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Usuku H, Yamamoto E, Sakata K, Hirata S, Toda A, Oike F, Tabata N, Ishii M, Hanatani S, Hoshiyama T, Sueta D, Kanazawa H, Arima Y, Takashio S, Matsuzawa Y, Kawano H, Yasunaga JI, Tsujita K. Usefulness of platelet count to predict concomitant valvular heart disease in patients with systemic lupus erythematosus. IJC HEART & VASCULATURE 2024; 53:101420. [PMID: 38826833 PMCID: PMC11143897 DOI: 10.1016/j.ijcha.2024.101420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 04/27/2024] [Accepted: 05/02/2024] [Indexed: 06/04/2024]
Abstract
Background Although the prevalence rate of valvular heart disease (VHD) is high in patients with systemic lupus erythematosus (SLE), the predictive factors of concomitant VHD have not been fully evaluated. Methods and results Among 288 patients with SLE who underwent transthoracic echocardiography at Kumamoto University Hospital from 2016 to 2021, 241 patients with sufficient echocardiographic data were retrospectively analysed. Among them, 22 (9 %) had VHD (10 had mitral regurgitation, 3 had aortic regurgitation, 6 had tricuspid regurgitation, 1 had mitral regurgitation and tricuspid regurgitation, and 2 had a prosthetic cardiac valve). After excluding the two patients with a prosthetic cardiac valve, we divided the remaining patients into two groups: the VHD group and non-VHD group. Multivariate logistic regression analysis revealed that age and the platelet count were significantly and independently associated with having VHD (age: odds ratio, 1.06; 95 % confidence interval, 1.02-1.10; p < 0.01) (platelet count: odds ratio, 0.99; 95 % confidence interval, 0.98-1.00; p < 0.05). After excluding 95 patients aged < 40 years, receiver operating characteristic analysis revealed that the area under the curve of the platelet count for prediction of VHD was 0.73 with an optimal cut-off value of 166.5 × 103/µL (sensitivity: 76.6 %, specificity: 60.0 %). Among patients with a low platelet count (<166.5 × 103/µL), the rate of having VHD was 29 % (12/41 patients). However, among those with a high platelet count (≥166.5 × 103/µL), this rate was only 8 % (8/103 patients). Conclusion The platelet count is useful to predict concomitant VHD in middle-aged and older patients with SLE.
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Affiliation(s)
- Hiroki Usuku
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Eiichiro Yamamoto
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Komei Sakata
- Department of Hematology, Rheumatology, and Infectious Diseases, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Shinya Hirata
- Department of Hematology, Rheumatology, and Infectious Diseases, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Ayano Toda
- Department of Laboratory Medicine, Kumamoto University Hospital, Kumamoto, Japan
| | - Fumi Oike
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Noriaki Tabata
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Masanobu Ishii
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Shinsuke Hanatani
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Tadashi Hoshiyama
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Daisuke Sueta
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Hisanori Kanazawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Yuichiro Arima
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Seiji Takashio
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Yasushi Matsuzawa
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Hiroaki Kawano
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
| | - Jun-ichirou Yasunaga
- Department of Hematology, Rheumatology, and Infectious Diseases, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Center of Metabolic Regulation of Healthy Aging, Kumamoto University Faculty of Life Sciences, Kumamoto, Japan
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152
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Çakan F, Önalan O, Adar A, Akbay E, Çöllüoğlu IT, Köktürk U, Akin Y, Özçalik E. Clinical characteristics of atrial fibrillation in nonagenarian population and relationship with mortality. Minerva Cardiol Angiol 2024; 72:372-384. [PMID: 38934266 DOI: 10.23736/s2724-5683.24.06464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2024]
Abstract
BACKGROUND There is a considerable amount of literature available on well-known risk factors for atrial fibrillation (AF); however, available data specifically focused on the ninth decade are scarce. The main objective of this study was to assess the demographic and clinical characteristics of AF and sinus rhythm in a nonagenarian population. METHODS All individuals aged >90 years who were admitted to the Cardiology outpatient clinic between April 2018 and January 2019 were enrolled in the study. The demographic and clinical characteristics of all patients were recorded. All deaths that occurred during the two-year follow-up period were recorded. RESULTS In total, 112 nonagenarian individuals were included in the study. Of these patients, 50 (44.6%) had AF. The groups showed similarities in demographic and clinical characteristics. During a mean follow-up period of 596±44 days, 39 patients (78%) in the AF group and 35 patients (56.5%) in the sinus group died. Patients with AF showed a lower overall survival distribution than those with sinus rhythm (P=0.005, log-rank test χ2=7.734). AF was associated with an increased risk of mortality (P=0.002, hazard ratio [HR] =2.104, 95% confidence interval [CI] = 1.326-3.339) in multivariate Cox regression analysis, while waist circumference and total cholesterol (P=0.003, HR=0.969, 95% CI=0.949-0.989 and P=0.046, HR=0.993, 95% CI=0.986-1.000, respectively) showed a decreased risk of mortality. CONCLUSIONS Atrial fibrillation is very common in individuals over the age of 90 years (44.6%). Well-known risk factors do not appear to be effective in this age group, and AF is associated with a 2.1-fold increase in the risk of mortality.
