (0.50–1.09) per 1-SD increase], E/E′ ratio [1.27 mmHg (0.92–1.61) per 1-SD increase], left ventricular volume [0.62 mmHg (0.25–0.98) per 1-SD increase], fractional shortening [0.45 mmHg (0.17–0.74) per 1-SD increase], aortic root diameter [− 0.43 mmHg (− 0.72 to − 0.14) per 1-SD increase], mitral valve deceleration time [− 0.31 mmHg (− 0.57 to − 0.05) per 1-SD increase], and E′ [1.04 mmHg (0.66–1.42) per 1-SD increase]. Results did not materially differ when restricting the analyses to participants free of symptoms of shortness of breath. Structural and functional echocardiographic parameters of subclinical cardiac dysfunction and increased filling pressures are associated with pulmonary arterial pressures in the unselected general ageing population.
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Affiliation(s)
- Ryan J Billar
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. .,Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Daphne Merkus
- Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Guy G O Brusselle
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bruno H Ch Stricker
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Internal Medicine, Erasmus MC - University Medical Center Rotterdam, Rotterdam, The Netherlands.,Inspectorate for Health Care, Utrecht, The Netherlands
| | - H Ardeschir Ghofrani
- Medizinische Klinik II, University of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Oscar H Franco
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Henning Gall
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.,Medizinische Klinik II, University of Giessen and Marburg Lung Center (UGMLC) - Member of the German Center for Lung Research (DZL), Giessen, Germany
| | - Janine F Felix
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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1520
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Smiseth OA. Evaluation of left ventricular diastolic function: state of the art after 35 years with Doppler assessment. J Echocardiogr 2017; 16:55-64. [PMID: 29236226 PMCID: PMC5966482 DOI: 10.1007/s12574-017-0364-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Revised: 12/02/2017] [Accepted: 12/05/2017] [Indexed: 11/30/2022]
Abstract
Left ventricular (LV) diastolic function can be evaluated by echocardiographic indices of LV relaxation/restoring forces, diastolic compliance, and filling pressure. By using a combination of indices, diastolic function can be graded and LV filling pressure estimated with high feasibility and good accuracy. Evaluation of diastolic function is of particular importance in patients with unexplained exertional dyspnea or other symptoms or signs of heart failure which cannot be attributed to impaired LV systolic function and to assess filling pressure in patients with heart failure and reduced LV ejection fraction. Furthermore, grading of diastolic dysfunction can be used for risk assessment in asymptomatic subjects and in patients with heart disease.
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Affiliation(s)
- Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Department of Cardiology and Institute for Surgical Research, Center for Cardiological Innovation and Center for Heart Failure Research, Oslo University Hospital and University of Oslo, Rikshospitalet, 0027, Oslo, Norway.
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1521
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van den Dorpel MMP, Heinonen I, Snelder SM, Vos HJ, Sorop O, van Domburg RT, Merkus D, Duncker DJ, van Dalen BM. Early detection of left ventricular diastolic dysfunction using conventional and speckle tracking echocardiography in a large animal model of metabolic dysfunction. Int J Cardiovasc Imaging 2017; 34:743-749. [PMID: 29234934 PMCID: PMC5889412 DOI: 10.1007/s10554-017-1287-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/01/2017] [Indexed: 11/26/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is one of the important mechanisms responsible for symptoms in patients with heart failure. The aim of the current study was to identify parameters that may be used to detect early signs of LV diastolic dysfunction in diabetic pigs on a high fat diet, using conventional and speckle tracking echocardiography. The study population consisted of 16 healthy Göttingen minipigs and 18 minipigs with experimentally induced metabolic dysfunction. Echocardiography measurements were performed at baseline and 3-month follow-up. The ratio of peak early (E) and late filling velocity (E/A ratio) and the ratio of E and the velocity of the mitral annulus early diastolic wave (E/Em ratio) did not change significantly in both groups. Peak untwisting velocity decreased in the metabolic dysfunction group (- 30.1 ± 18.5 vs. - 23.4 ± 15.5 °/ms) but not in controls (- 38.1 ± 23.6 vs. - 42.2 ± 23.0 °/ms), being significantly different between the groups at the 3-month time point (p < 0.05). In conclusion, whereas E/A ratio and E/Em ratio did not change significantly after 3 months of metabolic dysfunction, peak untwisting velocity was significantly decreased. Hence, peak untwisting velocity may serve as an important marker to detect early changes of LV diastolic dysfunction.
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Affiliation(s)
- Mark M P van den Dorpel
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ilkka Heinonen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
- Turku PET Centre, University of Turku, Turku, Finland
- Department of Clinical Physiology and Nuclear Medicine, University of Turku, Turku, Finland
| | - Sanne M Snelder
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands
| | - Hendrik J Vos
- Division of Biomedical Engineering, Thoraxcenter, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Oana Sorop
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Ron T van Domburg
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Daphne Merkus
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - Bas M van Dalen
- Department of Cardiology, Thoraxcenter, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
- Department of Cardiology, Franciscus Gasthuis, Rotterdam, The Netherlands.