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Affiliation(s)
- Fahri Çakan
- Department of Cardiology, Faculty of Medicine, Karabuk University, Karabuk, Türkiye -
| | - Orhan Önalan
- Department of Cardiology, Faculty of Medicine, Karabuk University, Karabuk, Türkiye
| | - Adem Adar
- Department of Cardiology, Alanya Research and Application Center, Baskent University, Antalya, Türkiye
| | - Ertan Akbay
- Department of Cardiology, Alanya Research and Application Center, Baskent University, Antalya, Türkiye
| | - Inci T Çöllüoğlu
- Department of Cardiology, Faculty of Medicine, Karabuk University, Karabuk, Türkiye
| | - Uğur Köktürk
- Department of Cardiology, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Türkiye
| | - Yeşim Akin
- Department of Cardiology, Faculty of Medicine, Karabuk University, Karabuk, Türkiye
| | - Emre Özçalik
- Department of Cardiology, Zubeyde Hanim Hospital, Baskent University, Izmir, Türkiye
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153
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Chang HC, Kuo L, Sung SH, Niu DM, Yu WC. Prognostic Implications of Left Ventricular Hypertrophy and Mechanical Function in Fabry Disease: A Longitudinal Cohort Study. J Am Soc Echocardiogr 2024; 37:787-796. [PMID: 38704103 DOI: 10.1016/j.echo.2024.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 04/02/2024] [Accepted: 04/03/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND The prognostic value of different grades of left ventricular hypertrophy (LVH) and left ventricular (LV) mechanical function in Fabry disease is unclear. We aimed to evaluate the association between the severity of LVH, LV mechanical function, and clinical outcomes in Fabry disease. METHODS We conducted a retrospective cohort study from a single-center registry of adult patients with Fabry disease. Left ventricular mass index (LVMI) was measured by echocardiography. The severity of LVH was categorized by LVMI using the sex-specific cutoff values. Left ventricular mechanical function was measured as LV global longitudinal strain (GLS) by speckle-tracking analysis. The primary outcome was a composite of major adverse cardiovascular events (MACE) at 5 years, including heart failure hospitalization, sustained ventricular tachycardia, acute ischemic stroke, and all-cause mortality. RESULTS The study included 268 patients (age 50.4 ± 15.4 years, men 46.6%) with Fabry disease (83.2% IVS4+919G > A mutation), and 106 patients (39.6%) had LVH. Patients with mild, moderate, or severe LVH had 5-year MACE rates of 7.4%, 10%, and 30.5%, respectively (P < .001). Moreover, patients with impaired LV GLS (<14.1%) had a higher 5-year MACE rate than those with preserved LV GLS (32.1% vs 2.4%, P < .001). Severe LVH was an independent predictor of MACE compared with absence of LVH (adjusted hazard ratio, 12.73; 95% CI, 1.3-124.71; P = .03), after adjusting for age, sex, hypertension, hyperlipidemia, atrial fibrillation, renal function, average E/e', enzyme replacement therapy, and LV GLS. Patients with severe LVH and impaired LV GLS had the highest incidence for MACE (log-rank P < .05), irrespective of sex, genotypes, and whether receiving enzyme replacement therapy or not. CONCLUSIONS Sex-specific grading of LVH by LVMI is practical for risk stratification in patients with Fabry disease, and impaired LV GLS further refines the prognostication.
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Affiliation(s)
- Hao-Chih Chang
- Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan; Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan; Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei Taiwan; Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling Kuo
- Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Shih-Hsien Sung
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei Taiwan; Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Emergency and Critical Care Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Dau-Ming Niu
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei Taiwan; Department of Internal Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
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154
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Möller FN, Fan JL, Futral JE, Hodgman CF, Kayser B, Lovering AT. Cardiopulmonary haemodynamics in Tibetans and Han Chinese during rest and exercise. J Physiol 2024; 602:3893-3907. [PMID: 38924564 DOI: 10.1113/jp286303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
During sea-level exercise, blood flow through intrapulmonary arteriovenous anastomoses (IPAVA) in humans without a patent foramen ovale (PFO) is negatively correlated with pulmonary pressure. Yet, it is unknown whether the superior exercise capacity of Tibetans well adapted to living at high altitude is the result of lower pulmonary pressure during exercise in hypoxia, and whether their cardiopulmonary characteristics are significantly different from lowland natives of comparable ancestry (e.g. Han Chinese). We found a 47% PFO prevalence in male Tibetans (n = 19) and Han Chinese (n = 19) participants. In participants without a PFO (n = 10 each group), we measured heart structure and function at rest and peak oxygen uptake (V ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ ), peak power output (W ̇ p e a k ${{\dot{W}}_{peak}}$ ), pulmonary artery systolic pressure (PASP), blood flow through IPAVA and cardiac output (Q ̇ T ${{\dot{Q}}_{\mathrm{T}}} $ ) at rest and during recumbent cycle ergometer exercise at 760 Torr (SL) and at 410 Torr (ALT) barometric pressure in a pressure chamber. Tibetans achieved a higherW peak ${W}_{\textit{peak}}$ than Han, and a higherV ̇ O 2 peak ${{\dot{V}}_{{{{\mathrm{O}}}_{\mathrm{2}}}{\mathrm{peak}}}}$ at ALT without differences in heart rate, stroke volume orQ ̇ T ${{\dot{Q}}_{\mathrm{T}}} $ . Blood flow through IPAVA was generally similar between groups. Increases in PASP and total pulmonary resistance at ALT were comparable between the groups. There were no differences in the slopes of PASP plotted as a function ofQ ̇ T ${{\dot{Q}}_{\mathrm{T}}} $ during exercise. In those without PFO, our data indicate that the superior aerobic exercise capacity of Tibetans over Han Chinese is independent of cardiopulmonary features and more probably linked to differences in local muscular oxygen extraction. KEY POINTS: Patent foramen ovale (PFO) prevalence was 47% in Tibetans and Han Chinese living at 2 275 m. Subjects with PFO were excluded from exercise studies. Compared to Han Chinese, Tibetans had a higher peak workload with acute compression to sea level barometric pressure (SL) and acute decompression to 5000 m altitude (ALT). Comprehensive cardiac structure and function at rest were not significantly different between Han Chinese and Tibetans. Tibetans and Han had similar blood flow through intrapulmonary arteriovenous anastomoses (IPAVA) during exercise at SL. Peak pulmonary artery systolic pressure (PASP) and total pulmonary resistance were different between SL and ALT, with significantly increased PASP for Han compared to Tibetans at ALT. No differences were observed between groups at acute SL and ALT.
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Affiliation(s)
- Fabian N Möller
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Boston, MA, USA
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
- German Sport University Cologne, Institute for Professional Sport Education and Qualification, Cologne, Germany
| | - Jui-Lin Fan
- Department of Physiology, Manaaki Manawa - The Centre for Heart Research, University of Auckland, Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Joel E Futral
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
- Oregon Heart & Vascular Institute, Springfield, Oregon, USA
| | - Charles F Hodgman
- Department of Health and Human Performance, University of Houston, Houston, TX, USA
| | - Bengt Kayser
- University of Lausanne, Institute of Sports Sciences, Lausanne, Switzerland
| | - Andrew T Lovering
- Department of Human Physiology, University of Oregon, Eugene, OR, USA
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155
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Zhang Y, Peng G, Leng W, Li Y, Li H, Zhou L, Ge L, Shao J, Li X, Long M. Association between serum β2-microglobulin and left ventricular hypertrophy in patients with type 2 diabetes mellitus: A cross-sectional study. J Diabetes 2024; 16:e13599. [PMID: 39155680 PMCID: PMC11331034 DOI: 10.1111/1753-0407.13599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 08/20/2024] Open
Abstract
BACKGROUND Beta 2-microglobulin (β2-MG) is a component of the class I major histocompatibility complex (MHCI) and has recently been reported to be involved in type 2 diabetes mellitus (T2DM) and cardiovascular disease. However, the association of β2-MG with left ventricular hypertrophy (LVH) in T2DM patients remains unknown. This study aims to investigate the correlation between serum β2-MG and LVH in T2DM patients. METHODS The retrospective analysis included 4602 eligible T2DM patients, divided into LVH and non-LVH groups based on echocardiography results. Serum β2-MG levels were measured, and participants were categorized into four groups (Q1-Q4) by their serum β2-MG quartile. The relationship of serum β2-MG level with LVH was evaluated using logistic regression, restricted cubic spline (RCS), subgroup analysis, and machine learning. RESULTS The prevalence of LVH in T2DM patients was 31.12%. Each standard deviation increase in serum β2-MG level corresponded to a 1.17-fold increase in the prevalence of LVH [OR = 1.17, (95% CI: 1.05-1.31); p = 0.006]. When considering β2-MG as a categorical variable (quartile), Q3 [OR = 1.36, (95% CI: 1.09-1.69); p = 0.007] and Q4 [OR = 1.77, (95% CI: 1.36-2.31); p < 0.001] had a significantly higher prevalence of LVH than Q1. RCS analysis found a nonlinear association between β2-MG and LVH prevalence (p for nonlinearity <0.05). Additionally, machine learning results confirmed the importance of β2-MG for LVH in T2DM patients. CONCLUSION Elevated serum β2-MG levels were likely to be associated with an increased prevalence of LVH in T2DM patients, suggesting its potential role in LVH development.
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Affiliation(s)
- Yuling Zhang
- Department of EndocrinologySouthwest Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Guiliang Peng
- Department of EndocrinologySouthwest Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Weiling Leng
- Department of EndocrinologySouthwest Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Ying Li
- Center for Medical Big Data and Artificial Intelligence, Southwest Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Haiyan Li
- Department of UltrasonographyChenjiaqiao HospitalChongqingChina
| | - Ling Zhou
- Department of EndocrinologySouthwest Hospital, Army Medical University (Third Military Medical University)ChongqingChina
| | - Lichao Ge
- Department of EndocrinologyJinling Hospital, Nanjing Medical UniversityNanjingChina
| | - Jiaqing Shao
- Department of EndocrinologyJinling Hospital, Nanjing Medical UniversityNanjingChina
- Department of EndocrinologyJinling Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of EndocrinologyJinling Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Xing Li
- Department of EndocrinologyJinling Hospital, Nanjing Medical UniversityNanjingChina
- Department of EndocrinologyJinling Hospital, Affiliated Hospital of Medical School, Nanjing UniversityNanjingChina
- Department of EndocrinologyJinling Hospital, School of Medicine, Southeast UniversityNanjingChina
| | - Min Long
- Department of EndocrinologySouthwest Hospital, Army Medical University (Third Military Medical University)ChongqingChina
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156
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Lauridsen AJ, Landler NE, Olsen FJ, Christensen J, Lassen MCH, Johansen ND, Skaarup KG, Christoffersen C, Ballegaard ELF, Sørensen IMH, Bjergfelt SS, Bro S, Feldt-Rasmussen B, Hansen D, Biering-Sørensen T. Prevalence and Implications of Heart Failure Stages A-D Among Patients With Chronic Kidney Disease. JACC. HEART FAILURE 2024; 12:1497-1499. [PMID: 38934963 DOI: 10.1016/j.jchf.2024.04.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 04/23/2024] [Indexed: 06/28/2024]
Affiliation(s)
- Amalie Johanne Lauridsen
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark.
| | - Nino Emanuel Landler
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Jacob Christensen
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | | | - Niklas Dyrby Johansen
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Christina Christoffersen
- University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | | | - Sasha Saurbrey Bjergfelt
- University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Susanne Bro
- Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bo Feldt-Rasmussen
- University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Ditte Hansen
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Copenhagen University Hospital-Herlev and Gentofte, Copenhagen, Denmark; University of Copenhagen, Copenhagen, Denmark; Copenhagen University Hospital, Rigshospitalet, Denmark; Steno Diabetes Center Copenhagen, Copenhagen, Denmark
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157
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Houska N, Albertz M, Frank B, Ing RJ. 2024 Guidelines for Performing a Comprehensive Pediatric Transthoracic Echocardiogram: Recommendations From the American Society of Echocardiography. J Cardiothorac Vasc Anesth 2024; 38:1627-1629. [PMID: 38834446 DOI: 10.1053/j.jvca.2024.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 03/24/2024] [Indexed: 06/06/2024]
Affiliation(s)
- Nicholas Houska
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Megan Albertz
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Benjamin Frank
- Department of Pediatric Cardiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO
| | - Richard J Ing
- Department of Anesthesiology, University of Colorado School of Medicine, Children's Hospital Colorado, Anschutz Medical Campus, Aurora, CO.
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158
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Masarone D, Falco L, d'Onofrio A, Nigro G, Ammendola E, Pacileo G. Response to levosimendan predicts response to cardiac contractility modulation therapy: a pilot study. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:703-705. [PMID: 38460883 DOI: 10.1016/j.rec.2024.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Accepted: 02/22/2024] [Indexed: 03/11/2024]
Affiliation(s)
- Daniele Masarone
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy.