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1522
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Edvardsen T, Smiseth OA. Evaluation of diastolic function by echocardiography: important progression, but issues to be resolved. Eur Heart J Cardiovasc Imaging 2017; 19:387-388. [DOI: 10.1093/ehjci/jex319] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, 0027 Oslo, Norway
| | - Otto A Smiseth
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, 0027 Oslo, Norway
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1523
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Almeida JG, Fontes-Carvalho R, Sampaio F, Ribeiro J, Bettencourt P, Flachskampf FA, Leite-Moreira A, Azevedo A. Impact of the 2016 ASE/EACVI recommendations on the prevalence of diastolic dysfunction in the general population. Eur Heart J Cardiovasc Imaging 2017; 19:380-386. [DOI: 10.1093/ehjci/jex252] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 10/04/2017] [Indexed: 01/07/2023] Open
Affiliation(s)
- João G Almeida
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
| | - Ricardo Fontes-Carvalho
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
| | - Francisco Sampaio
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
| | - José Ribeiro
- Department of Cardiology, Centro Hospitalar Gaia/Espinho, R. Conceição Fernandes 1079, Vila Nova de Gaia, Portugal
| | - Paulo Bettencourt
- Department of Medicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
| | - Frank A Flachskampf
- Institutionen för Medicinska Vetenskaper, Uppsala Universitet, Sjukhusvägen 7, 753 09 Uppsala, Sweden
| | - Adelino Leite-Moreira
- Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
- Department of Cardiothoracic Surgery, São João Hospital Center, Alameda Prof. Hernâni Monteiro, 4200–319 Porto, Portugal
| | - Ana Azevedo
- Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Alameda Prof. Hernâni Monteiro, 4200–319 Portugal
- Epidemiology Research Unit (EPIUnit), Institute of Public Health of the University of Porto (ISPUP), Rua das Taipas n°135 Porto 4050-600, Portugal
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1524
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Lee SC, Daimon M, Di Tullio MR, Homma S, Hasegawa T, Chiou SH, Nakao T, Hirokawa M, Mizuno Y, Yatomi Y, Yamazaki T, Komuro I. Beneficial effect of body weight control on left ventricular diastolic function in the general population: an analysis of longitudinal data from a health check-up clinic. Eur Heart J Cardiovasc Imaging 2017; 19:136-142. [PMID: 29237001 DOI: 10.1093/ehjci/jex219] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/24/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Seitetz C Lee
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Masao Daimon
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Marco R Di Tullio
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Shunichi Homma
- Department of Medicine, Columbia University, 630 West 168th Street, New York 10032, NY, USA
| | - Takahiro Hasegawa
- Department of Biostatistics, Shionogi & Co., Ltd, 1-8-3, Doshomachi, Chuo, Osaka 541-0045, Japan
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115, USA
| | - Sy Han Chiou
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, 677 Huntington Ave, Boston, MA 02115, USA
| | - Tomoko Nakao
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Megumi Hirokawa
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
- Department of Clinical Epidemiology and Systems, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Tsutomu Yamazaki
- Clinical Research Support Center, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo, Tokyo 113-8655, Japan
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1525
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Alcidi GM, Esposito R, Evola V, Santoro C, Lembo M, Sorrentino R, Lo Iudice F, Borgia F, Novo G, Trimarco B, Lancellotti P, Galderisi M. Normal reference values of multilayer longitudinal strain according to age decades in a healthy population: A single-centre experience. Eur Heart J Cardiovasc Imaging 2017. [DOI: 10.1093/ehjci/jex306] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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1526
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Klein Hesselink MS, Bocca G, Hummel YM, Brouwers AH, Burgerhof JGM, van Dam EWCM, Gietema JA, Havekes B, van den Heuvel-Eibrink MM, Corssmit EPM, Kremer LCM, Netea-Maier RT, van der Pal HJH, Peeters RP, Plukker JTM, Ronckers CM, van Santen HM, van der Meer P, Links TP, Tissing WJE. Diastolic Dysfunction is Common in Survivors of Pediatric Differentiated Thyroid Carcinoma. Thyroid 2017; 27:1481-1489. [PMID: 29132262 DOI: 10.1089/thy.2017.0383] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Whether pediatric patients with differentiated thyroid carcinoma (DTC) are at risk of developing treatment-related adverse effects on cardiac function is unknown. We therefore studied in long-term survivors of pediatric DTC the prevalence of cardiac dysfunction and atrial fibrillation in relation to treatment variables, and the association between cardiac dysfunction and plasma biomarkers. METHODS In this nationwide prospective multicenter study, cardiac assessments were performed in 66 adult survivors of pediatric DTC (age at diagnosis ≤18 years and follow-up ≥5 years after diagnosis) treated in the Netherlands between 1970 and 2009. Assessment included echocardiography, plasma biomarkers (N-terminal pro-brain natriuretic peptide, high-sensitive troponin-T, galectin-3), and 24-hour Holter electrocardiography. Echocardiographic measurements were compared with retrospective data of 66 sex- and age-matched unaffected Dutch controls. Diastolic dysfunction was defined as an early diastolic septal and/or lateral tissue velocity (e') less than 2 SD of mean age-adjusted reference data. RESULTS The survivors (86.4% women) had at DTC diagnosis a median age of 16 years. Median follow-up was 17 years. Left ventricular ejection fraction <50% was found in one survivor, and median global longitudinal systolic strain was near normal. Diastolic dysfunction was present in 14 asymptomatic survivors (21.2%). Overall, diastolic function of survivors was lower compared with controls (e'mean 14.5 versus 15.8 cm/s, P = 0.006). Older attained age and higher waist circumference were associated with decreased diastolic function, whereas thyrotropin levels and cumulative administered radioiodine dose were not. In survivors, biomarkers were not associated with diastolic dysfunction; atrial fibrillation was not observed. CONCLUSION While systolic function is unaffected, diastolic dysfunction is frequently observed in asymptomatic long-term survivors of pediatric DTC, which may suggest early cardiac aging.