| | - Luigi Falco
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Antonio d'Onofrio
- Electrophysiology Unit, Department of Cardiology, AORN dei Colli Monaldi Hospital, Naples, Italy
| | - Gerardo Nigro
- Cardiology Unit, Department of Medical Translational Sciences, University of Campania "Luigi Van-Vitelli" Naples, Italy
| | - Ernesto Ammendola
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
| | - Giuseppe Pacileo
- Heart Failure Unit, Department of Cardiology, AORN dei Colli-Monaldi Hospital, Naples, Italy
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159
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Kim MS, Bong W, Choi JH, Shin M, Lee B. Usefulness of oxygen uptake efficiency slope in a 6 min walk test in chronic heart failure. ESC Heart Fail 2024; 11:2055-2062. [PMID: 38529745 PMCID: PMC11287357 DOI: 10.1002/ehf2.14754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 02/24/2024] [Accepted: 02/29/2024] [Indexed: 03/27/2024] Open
Abstract
AIMS Frailty is an obstacle to performing cardiopulmonary exercise test (CPET) in patients with chronic heart failure (CHF). We evaluated the usefulness of oxygen uptake efficiency slope (OUES) using a 6 min walk test (6MWT) with portable gas analysis compared with CPET-derived parameters in patients with CHF. METHODS AND RESULTS Patients with CHF who underwent both the 6MWT with portable gas analysis and CPET between December 2016 and May 2020 were retrospectively investigated. The 6MWT-derived and echocardiographic parameters were compared with the OUES and peak oxygen consumption (VO2) from the CPET. Forty patients were analysed; 50% were male with a mean age of 55.45 ± 14.70 years. Twenty-six patients (65%) had New York Heart Association Functional Classification II or III dyspnoea. Twenty-five patients (62.5%) had heart failure (HF) with preserved ejection fraction (EF) (left ventricular EF > 50%), and nine patients (22.5%) had HF with reduced EF (EF < 40%). During the 6MWT, the peak VO2 was 14.97 ± 3.80 mL/kg/min, which was only 74% of the peak VO2 in the CPET, 20.18 ± 5.64 mL/kg/min. The OUES in the 6MWT was lower than that in the CPET (1528.87 ± 579.01 in the 6MWT vs. 1638.69 ± 601.31 in the CPET). The 6 min walk distance (6MWD) and OUES in the 6MWT were positively correlated with the OUES in the CPET (6MWD, r = 0.434, P = 0.005; OUES, r = 0.729, P < 0.001). The OUES in the 6MWT showed the strongest correlation with the OUES in the CPET. When we divided patients into two groups according to peak VO2 in the CPET, the correlation between OUES values of the 6MWT and that of the CPET was consistently confirmed (peak VO2 ≥ 20 mL/kg/min group, r = 0.661, P = 0.001; peak VO2 < 20 mL/kg/min group, r = 0.526, P = 0.021). In addition, the 6MWD, OUES, and peak VO2 in the 6MWT were associated with peak VO2 in the CPET (6MWD, r = 0.627, P < 0.001; OUES, r = 0.452, P = 0.003; and peak VO2, r = 0.492, P = 0.001). CONCLUSIONS In frail patients with CHF who have difficulty performing maximal exercises, the OUES through the 6MWT may be applied instead of the OUES and peak VO2 from the CPET.
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Affiliation(s)
- Min Sun Kim
- Division of Cardiology, Department of Internal Medicine, Biomedical Research InstitutePusan National University HospitalBusanRepublic of Korea
| | - Woori Bong
- Division of Cardiology, Department of Internal Medicine, Biomedical Research InstitutePusan National University HospitalBusanRepublic of Korea
- Division of Cardiology, Department of Internal MedicineBusan Veterans HospitalBusanRepublic of Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Biomedical Research InstitutePusan National University HospitalBusanRepublic of Korea
- Division of Cardiology, Department of Internal MedicinePusan National University Hospital, Pusan National University School of MedicineBusanRepublic of Korea
| | - Myung‐Jun Shin
- Department of Rehabilitation Medicine, Biomedical Research InstitutePusan National University Hospital, Pusan National University School of MedicineBusanRepublic of Korea
| | - Byeong‐Ju Lee
- Department of Rehabilitation Medicine, Biomedical Research InstitutePusan National University Hospital, Pusan National University School of MedicineBusanRepublic of Korea
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Yanagi Y, Amano M, Tamai Y, Mizumoto A, Nakagawa S, Moriuchi K, Asano R, Kurashima S, Irie Y, Sakamoto T, Amaki M, Kanzaki H, Ohta Y, Morita Y, Ogo T, Kitai T, Izumi C. Accuracy of Shunt Volume Measured by Three-Dimensional Echocardiography and Cardiac Magnetic Resonance in Patients With an Atrial Septal Defect and a Dilated Right Ventricle. J Am Soc Echocardiogr 2024; 37:797-805. [PMID: 38754748 DOI: 10.1016/j.echo.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/27/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND The accuracy of right ventricular (RV) quantification by three-dimensional echocardiography (3DE) has been reported mainly in patients with a normal right ventricle (RV). However, there are no data regarding the accuracy of 3DE in patients with a dilated RV, as in shunt diseases. In this study, we evaluated the accuracy of 3DE and that of volumetric (Vol) cardiac magnetic resonance (CMR) for assessment of RV and left ventricular (LV) stroke volume (SV) and the pulmonary (Qp)/systemic (Qs) blood flow ratio in patients with an atrial septal defect (ASD) using the two-dimensional phase contrast (2DPC) method as the gold standard. METHODS We retrospectively investigated 83 patients with ASD who underwent transcatheter closure and clinically indicated CMR and 3DE examinations. The ratio Qp/Qs was calculated using RV and LV SV measured by full-volume volumetric 3DE (Vol-3DE) and CMR (Vol-CMR) and by two-dimensional pulsed Doppler quantification (2D-Dop); the parameters were compared using 2DPC-CMR as the gold standard. RESULTS There was no significant difference in the Qp/Qs value between 2DPC-CMR and Vol-3DE (2.29 ± 0.70 vs 2.21 ± 0.63, P = .79) and 2D-Dop (vs 2.21 ± 0.65, P = 1.00); however, a significant difference was found between 2DPC-CMR and Vol-CMR (P < .001). The Qp/Qs value obtained using Vol-3DE showed the best correlation with 2DPC-CMR (r = 0.93, P < .001). The RV and LV SV values obtained by Vol-3DE showed the best correlation with 2DPC-CMR (RV SV, r = 0.82, P < .001; LV SV, r = 0.73, P < .001), although the absolute values were underestimated. CONCLUSION Qp/Qs was more accurately evaluated by Vol-3DE than by Vol-CMR or 2D-Dop. Three-dimensional echocardiography assessment was feasible and reproducible even in a dilated RV.