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Affiliation(s)
- Mariëlle S Klein Hesselink
- 1 Department of Endocrinology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Gianni Bocca
- 2 Department of Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Yoran M Hummel
- 3 Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Adrienne H Brouwers
- 4 Department of Nuclear Medicine and Molecular Imaging, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Johannes G M Burgerhof
- 5 Department of Epidemiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Eveline W C M van Dam
- 6 Department of Internal Medicine, VU University Medical Center , Amsterdam, The Netherlands
| | - Jourik A Gietema
- 7 Department of Medical Oncology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Bas Havekes
- 8 Department of Internal Medicine, Division of Endocrinology, Maastricht University Medical Center , Maastricht, The Netherlands
| | - Marry M van den Heuvel-Eibrink
- 9 Department of Pediatric Oncology, Sophia Children's Hospital, Erasmus Medical Center , Rotterdam, The Netherlands
- 10 Princess Máxima Center for Pediatric Oncology , Utrecht, The Netherlands
| | - Eleonora P M Corssmit
- 11 Department of Internal Medicine, Division of Endocrinology, Leiden University Medical Center , Leiden, The Netherlands
| | - Leontien C M Kremer
- 12 Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
| | - Romana T Netea-Maier
- 13 Department of Internal Medicine, Division of Endocrinology, Radboud University Medical Center , Nijmegen, The Netherlands
| | - Helena J H van der Pal
- 12 Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
- 14 Department of Medical Oncology, Academic Medical Center , Amsterdam, The Netherlands
| | - Robin P Peeters
- 15 Department of Internal Medicine, Erasmus Medical Center , Rotterdam, The Netherlands
- 16 Rotterdam Thyroid Center, Erasmus Medical Center , Rotterdam, The Netherlands
| | - John T M Plukker
- 17 Department of Surgical Oncology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Cécile M Ronckers
- 12 Department of Pediatric Oncology, Emma Children's Hospital, Academic Medical Center , Amsterdam, The Netherlands
| | - Hanneke M van Santen
- 18 Department of Pediatrics, Wilhelmina Children's Hospital, University Medical Center Utrecht , Utrecht, The Netherlands
| | - Peter van der Meer
- 3 Department of Cardiology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Thera P Links
- 1 Department of Endocrinology, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
| | - Wim J E Tissing
- 19 Department of Pediatric Endocrinology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen , Groningen, The Netherlands
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1527
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Hammami R, Boudabbous M, Jdidi J, Trabelsi F, Mroua F, Kallel R, Amouri A, Abid D, Tahri N, Abid L, Kammoun S. Cirrhotic cardiomyopathy: is there any correlation between the stage of cardiac impairment and the severity of liver disease? Libyan J Med 2017; 12:1283162. [PMID: 28245727 PMCID: PMC5345598 DOI: 10.1080/19932820.2017.1283162] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 01/12/2017] [Indexed: 02/08/2023] Open
Abstract
Cirrhotic cardiomyopathy is associated with poor prognosis and risk of acute heart failure after liver transplantation or interventional procedures. We aimed to assess the relationship between the severity of cardiac impairment and hepatic disease. Eighty patients and eighty controls underwent echocardiography, tissue Doppler imaging and speckle tracking measures. We assess the correlation between echocardiographic parameters and Child and MELD scores. Systolic parameters function (s wave, p < 0.001) and global longitudinal strain (p < 0.001) as well as diastolic parameters were significantly more impaired in cirrhotic patients compared to controls. There were no differences among the different groups in 'Child score' regarding systolic function as well as diastolic function. Paradoxically, the left atrium size correlated positively to both Child (p = 0.01, r = 0.26) and MELD scores (p = 0.02, r = 0.24). Left ventricular ejection fraction was significantly lower in decompensated patients as compared to compensated patients(p = 0.02).. We did not identify any association between severity of liver disease and cardiac dysfunction. Therefore, a transthoracic echocardiography should be performed in all cirrhotic patients before interventional and surgical procedures regardless of the severity of liver disease.
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Affiliation(s)
- Rania Hammami
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | | | - Jihen Jdidi
- Epidemiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Fatma Trabelsi
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Fakher Mroua
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Rahma Kallel
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Ali Amouri
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Dorra Abid
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Nabil Tahri
- HepatoGastrology Department, HediChaker Hospital, Sfax, Tunisia
| | - Leila Abid
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
| | - Samir Kammoun
- Cardiology Department, HediChaker Hospital, Sfax, Tunisia
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1528
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Degiovanni A, Boggio E, Prenna E, Sartori C, De Vecchi F, Marino PN. Association between left atrial phasic conduit function and early atrial fibrillation recurrence in patients undergoing electrical cardioversion. Clin Res Cardiol 2017; 107:329-337. [PMID: 29181725 PMCID: PMC5869942 DOI: 10.1007/s00392-017-1188-9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 11/23/2017] [Indexed: 01/08/2023]
Abstract
Background Diastolic dysfunction promotes atrial fibrillation (AF) inducing left atrial (LA) remodeling, with chamber dilation and fibrosis. Predominance of LA phasic conduit (LAC) function should reflect not only chamber alterations but also underlying left ventricular (LV) filling impairment. Thus, LAC was tested as possible predictor of early AF relapse after electrical cardioversion (EC). Methods 96 consecutive patients, who underwent EC for persistent non-valvular AF, were prospectively enrolled. Immediately after successful EC (3 h ± 15 min), an echocardiographic apical four-chamber view was acquired with transmitral velocities, annular tissue Doppler and simultaneous LV and LA three-dimensional full-volume datasets. Then, from LA–LV volumetric curves we computed LAC as: [(LV maximum − LV minimum) − (LA maximum − LA minimum) volume], expressed as % LV stroke volume. LA pump, immediately post-EC, was assumed and verified as being negligible. Sinus rhythm persistence at 1 month was checked with ECG-Holter monitoring. Results At 1 month 62 patients were in sinus rhythm and 34 in AF. AF patients presented pre-EC higher E/é values (p = 0.012), no major LA volume differences (p = NS), but a stiffer LV cavity (p = 0.012) for a comparable LV capacitance (p = 0.461). Conduit contributed more (p < 0.001) to LV stroke volume in AF subpopulation. Multiple regression revealed LAC as the most significant AF predictor (p = 0.013), even after correction for biometric characteristics and pharmacotherapy (p = 0.008). Conclusion Our data suggest that LAC larger contribution to LV filling soon after EC reflects LA–LV stiffening, which skews atrioventricular interaction leading to AF perpetuation and makes conduit dominance a powerful predictor of early AF recurrence. Electronic supplementary material The online version of this article (10.1007/s00392-017-1188-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Degiovanni
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Enrico Boggio
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Eleonora Prenna
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Chiara Sartori
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Federica De Vecchi
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy
| | - Paolo N Marino
- Department of Translational Medicine, Clinical Cardiology, Università del Piemonte Orientale, Azienda Ospedaliera Universitaria "Maggiore della Carità", Corso Mazzini 18, 28100, Novara, Italy.