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Affiliation(s)
- Yoshiki Yanagi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Masashi Amano
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Yurie Tamai
- Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ayaka Mizumoto
- Department of Clinical Laboratory, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shoko Nakagawa
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Kenji Moriuchi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Ryotaro Asano
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Shinichi Kurashima
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yuki Irie
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takahiro Sakamoto
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Amaki
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Hideaki Kanzaki
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yasutoshi Ohta
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Yoshiaki Morita
- Department of Radiology, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Ogo
- Division of Pulmonary Circulation, Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Takeshi Kitai
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
| | - Chisato Izumi
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, Suita, Japan
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161
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Tomšič A, Meucci MC, de Jong AR, Braun J, Marsan NA, Klautz RJM, Palmen M. Mitral regurgitation in atrial fibrillation: Is a simple repair enough to tackle a complex problem? J Cardiol 2024; 84:86-92. [PMID: 38103635 DOI: 10.1016/j.jjcc.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/24/2023] [Accepted: 12/04/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Clinical and echocardiographic results of valve repair for mitral regurgitation in the setting of atrial fibrillation are poorly studied. METHODS Between January 2008 and December 2020, 89 patients underwent valve repair for mitral regurgitation in the setting of atrial fibrillation. Clinical and echocardiographic follow-up data were collected and studied. The primary composite endpoint consisted of all-cause mortality or hospitalization for heart failure. RESULTS Valve repair with true-sized annuloplasty was performed in 83 (93 %) and restrictive annuloplasty in 6 (7 %) patients. Early mortality occurred in 3 (3 %) and residual mitral regurgitation in 1 (1 %) patient. During a median follow-up of 5.4 years (interquartile range 3.4-9.5), 25 patients died, 6 due to end-stage heart failure. Ten patients were hospitalized for heart failure. The estimated event-free survival rate at 10 years was 48.2 % (95 % CI 33.5 %-62.9 %). Recurrent mitral regurgitation was observed in 14 patients and most often caused by leaflet tethering. When analyzed as a time-dependent variable, recurrent regurgitation was related to the occurrence of the primary endpoint (hazard ratio 3.192, 95 % CI 1.219-8.359, p = 0.018). On exploratory sub-analyses, no recurrent regurgitation was observed after restrictive annuloplasty or in patients with paroxysmal atrial fibrillation. Moreover, recurrent regurgitation was observed more often when signs of left ventricular impairment were present preoperatively. CONCLUSIONS Despite good initial results, recurrent regurgitation was a frequent observation after valve repair for mitral regurgitation in atrial fibrillation and had an effect on heart failure related morbidity and mortality. Refinements in the timing of surgery and surgical technique might help improve outcomes.
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Affiliation(s)
- Anton Tomšič
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.
| | - Maria Chiara Meucci
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands; Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Anne R de Jong
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Jerry Braun
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
| | - Meindert Palmen
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands
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162
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Khoury S, Zornitzki L, Laufer-Perl M, Bhatia RT, Marwaha S, Tome M, Granot Y, Gvili Perelman M, Avivi I, Shacham Y, Szekely Y, Banai S, Hochstadt A, Flint N, Topilsky Y. Sex-related differences in the association between septal wall thickness and survival. IJC HEART & VASCULATURE 2024; 53:101427. [PMID: 38846157 PMCID: PMC11152968 DOI: 10.1016/j.ijcha.2024.101427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2024] [Revised: 05/08/2024] [Accepted: 05/11/2024] [Indexed: 06/09/2024]
Abstract
Background In many conditions characterised by septal hypertrophy, females have been shown to have worse outcomes compared to males. In clinical practice and research, similar cutoff points for septal hypertrophy are still used for both sexes. Here, we explore the association between different cutoff points for septal hypertrophy and survival in relation to sex. Methods and results We performed a retrospective analysis of consecutive patients undergoing echocardiography between March 2010 and February 2021 in a large tertiary referral centre. A total of 70,965 individuals were included. Over a mean follow-up period of 59.1 ± 37 months, 9631 (25 %) males and 8429 (26 %) females died. When the same cutoff point for septal hypertrophy was used for both sexes, females had worse prognosis than males. The impact of septal hypotrophy on survival became statistically significant at a lower threshold in females compared to males: 11.1 mm (HR 1.13, CI 95 %:1.03-1.23, p = 0.01) vs 13.1 mm (HR 1.21, CI 95 %: 1.12-1.32, p < 0.001). However, when indexed wall thickness was used, the cutoff points were 6 mm/body surface area (BSA) (HR 1.08, CI 95 %: 1-1.18, p = 0.04) and 6.2 mm/BSA (HR 1.07, CI 95 %: 1-1.15, p = 0.05) for females and males, respectively. Conclusions Septal hypertrophy is associated with increased mortality at a lower threshold in females than in males. This may account for the worse prognosis reported in females in many conditions characterised by septal hypertrophy. Applying a lower absolute value or using indexed measurements may facilitate early diagnosis and improve prognostication in females.
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Affiliation(s)
- Shafik Khoury
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Lior Zornitzki
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Raghav T. Bhatia
- Cardiovascular Clinical Academic Group, St. George’s, University of London, St. George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Sarandeep Marwaha
- Cardiovascular Clinical Academic Group, St. George’s, University of London, St. George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Maite Tome
- Cardiovascular Clinical Academic Group, St. George’s, University of London, St. George’s University Hospitals NHS Foundation Trust, United Kingdom
| | - Yoav Granot
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Moran Gvili Perelman
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Ido Avivi
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Yishay Szekely
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Shmuel Banai
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Aviram Hochstadt
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Nir Flint
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center, Tel-Aviv, Israel
- Tel Aviv University, Tel Aviv, Israel
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Denault A, Couture EJ, Perry T, Saade E, Calderone A, Zeng YH, Scherb D, Moses K, Potes C, Hammoud A, Beaubien-Souligny W, Elmi-Sarabi M, Grønlykke L, Lamarche Y, Lebon JS, Rousseau-Saine N, Desjardins G, Rochon A. Continuous Right Ventricular Pressure Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth 2024; 38:1673-1682. [PMID: 38862285 DOI: 10.1053/j.jvca.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Right ventricular (RV) dysfunction in cardiac surgery can lead to RV failure, which is associated with increased morbidity and mortality. Abnormal RV function can be identified using RV pressure monitoring. The primary objective of the study is to determine the proportion of patients with abnormal RV early to end-diastole diastolic pressure gradient (RVDPG) and abnormal RV end-diastolic pressure (RVEDP) before initiation and after cardiopulmonary bypass (CPB) separation. The secondary objective is to evaluate if RVDPG before CPB initiation is associated with difficult and complex separation from CPB, RV dysfunction, and failure at the end of cardiac surgery. DESIGN Prospective study. SETTING Tertiary care cardiac institute. PARTICIPANTS Cardiac surgical patients. INTERVENTION Cardiac surgery. MEASUREMENTS AND MAIN RESULTS Automated electronic quantification of RVDPG and RVEDP were obtained. Hemodynamic measurements were correlated with cardiac and extracardiac parameters from transesophageal echocardiography and postoperative complications. Abnormal RVDPG was present in 80% of the patients (n = 105) at baseline, with a mean RVEDP of 14.2 ± 3.9 mmHg. Patients experienced an RVDPG > 4 mmHg for a median duration of 50.2% of the intraoperative period before CPB initiation and 60.6% after CPB separation. A total of 46 (43.8%) patients had difficult/complex separation from CPB, 18 (38.3%) patients had RV dysfunction, and 8 (17%) had RV failure. Abnormal RVDPG before CPB was not associated with postoperative outcome. CONCLUSION Elevated RVDPG and RVEDP are common in cardiac surgery. RVDPG and RVEDP before CPB initiation are not associated with RV dysfunction and failure but can be used to diagnose them.