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1529
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Cardiac function in patients with polymyositis or dermatomyositis: a three-dimensional speckle-tracking echocardiography study. Int J Cardiovasc Imaging 2017; 34:683-693. [PMID: 29168054 DOI: 10.1007/s10554-017-1278-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 11/13/2017] [Indexed: 02/05/2023]
Abstract
Cardiac event is a major cause of death in patients with idiopathic inflammatory myopathies (IIM). The most frequent IIMs are polymyositis (PM) and dermatomyositis (DM). The purpose of this study was to analyze cardiac involvement by three-dimensional speckle-tracking echocardiography (3D STE) in patients with PM or DM, and to identify the relationship of cardiac injury with clinical characteristics and disease-specific parameters. 60 PM/DM patients with preserved left ventricular ejection fraction and 30 matched healthy controls were assessed by conventional echocardiography, 3D STE with biventricular strain analysis and electrocardiogram. Compared to controls, patients with PM/DM had significantly diminished left ventricular global longitudinal systolic strain and right ventricular longitudinal systolic strain (LVGLS, - 20.3 ± 2.5 vs. - 23.4 ± 1.7%; RVLS, - 19.4 ± 4.2 vs - 24.8 ± 2.0%; both P < 0.001), and longer QTc intervals(421.0 ± 38.4 vs 400.6 ± 14.5 ms, P = 0.001). Multiple regression analysis showed that Myositis Damage Index (MDI) was independently associated with LVGLS (R2 = 0.44, P = 0.002) and RVLS (R2 = 0.56, P < 0.001) in PM/DM patients with established disease course more than 1 year. In multivariate analysis of pooled data for all the PM/DM patients, when MDI was excluded due to missing observations, disease duration correlated with worse LVGLS (R2 = 0.24, P = 0.002), while concomitant interstitial lung disease correlated with worse RVLS (R2 = 0.30, P < 0.001). Disease activity scores (Myositis Intention to Treat Activities Index) had a weak positive correlation with QTc intervals (rsp = 0.31, P = 0.02). Our results suggest that cardiac injury in PM/DM is a long-term process and its severity depends on patients' heterogeneous clinical features and systemic disease burden.
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1530
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Smiseth OA. Need for better diastolic stress test: twistin’ time is here? Eur Heart J Cardiovasc Imaging 2017; 19:20-22. [DOI: 10.1093/ehjci/jex307] [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: 11/12/2022] Open
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1531
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Brand A, Bathe M, Oertelt-Prigione S, Seeland U, Rücke M, Regitz-Zagrosek V, Stangl K, Knebel F, Stangl V, Dreger H. Right heart function in impaired left ventricular diastolic function: 2D speckle tracking echocardiography-based and Doppler tissue imaging-based analysis of right atrial and ventricular function. Echocardiography 2017; 35:47-55. [DOI: 10.1111/echo.13745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Anna Brand
- Department of Cardiology and Angiology; Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin Germany
| | - Marny Bathe
- Department of Cardiology and Angiology; Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Sabine Oertelt-Prigione
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin Germany
- Institute of Forensic Medicine; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Ute Seeland
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin Germany
- Institute of Gender in Medicine (GiM); Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Mirjam Rücke
- Institute of Gender in Medicine (GiM); Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Vera Regitz-Zagrosek
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin Germany
- Institute of Gender in Medicine (GiM); Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Karl Stangl
- Department of Cardiology and Angiology; Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Fabian Knebel
- Department of Cardiology and Angiology; Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin Germany
| | - Verena Stangl
- Department of Cardiology and Angiology; Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
- DZHK (German Centre for Cardiovascular Research), Partner Site Berlin; Berlin Germany
| | - Henryk Dreger
- Department of Cardiology and Angiology; Campus Charité Mitte; Charité-Universitätsmedizin Berlin; Berlin Germany
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1532
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Zajac J, Eriksson J, Alehagen U, Ebbers T, Bolger AF, Carlhäll CJ. Mechanical dyssynchrony alters left ventricular flow energetics in failing hearts with LBBB: a 4D flow CMR pilot study. Int J Cardiovasc Imaging 2017; 34:587-596. [PMID: 29098524 PMCID: PMC5859696 DOI: 10.1007/s10554-017-1261-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 10/19/2017] [Indexed: 11/23/2022]
Abstract
The impact of left bundle branch block (LBBB) related mechanical dyssynchrony on left ventricular (LV) diastolic function remains unclear. 4D flow cardiovascular magnetic resonance (CMR) has provided reliable markers of LV dysfunction: reduced volume and kinetic energy (KE) of the portion of LV inflow which passes directly to outflow (Direct Flow) has been demonstrated in failing hearts compared to normal hearts. We sought to investigate the impact of mechanical dyssynchrony on diastolic function by comparing 4D flow in myopathic LVs with and without LBBB. CMR data were acquired at 3 T in 22 heart failure patients; 11 with LBBB and 11 without LBBB matched according to several demographic and clinical parameters. An established 4D flow analysis method was used to separate the LV end-diastolic (ED) volume into functional flow components based on the blood’s timing and route through the heart cavities. While the Direct Flow volume was not different between the groups, the KE possessed at ED was lower in LBBB patients (P = 0.018). Direct Flow entering the LV during early diastolic filling possessed less KE at ED in LBBB patients compared to non-LBBB patients, whereas no intergroup difference was observed during late filling. Pre-systolic KE of LV Direct Flow was reduced in patients with LBBB compared to matched patients with normal conduction. These intriguing findings propose that 4D flow specific measures can serve as markers of LV mechanical dyssynchrony in heart failure patients, and could possibly be investigated as predictors of response to cardiac resynchronization therapy.
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Affiliation(s)
- Jakub Zajac
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden. .,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden. .,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
| | - Jonatan Eriksson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Urban Alehagen
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Department of Cardiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, 581 85, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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1533
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Usefulness of Myocardial Annular Velocity Change During Mental Stress to Predict Cardiovascular Outcome in Patients With Coronary Artery Disease (From the Responses of Mental Stress-Induced Myocardial Ischemia to Escitalopram Treatment Trial). Am J Cardiol 2017; 120:1495-1500. [PMID: 28917493 DOI: 10.1016/j.amjcard.2017.07.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 11/20/2022]
Abstract
Mental stress-induced myocardial ischemia is common and a prognostic factor of adverse cardiovascular outcomes in patients with coronary artery disease (CAD). The present study aimed at examining associations between mental stress-induced myocardial annular velocity (MAV) and cardiovascular outcome in patients with CAD. MAV, specifically, diastolic early (e'), diastolic late (a'), and systolic (s') velocities were obtained at rest and during mental stress testing in 224 patients with clinically stable CAD. Using Cox regression models, age, sex, and baseline-adjusted mental stress-induced MAV measures were examined as predictors of a priori defined composite event term that comprised all-cause mortality and/or nonfatal cardiovascular events, resulting in an unplanned hospitalization (major adverse cardiovascular events [MACE]). Median follow-up was 4 years. The sample was predominantly male, Caucasian with New York Heart Association functional class I and a mean age of 63 ± 10.2 years. MS-induced changes in e' (hazard ratio [HR] = .73) and s' (HR = .73) were significant (p <0.05) predictors of MACE, and the change in a' (HR = .74) was marginal (p = 0.05). The pattern of the relation for each MAV measure was such that patients with a greater decrease in e' and/or s' velocity had a higher probability of experiencing an MACE, and the association of the change in a' and MACE was marginal (p = 0.05), but the same tendency. The associations between MS-induced values of e' and a' for MACE were independent of resting levels. Mental stress-induced MAV changes independently predict an adverse cardiovascular outcome in patients with stable CAD.
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1534
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Dietary Fat, Sugar Consumption, and Cardiorespiratory Fitness in Patients With Heart Failure With Preserved Ejection Fraction. JACC Basic Transl Sci 2017; 2:513-525. [PMID: 30062167 PMCID: PMC6058958 DOI: 10.1016/j.jacbts.2017.06.009] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 01/05/2023]
Abstract
Heart failure with preserved ejection fraction (HFpEF) is associated with obesity and, indirectly, with unhealthy diet. The role of dietary components in HFpEF is, however, largely unknown. In this study, the authors showed that in obese HFpEF patients, consumption of unsaturated fatty acids (UFA), was associated with better cardiorespiratory fitness, and UFA consumption correlated with better diastolic function and with greater fat-free mass. Similarly, mice fed with a high-fat diet rich in UFA and low in sugars had preserved myocardial function and reduced weight gain. Randomized clinical trials increasing dietary UFA consumption and reducing sugar consumption are warranted to confirm and expand our findings.
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Key Words
- CPX, cardiopulmonary exercise testing
- CRF, cardiorespiratory fitness
- CV, cardiovascular
- DT, deceleration time
- FFM, fat-free mass
- FM, fat mass
- HF, heart failure
- HFpEF, heart failure with preserved ejection fraction
- IQR, interquartile range
- MUFA, monounsaturated fatty acid
- PUFA, polyunsaturated fatty acid
- SFA, saturated fatty acid
- UFA, unsaturated fatty acid
- Vo2, oxygen consumption
- body composition
- diet
- heart failure with preserved ejection fraction
- obesity
- unsaturated fatty acids
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1535
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Multimodality imaging: Bird’s eye view from The European Society of Cardiology Congress 2017, Barcelona, August 26-30, 2017. J Nucl Cardiol 2017. [DOI: 10.1007/s12350-017-1108-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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1536
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Thromboembolisms in atrial fibrillation and heart failure patients with a preserved ejection fraction (HFpEF) compared to those with a reduced ejection fraction (HFrEF). Heart Vessels 2017; 33:403-412. [PMID: 29067492 DOI: 10.1007/s00380-017-1073-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 10/20/2017] [Indexed: 12/28/2022]
Abstract
Heart failure (HF) is classified into three clinical subtypes: HF with a preserved ejection fraction (HFpEF: EF ≥ 50%), HF with a mid-range ejection fraction (HFmrEF: 40 ≤ EF < 49%), and HF with a reduced ejection fraction (HFrEF: EF < 40%). These types often coexist with atrial fibrillation (AF). We investigated the rate of strokes/systemic embolisms (SSEs) in AF patients with HFpEF (AF-HFpEF) compared to that in those with HFrEF (AF-HFrEF: HFmrEF and HFrEF), and examined the independent predictors. We prospectively enrolled 1350 patients admitted to our hospital for worsening HF. We identified 301 patients with either AF-HFpEF (n = 129, 43%) or AF-HFrEF (n = 172, 57%). Compared to the patients with AF-HFrEF, those with AF-HFpEF were older and more likely to be female. Oral anticoagulant use was 63 vs. 66%, respectively. During a mean follow-up period of 26 months, 21 (7%) and 66 (22%) patients had SSEs and all-cause death, respectively. The crude annual rates of SSEs (3.9 vs. 2.7%, P = 0.47) were similar between the groups. In a multivariate Cox regression analysis, an age ≥ 75 years (hazard ratio 2.14, 95% confidence interval 1.32-3.58, P < 0.01) and the plasma B-type natriuretic peptide (BNP) level ≥ 341 pg/ml (hazard ratio 1.60, 95% confidence interval 1.07-2.39, P < 0.05) were associated with SSEs. The EF was not an independent predictor of SSEs (hazard ratio 1.01, 95% confidence interval 0.98-1.04, P = 0.51). There were no significant differences in the rates of SSEs between AF-HFpEF and AF-HFrEF. Patients with HF and concomitant AF should be treated with anticoagulants irrespective of EF.