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Affiliation(s)
- André Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
| | - Etienne J Couture
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Tjorvi Perry
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Elena Saade
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander Calderone
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yu Hao Zeng
- Departments of Medicine and of Family Medicine, Jewish General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Ali Hammoud
- Division of Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Mahsa Elmi-Sarabi
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Lars Grønlykke
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Yoan Lamarche
- Department of Cardiothoracic Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Rousseau-Saine
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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Whalley GA, Gamble GD, Harrington A, Dugo C, Morgan A, Ikenasio B, Deo A, Crengle S, Christiansen J. Measuring Linear Left Ventricular Mass-Do M-Mode and Two-Dimensional Linear Measurements Produce the Same Results in Healthy Volunteers? J Am Soc Echocardiogr 2024; 37:806-807. [PMID: 38614436 DOI: 10.1016/j.echo.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 03/30/2024] [Accepted: 04/02/2024] [Indexed: 04/15/2024]
Affiliation(s)
- Gillian A Whalley
- Department of Medicine and HeartOtago, Otago School of Medicine, University of Otago, Dunedin, New Zealand; Unitec Institute of Technology, Auckland, New Zealand
| | - Greg D Gamble
- Department of Medicine, University of Auckland, Auckland, New Zealand
| | - Allanah Harrington
- Unitec Institute of Technology, Auckland, New Zealand; Te Whatu Ora, Auckland, New Zealand
| | | | - Angela Morgan
- Unitec Institute of Technology, Auckland, New Zealand
| | | | - Arun Deo
- Unitec Institute of Technology, Auckland, New Zealand
| | - Sue Crengle
- Department of Preventive and Social Medicine, Otago School of Medicine, University of Otago, Dunedin, New Zealand
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165
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Mahashabde ML, Kumar L, Bhimani YR, Reddy SK, Nitendra Saketh BV, Gharge SS. A Critical Investigation of Sick Euthyroid Syndrome in Chronic Heart Failure Patients: Addressing the Need for Accurate Thyroid Assessment. Cureus 2024; 16:e65985. [PMID: 39221332 PMCID: PMC11366387 DOI: 10.7759/cureus.65985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2024] [Accepted: 08/01/2024] [Indexed: 09/04/2024] Open
Abstract
Background The body undergoes numerous metabolic changes during severe illness or physiological stress to protect itself by lowering metabolism and reducing overall demands. This evolutionary adaptation dates back to early human development, long before the advent of ICU facilities and advanced treatments. One such protective mechanism is Sick Euthyroid Syndrome (SES), also known as Non-thyroidal Illness Syndrome (NTIS). SES commonly occurs in critically ill patients and is frequently observed in conditions such as heart failure, chronic kidney disease, and severe sepsis. This syndrome is characterized by abnormal thyroid function tests in patients with acute or chronic systemic illnesses who do not have intrinsic thyroid disease. Typically, these patients exhibit low serum levels of triiodothyronine (T3), normal or low levels of thyroxine (T4), and normal or low thyroid-stimulating hormone (TSH) levels. SES is believed to be an adaptive response to illness, aimed at reducing the body's metabolic rate and conserving energy during severe physiological stress. This original article delves into SES's prevalence and clinical impact in these settings. Materials and methods The study aims to determine the prevalence of SES in patients with long-standing heart failure, elucidate the relationship between thyroid function and heart failure severity, and assess its impact on various hematological and clinical parameters. This observational, cross-sectional study was conducted at Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, India, a 2011-bed hospital, over one and a half years. This study included 70 patients with chronic heart failure, aged 18 years and above, defined by a left ventricular ejection fraction of 40% or less and a Boston criteria score of 8 or more. Patients were excluded if they had a history of thyroid dysfunction, clinical sepsis, or were taking thyroid-affecting drugs. Results The study provides important insights into the prevalence and impact of SES in long-standing heart failure patients. It found that a significant 44.29% of these patients exhibited low T3 levels, highlighting the substantial occurrence of SES in this population. Additionally, the study revealed a negative correlation between N-terminal pro-b-type natriuretic peptide (NT-proBNP) levels, Boston score, and total T3, suggesting that as indicators of heart failure severity worsen, total T3 levels may decrease further. Another key finding is the high prevalence of anemia among heart failure patients, with a notable gender disparity: 92.11% of male patients were affected compared to 50% of female patients. Conclusion The study concluded that SES is significantly prevalent among long-standing heart failure patients, further indicating that thyroid suppression increases with the severity of heart failure. Recognizing SES can guide tailored treatments, prompting intensive monitoring and optimized heart failure management. Additionally, the study found a high prevalence of anemia, particularly among male patients, highlighting the need for gender-specific considerations in managing heart failure. These findings underscore the importance of routine thyroid function assessments and regular monitoring of anemia in heart failure patients. Future research should focus on improving clinical outcomes through comprehensive management of both thyroid function and anemia in these patients.