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1537
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Edvardsen T, Gerber B, Donal E, Maurovich-Horvat P, Maurer G, Popescu BA. The year 2015–16 in the European Heart Journal—Cardiovascular Imaging. Part II. Eur Heart J Cardiovasc Imaging 2017; 18:1322-1330. [DOI: 10.1093/ehjci/jex237] [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: 09/09/2017] [Accepted: 09/12/2017] [Indexed: 12/18/2022] Open
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1538
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Ricci F, Barison A, Todiere G, Mantini C, Cotroneo AR, Emdin M, De Caterina R, Galllina S, Aquaro GD. Prognostic value of pulmonary blood volume by first-pass contrast-enhanced CMR in heart failure outpatients: the PROVE-HF study. Eur Heart J Cardiovasc Imaging 2017; 19:896-904. [DOI: 10.1093/ehjci/jex214] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Accepted: 08/16/2017] [Indexed: 12/24/2022] Open
Affiliation(s)
- F Ricci
- Institute for Advanced Biomedical Technologies, “G. d'Annunzio” University, Via Luigi Polacchi, 11 - 66100 Chieti, Italy
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Via dei Vestini. 31 - 66100 Chieti, Italy
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Via dei Vestini, 31 - 66100 Chieti, Italy
| | - A Barison
- G. Monasterio Foundation, MRI-laboratory, Via Giuseppe Moruzzi, 1 - 56124 Pisa, Italy
| | - G Todiere
- G. Monasterio Foundation, MRI-laboratory, Via Giuseppe Moruzzi, 1 - 56124 Pisa, Italy
| | - C Mantini
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Via dei Vestini. 31 - 66100 Chieti, Italy
| | - A R Cotroneo
- Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Via dei Vestini. 31 - 66100 Chieti, Italy
| | - M Emdin
- G. Monasterio Foundation, MRI-laboratory, Via Giuseppe Moruzzi, 1 - 56124 Pisa, Italy
| | - R De Caterina
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Via dei Vestini, 31 - 66100 Chieti, Italy
| | - S Galllina
- Institute of Cardiology, Department of Neuroscience, Imaging and Clinical Sciences, “G. d'Annunzio” University, Via dei Vestini, 31 - 66100 Chieti, Italy
| | - G D Aquaro
- G. Monasterio Foundation, MRI-laboratory, Via Giuseppe Moruzzi, 1 - 56124 Pisa, Italy
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1539
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van Grootel RWJ, Menting ME, McGhie J, Roos-Hesselink JW, van den Bosch AE. Echocardiographic chamber quantification in a healthy Dutch population. Neth Heart J 2017; 25:682-690. [PMID: 29019026 PMCID: PMC5691816 DOI: 10.1007/s12471-017-1035-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Aim For accurate interpretation of echocardiographic measurements normative data are required, which are provided by guidelines. For this article, the hypothesis was that these cannot be extrapolated to the Dutch population, since in Dutch clinical practice often higher values are found, which may not be pathological but physiological. Therefore this study aimed to 1) obtain and propose normative values for cardiac chamber quantification in a healthy Dutch population and 2) determine influences of baseline characteristics on these measurements. Methods Prospectively recruited healthy subjects, aged 20–72 years (at least 28 subjects per age decade, equally distributed for gender) underwent physical examination and 2D and 3D echocardiography. Both ventricles and atria were assessed and volumes were calculated. Results 147 subjects were included (age 44 ± 14 years, 50% female). Overall, feasibility was good for both linear and volumetric measurements. Linear and volumetric parameters were consistently higher than current guidelines recommend, while functional parameters were in line with the guidelines. This was more so in the older population. 3D volumes were higher than 2D volumes. Gender dependency was seen in all body surface area (BSA) corrected volumes and with increasing age, ejection fractions decreased. Conclusion This study provides 2D and 3D echocardiographic reference ranges for both ventricles and atria derived from a healthy Dutch population. BSA indexed volumes are gender-dependent, age did not influence ventricular volumes and a rise in blood pressure was independently associated with increased right ventricular volumes. The higher volumes found may be indicative for the Dutch population being the tallest in the world.
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Affiliation(s)
| | - M E Menting
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - J McGhie
- Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
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1540
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Kanar B, Ozben B, Kanar HS, Arsan A, Tigen K. Left atrial volume changes are an early marker of end-organ damage in essential hypertension: A multidisciplinary approach to an old problem. Echocardiography 2017; 34:1895-1902. [DOI: 10.1111/echo.13710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Batur Kanar
- Department of Cardiology; Marmara University Faculty of Medicine; Istanbul Turkey
| | - Beste Ozben
- Department of Cardiology; Marmara University Faculty of Medicine; Istanbul Turkey
| | - Hatice Selen Kanar
- Department of Ophthalmology; Fatih Sultan Mehmet Training and Research Hospital; Istanbul Turkey
| | - Aysu Arsan
- Department of Ophthalmology; Dr. Lutfi Kirdar Training and Research Hospital; Istanbul Turkey
| | - Kursat Tigen
- Department of Cardiology; Marmara University Faculty of Medicine; Istanbul Turkey
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1541
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Donal E, Galli E, Fraser AG. Non-invasive estimation of left heart filling pressures: another nail in the coffin for E/e'? Eur J Heart Fail 2017; 19:1661-1663. [DOI: 10.1002/ejhf.944] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 06/21/2017] [Indexed: 11/05/2022] Open
Affiliation(s)
- Erwan Donal
- CHU Rennes, Service de Cardiologie et Maladies Vasculaires; CIC-IT 1414 Rennes France
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | - Elena Galli
- CHU Rennes, Service de Cardiologie et Maladies Vasculaires; CIC-IT 1414 Rennes France
- INSERM, U1099; Rennes France
- Université de Rennes 1, LTSI; Rennes France
| | - Alan G. Fraser
- Department of Cardiology; University Hospital of Wales; Cardiff UK
- Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences; Katholieke University Leuven; Leuven Belgium
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1542
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Jørgensen PG, Biering-Sørensen T, Mogelvang R, Fritz-Hansen T, Vilsbøll T, Rossing P, Jensen JS. Presence of micro- and macroalbuminuria and the association with cardiac mechanics in patients with type 2 diabetes. Eur Heart J Cardiovasc Imaging 2017; 19:1034-1041. [DOI: 10.1093/ehjci/jex231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 09/07/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Peter Godsk Jørgensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
| | - Thomas Fritz-Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
| | - Tina Vilsbøll
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
- Center for Diabetes Research, Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Hellerup, Denmark
| | - Peter Rossing
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
- Steno Diabetes Center Copenhagen, Niels Steensens Vej 2-2, Gentofte, Denmark
- Faculty of Health, Aarhus University, Nordre Ringgade 1, Aarhus C, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Post 835, Kildegårdsvej 28, Hellerup, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen N., Denmark
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1543
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Kindel TL, Strande JL. Bariatric surgery as a treatment for heart failure: review of the literature and potential mechanisms. Surg Obes Relat Dis 2017; 14:117-122. [PMID: 29108893 DOI: 10.1016/j.soard.2017.09.534] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/02/2017] [Accepted: 09/27/2017] [Indexed: 01/07/2023]
Abstract
Heart failure due to severe obesity is a complex disease due to multiple mechanisms, including increased body mass, inflammation, and impaired cardiac metabolism that is complicated by obesity-associated co-morbidities, such as type 2 diabetes and obstructive sleep apnea. Bariatric surgery significantly improves cardiac geometry, function, and symptoms related to obesity cardiomyopathy. There is a consistently positive impact of bariatric surgery on diastolic function with the potential to significantly improve systolic function as measured by ejection fraction in patients with advanced heart failure. For end-stage heart failure patients, including those requiring mechanical circulatory support who are ineligible for organ transplant due to morbid obesity, bariatric surgery has been successfully used for weight loss as a bridge to cardiac transplantation.
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Affiliation(s)
- Tammy L Kindel
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
| | - Jennifer L Strande
- Department of Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin
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1544
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Edvardsen T, Donal E, Bucciarelli-Ducci C, Maurovich-Horvat P, Maurer G, Popescu BA. The years 2015-2016 in the European Heart Journal-Cardiovascular Imaging. Part I. Eur Heart J Cardiovasc Imaging 2017; 18:1092-1098. [PMID: 28984893 DOI: 10.1093/ehjci/jex192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 07/08/2017] [Indexed: 11/12/2022] Open
Abstract
The multimodality cardiovascular imaging journal, European Heart Journal-Cardiovascular Imaging, was launched in 2012. It has gained an impressive impact factor of 5.99 during its 5 first years and is now established as the most important cardiovascular imaging journal in Europe. The most important studies from the journal's forth and fifth years will be highlighted in two reports. Part I of the review will focus on studies about myocardial function and risk prediction, myocardial ischaemia, and emerging techniques in cardiovascular imaging, while Part II will focus on valvular heart disease, heart failure, cardiomyopathies, and congenital heart disease.
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Affiliation(s)
- Thor Edvardsen
- Department of Cardiology, Centre of Cardiological Innovation Oslo University Hospital, Rikshospitalet and University of Oslo, PO Box 4950 Nydalen, NO-0424 Oslo, Norway
| | - Erwan Donal
- Cardiologie Department and CIC-IT 1414, CHU Rennes, Hôpital Pontchaillou, LTSI INSERM U 1099, University Rennes-1, 35000 Rennes, France
| | - Chiara Bucciarelli-Ducci
- Bristol Heart Institute, University Hospitals Bristol NHS Trust, Upper Maudlin St, Bristol, BS2 8HW, UK and Clinical Research and Imaging Centre (CRIC) Bristol, 60 St Michael Hill, Bristol, BS2 8DX, UK
| | - Pál Maurovich-Horvat
- MTA-SE Cardiovascular Imaging Research Group (CIRG), Heart and Vascular Center, Semmelweis University, 68 Varosmajor u., 1122 Budapest, Hungary
| | - Gerald Maurer
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Wien, Austria
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy 'Carol Davila'-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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1545
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Sanfilippo F, Corredor C, Arcadipane A, Landesberg G, Vieillard-Baron A, Cecconi M, Fletcher N. Tissue Doppler assessment of diastolic function and relationship with mortality in critically ill septic patients: a systematic review and meta-analysis. Br J Anaesth 2017; 119:583-594. [DOI: 10.1093/bja/aex254] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
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1546
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1547
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Affiliation(s)
- Erwan Donal
- From the CHU Rennes, Service de Cardiologie et Maladies Vasculaires, CIC-IT 1414, 2 rue Henri Le Guilloux, Rennes, France (E.D., E.G.); INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, Rennes, France (E.D., E.G., F.S.); Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, Rennes, France (E.D., E.G., F.S.); and Service de Médecine du Sport, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France (F.S.)
| | - Elena Galli
- From the CHU Rennes, Service de Cardiologie et Maladies Vasculaires, CIC-IT 1414, 2 rue Henri Le Guilloux, Rennes, France (E.D., E.G.); INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, Rennes, France (E.D., E.G., F.S.); Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, Rennes, France (E.D., E.G., F.S.); and Service de Médecine du Sport, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France (F.S.)
| | - Frederic Schnell
- From the CHU Rennes, Service de Cardiologie et Maladies Vasculaires, CIC-IT 1414, 2 rue Henri Le Guilloux, Rennes, France (E.D., E.G.); INSERM, U1099, 2 avenue du Pr Léon Bernard, CS 34317, Rennes, France (E.D., E.G., F.S.); Université de Rennes 1, LTSI, 2 avenue du Pr Léon Bernard, Rennes, France (E.D., E.G., F.S.); and Service de Médecine du Sport, CHU Rennes, 2 rue Henri Le Guilloux, Rennes, France (F.S.)