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Affiliation(s)
- Madhulika L Mahashabde
- Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Lokesh Kumar
- Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Yash R Bhimani
- Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Sai Krishna Reddy
- Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Brugumalla V Nitendra Saketh
- Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
| | - Siddharth S Gharge
- Department of Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune (Deemed to be University), Pune, IND
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166
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Yamada Y, Sato K, Yamamoto M, Nabeta T, Naruse Y, Taniguchi T, Kitai T, Yoshioka K, Tanaka H, Okumura T, Baba Y, Fujimoto Y, Matsue Y, Komatsu Y, Nogami A, Ishizu T. Association Between Right Bundle Branch Block and Ventricular Arrhythmia in Patients With Cardiac Sarcoidosis. JACC. ADVANCES 2024; 3:101105. [PMID: 39105116 PMCID: PMC11299579 DOI: 10.1016/j.jacadv.2024.101105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 05/17/2024] [Accepted: 06/05/2024] [Indexed: 08/07/2024]
Abstract
Background Ventricular arrhythmia (VA) is a life-threatening condition associated with cardiac sarcoidosis (CS). Right bundle branch block (RBBB) is a common conduction disorder in CS; however, its association with VA remains unknown. Objectives This study aimed to investigate the relationship between RBBB and VA in patients with CS. Methods This was a post hoc analysis of ILLUMINATE-CS (Illustration of the Management and Prognosis of Japanese Patients with Cardiac Sarcoidosis), a multicenter, retrospective, and observational study that evaluated the clinical characteristics and prognosis of CS. Eligible patients were divided into two groups based on the presence or absence of RBBB at the time of diagnosis. The primary outcome was serious ventricular arrhythmia events (SVAEs), defined as a combination of sudden cardiac death and documented ventricular fibrillation, sustained ventricular tachycardia, or appropriate implantable cardioverter-defibrillator therapy. Results Overall, 312 patients were studied, with 155 (49.7%) patients presenting with RBBB (RBBB group). Patients in the RBBB group had a higher prevalence of basal interventricular septum (IVS) thinning and prominent late gadolinium enhancement in the basal IVS on cardiac magnetic resonance imaging than those in the non-RBBB group. During a median follow-up of 3.0 years (IQR: 1.6-6.0 years), 66 patients experienced SVAE. In multivariable Cox regression analysis, the RBBB group was independently associated with a higher incidence of SVAEs (HR: 1.93 [95% CI: 1.14-3.28]; P = 0.015). Conclusions In patients with CS, RBBB was an independent predictor of SVAEs, which might reflect the specific scar distribution that is predominant in the IVS.
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Affiliation(s)
- Yu Yamada
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Kimi Sato
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Takeru Nabeta
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Sagamihara, Japan
| | - Yoshihisa Naruse
- Division of Cardiology, Internal Medicine III, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Tatsunori Taniguchi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Kitai
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan
- Department of Cardiovascular Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kenji Yoshioka
- Department of Cardiology, Kameda Medical Center, Kamogawa, Japan
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Okumura
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yuichi Baba
- Department of Cardiology and Geriatrics, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Yudai Fujimoto
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Hongo, Japan
| | - Yuya Matsue
- Department of Cardiovascular Biology and Medicine, Juntendo University Graduate School of Medicine, Hongo, Japan
| | - Yuki Komatsu
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Akihiko Nogami
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Institute of Medicine; University of Tsukuba, Tsukuba, Japan
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167
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Wan J, Wang P, Liu S, Wang X, Zhou P, Yang J. Risk factors and a predictive model for left ventricular hypertrophy in young adults with salt-sensitive hypertension. J Clin Hypertens (Greenwich) 2024; 26:933-944. [PMID: 38940286 PMCID: PMC11301447 DOI: 10.1111/jch.14863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/16/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
Salt-sensitive hypertension is common among individuals with essential hypertension, and the prevalence of left ventricular hypertrophy (LVH) has increased. However, data from early identification of the risk of developing LVH in young adults with salt-sensitive hypertension are lacking. Thus, the present study aimed to design a nomogram for predicting the risk of developing LVH in young adults with salt-sensitive hypertension. A retrospective analysis of 580 patients with salt-sensitive hypertension was conducted. The training set consisted of 70% (n = 406) of the patients, while the validation set consisted of the remaining 30% (n = 174). Based on multivariate analysis of the training set, predictors for LVH were extracted to develop a nomogram. Discrimination curves, calibration curves, and clinical utility were employed to assess the predictive performance of the nomogram. The final simplified nomogram model included age, sex, office systolic blood pressure, duration of hypertension, abdominal obesity, triglyceride-glucose index, and estimated glomerular filtration rate (eGFR). In the training set, the model demonstrated moderate discrimination, as indicated by an area under the receiver operating characteristic (ROC) curve of 0.863 (95% confidence interval: 0.831-0.894). The calibration curve exhibited good agreement between the predicted and actual probabilities of LVH in the training set. Additionally, the validation set further confirmed the reliability of the prediction nomogram. In conclusions, the simplified nomogram, which consists of seven routine clinical variables, has shown good performance and clinical utility in identifying young adults with salt-sensitive hypertension who are at high risk of LVH at an early stage.
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Affiliation(s)
- Jindong Wan
- Research Center for Metabolic and Cardiovascular DiseasesThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of Clinical NutritionThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
| | - Peijian Wang
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Sen Liu
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Xinquan Wang
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Peng Zhou
- Department of CardiologyThe First Affiliated Hospital of Chengdu Medical CollegeChengduSichuanChina
| | - Jian Yang
- Research Center for Metabolic and Cardiovascular DiseasesThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
- Department of Clinical NutritionThe Third Affiliated Hospital of Chongqing Medical UniversityChongqingChina
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Dumitriu Carcoana AO, Scoma CB, Maletz SN, Malavet JA, Crousillat DR, Matar FA. Most hospitalized patients with significant tricuspid regurgitation have advanced disease preventing transcatheter tricuspid valve intervention. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 65:18-24. [PMID: 38503645 DOI: 10.1016/j.carrev.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 02/04/2024] [Accepted: 03/06/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND More than moderate tricuspid regurgitation (TR) is associated with high mortality. Surgical tricuspid valve repair and replacements are rarely performed due to high operative mortality risk, mainly attributed to late presentation. Novel transcatheter tricuspid valve intervention (TTVI) devices are being developed as an alternative to surgery. The population of patients presenting to tertiary care centers who can benefit from TTVI has not been well defined. METHODS We retrospectively analyzed 12,677 consecutive 2D echocardiograms completed at our tertiary care center between March 2021 and March 2022 and identified hospitalized patients with more than moderate TR. A total of 569 patients were included in this study. Clinical and echocardiographic data were collected by individual chart review. We used the European Society of Cardiology (ESC) guidelines on the management of valvular disease to retrospectively assign patients to medical, surgical, or transcatheter therapy. RESULTS 458 patients (80.5 %) were assigned to medical therapy, 57 (10.0 %) were assigned to TTVI, and 54 (9.5 %) were assigned to tricuspid valve surgery. Of note, 75.7 % (431/569) of patients were precluded from any intervention due to advanced disease, and only 4.7 % (27/569) presented too early for intervention, being both asymptomatic and without RV dilatation. CONCLUSION Only 10.0 % of patients presenting to a tertiary care center with significant TR would be candidates for TTVI when these technologies are approved in the United States. Earlier identification and treatment of TR could increase the number of patients who may benefit from interventions including TTVI.