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1548
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Ali A, Holm H, Molvin J, Bachus E, Tasevska-Dinevska G, Fedorowski A, Jujic A, Magnusson M. Autonomic dysfunction is associated with cardiac remodelling in heart failure patients. ESC Heart Fail 2017; 5:46-52. [PMID: 28960944 PMCID: PMC5793984 DOI: 10.1002/ehf2.12223] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 08/07/2017] [Accepted: 08/25/2017] [Indexed: 01/01/2023] Open
Abstract
Aims Orthostatic hypotension (OH) is a cardinal sign of autonomic dysfunction and a common co‐morbidity in heart failure (HF). The role of autonomic dysfunction in the development of structural cardiac anomalies in HF patients has not been sufficiently explored. We aimed to assess relations between orthostatic blood pressure (BP) responses during active standing and echocardiographic changes in a series of patients admitted for HF. Methods and results One hundred and forty‐nine patients hospitalized for HF [mean age: 74 years; 30% women; ejection fraction (LVEF) 40 ± 16%] were examined with conventional echocardiograms and active‐standing test. Associations of cardiac remodelling parameters with the difference between supine and standing (after 3 min) systolic/diastolic BP were examined. Systolic BP decreased (−1.1 ± 15 mmHg), whereas diastolic BP increased (+1.0 ± 9.5 mmHg) after 3 min of active standing. A total of 34 patients (23%) met conventional OH criteria; i.e. systolic/diastolic BP decreases by ≥20/10 mmHg. In the multivariable linear regression analysis, adjusted for traditional cardiovascular risk factors and LVEF, a decrease in systolic BP upon standing was associated with greater left atrial volume [β per −10 mmHg: 2.37, standard error (SE) = 1.16, P = 0.043], and greater left ventricular mass (β per −10 mmHg: 5.67, SE = 2.24, P = 0.012), but not with other echocardiographic parameters. No significant associations were observed between signs of cardiac remodelling and decrease in diastolic BP. Conclusions Orthostatic decrease in systolic BP among older HF patients is associated with structural cardiac changes such as increased left atrial volume and left ventricular mass, independently of traditional risk factors and left ventricular dysfunction.
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Affiliation(s)
- Amna Ali
- Department of Medical Imaging and Physiology, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Hannes Holm
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - John Molvin
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Lund University, Skåne University Hospital, Inga Marie Nillsons Gata 46, 205 02, Malmö, Sweden
| | - Erasmus Bachus
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Internal Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Gordana Tasevska-Dinevska
- Department of Cardiology, Lund University, Skåne University Hospital, Inga Marie Nillsons Gata 46, 205 02, Malmö, Sweden
| | - Artur Fedorowski
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Lund University, Skåne University Hospital, Inga Marie Nillsons Gata 46, 205 02, Malmö, Sweden
| | - Amra Jujic
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden.,Department of Cardiology, Lund University, Skåne University Hospital, Inga Marie Nillsons Gata 46, 205 02, Malmö, Sweden
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1549
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Dominguez F, González-López E, Padron-Barthe L, Cavero MA, Garcia-Pavia P. Role of echocardiography in the diagnosis and management of hypertrophic cardiomyopathy. Heart 2017; 104:261-273. [PMID: 28928240 DOI: 10.1136/heartjnl-2016-310559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/09/2017] [Accepted: 08/13/2017] [Indexed: 12/26/2022] Open
Affiliation(s)
- Fernando Dominguez
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Esther González-López
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Laura Padron-Barthe
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel Angel Cavero
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain
| | - Pablo Garcia-Pavia
- Department of Cardiology, Heart Failure and Inherited Cardiac Diseases Unit, Hospital Universitario Puerta de Hierro, Madrid, Spain.,Myocardial Biology Programme, Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Centro de Investigacion Biomedica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,University Francisco de Vitoria (UFV), Pozuelo de Alarcon, Madrid, Spain.,European Reference Network in Heart Diseases (ERN GUARD-HEART)
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1550
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Khalil H, Kanisicak O, Prasad V, Correll RN, Fu X, Schips T, Vagnozzi RJ, Liu R, Huynh T, Lee SJ, Karch J, Molkentin JD. Fibroblast-specific TGF-β-Smad2/3 signaling underlies cardiac fibrosis. J Clin Invest 2017; 127:3770-3783. [PMID: 28891814 DOI: 10.1172/jci94753] [Citation(s) in RCA: 599] [Impact Index Per Article: 85.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 07/26/2017] [Indexed: 02/06/2023] Open
Abstract
The master cytokine TGF-β mediates tissue fibrosis associated with inflammation and tissue injury. TGF-β induces fibroblast activation and differentiation into myofibroblasts that secrete extracellular matrix proteins. Canonical TGF-β signaling mobilizes Smad2 and Smad3 transcription factors that control fibrosis by promoting gene expression. However, the importance of TGF-β-Smad2/3 signaling in fibroblast-mediated cardiac fibrosis has not been directly evaluated in vivo. Here, we examined pressure overload-induced cardiac fibrosis in fibroblast- and myofibroblast-specific inducible Cre-expressing mouse lines with selective deletion of the TGF-β receptors Tgfbr1/2, Smad2, or Smad3. Fibroblast-specific deletion of Tgfbr1/2 or Smad3, but not Smad2, markedly reduced the pressure overload-induced fibrotic response as well as fibrosis mediated by a heart-specific, latency-resistant TGF-β mutant transgene. Interestingly, cardiac fibroblast-specific deletion of Tgfbr1/2, but not Smad2/3, attenuated the cardiac hypertrophic response to pressure overload stimulation. Mechanistically, loss of Smad2/3 from tissue-resident fibroblasts attenuated injury-induced cellular expansion within the heart and the expression of fibrosis-mediating genes. Deletion of Smad2/3 or Tgfbr1/2 from cardiac fibroblasts similarly inhibited the gene program for fibrosis and extracellular matrix remodeling, although deletion of Tgfbr1/2 uniquely altered expression of an array of regulatory genes involved in cardiomyocyte homeostasis and disease compensation. These findings implicate TGF-β-Smad2/3 signaling in activated tissue-resident cardiac fibroblasts as principal mediators of the fibrotic response.
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Affiliation(s)
- Hadi Khalil
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Onur Kanisicak
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Vikram Prasad
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Robert N Correll
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Xing Fu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Tobias Schips
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ronald J Vagnozzi
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Ruijie Liu
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.,Department of Biomedical Sciences, Grand Valley State University, Allendale, Michigan, USA
| | - Thanh Huynh
- Department of Molecular Biology and Genetics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Se-Jin Lee
- Department of Molecular Biology and Genetics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jason Karch
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA
| | - Jeffery D Molkentin
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio, USA.,Howard Hughes Medical Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
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