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Affiliation(s)
| | | | - Sebastian N Maletz
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Jose A Malavet
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA
| | - Daniela R Crousillat
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; The Heart & Vascular Institute, Tampa General Hospital, Tampa, FL, USA
| | - Fadi A Matar
- The University of South Florida Health Morsani College of Medicine, Tampa, FL, USA; The Heart & Vascular Institute, Tampa General Hospital, Tampa, FL, USA.
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169
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Di Lisi D, Madaudo C, Ortello A, Rubino L, Scelfo D, Sinagra FP, Comparato F, Triolo OF, Rossetto L, Galassi AR, Novo G. Assessment of cancer therapy-related cardiac dysfunction in breast cancer women using a new speckle tracking echocardiography index: The GAVS. Echocardiography 2024; 41:e15881. [PMID: 39007868 DOI: 10.1111/echo.15881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 06/15/2024] [Accepted: 06/23/2024] [Indexed: 07/16/2024] Open
Abstract
BACKGROUND Recently, peak atrial longitudinal strain (PALS) has emerged as a possible predictor of Cancer therapy-related cardiac dysfunction (CTRCD) in cancer patients (CP), in addition to left ventricular global longitudinal strain (GLS). Thus, considering the link between left atrium and left ventricle, the aim of this study was to assess the global atrio-ventricular strain (GAVS) in CP, to detect early cardiotoxicity. METHODS A prospective study was carried out enrolling 131 breast cancer women (mean age 51.4 ± 10.4 years) receiving anti-cancer treatment. Clinical and echocardiographic evaluation was performed at baseline (T0), 3 (T1), 6 (T2) and 12 months (T3) after starting treatment. CTRCD was defined according to the 2022 ESC Cardio-Oncology guidelines. RESULTS Forty-four patients developed CTRCD (3 moderate and 41 mild CTRCD group A) and 87 patients did not (group B). In group A, significant changes in GLS, PALS, GAVS, LASi (left atrial stiffness index) and LVEF/GLS occurred earlier than LVEF, that reduced significantly only at T3 (p-value < .05). Significant changes in LASi, PALS and GAVS occurred even in group B but reduction in GAVS (-21% vs. -5%) and PALS (-24% vs. -12%) was significantly greater in group A compared to group B (p-value = .04). CONCLUSIONS Our study confirms high sensitivity of speckle tracking echocardiography in detecting subclinical myocardial damage in CP and the usefulness of a multiparametric echocardiographic evaluation including PALS and GLS (GAVS) for having a global evaluation of the phenomenon cardiotoxicity.
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Affiliation(s)
- Daniela Di Lisi
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Cristina Madaudo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Antonella Ortello
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Luigi Rubino
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Domenico Scelfo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Paolo Sinagra
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Francesco Comparato
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Ludovico Rossetto
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
| | - Alfredo Ruggero Galassi
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Giuseppina Novo
- Division of Cardiology, University Hospital Paolo Giaccone, Palermo, Italy
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) "G. D'Alessandro", University of Palermo, Palermo, Italy
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Sempere A, Salvador F, Milà L, Casas G, Durà-Miralles X, Sulleiro E, Vila-Olives R, Bosch-Nicolau P, Aznar ML, Espinosa-Pereiro J, Treviño B, Sánchez-Montalvá A, Serre-Delcor N, Oliveira-Souto I, Pou D, Rodríguez-Palomares J, Molina I. Endomyocardial involvement in asymptomatic Latin American migrants with eosinophilia related to helminth infection: A pilot study. PLoS Negl Trop Dis 2024; 18:e0012410. [PMID: 39102438 PMCID: PMC11326544 DOI: 10.1371/journal.pntd.0012410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 08/15/2024] [Accepted: 07/26/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Hypereosinophilic syndrome can produce cardiac involvement and endomyocardial fibrosis, which have a poor prognosis. However, there is limited information regarding cardiac involvement among migrants from Latin America with eosinophilia related to helminthiasis. METHODS We conducted a pilot observational study where an echocardiography was performed on migrants from Latin America with both eosinophilia (>450 cells/μL) and a diagnosis of helminth infection, and on migrants from Latin America without eosinophilia or helminth infection. Microbiological techniques included a stool microscopic examination using the Ritchie's formalin-ether technique, and a specific serology to detect Strongyloides stercoralis antibodies. RESULTS 37 participants were included, 20 with eosinophilia and 17 without eosinophilia. Twenty (54.1%) were men with a mean age of 41.3 (SD 14.3) years. Helminthic infections diagnosed in the group with eosinophilia were: 17 cases of S. stercoralis infection, 1 case of hookworm infection, and 2 cases of S. stercoralis and hookworm coinfection. Among participants with eosinophilia, echocardiographic findings revealed a greater right ventricle thickness (p = 0.001) and left atrial area and volume index (p = 0.003 and p = 0.004, respectively), while showing a lower left atrial strain (p = 0.006) and E-wave deceleration time (p = 0.008). An increase was shown in both posterior and anterior mitral leaflet thickness (p = 0.0014 and p = 0.004, respectively) when compared with participants without eosinophilia. CONCLUSIONS Migrants from Latin America with eosinophilia related to helminthic infections might present incipient echocardiographic alterations suggestive of early diastolic dysfunction, that could be related to eosinophilia-induced changes in the endomyocardium.
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Affiliation(s)
- Abiu Sempere
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Fernando Salvador
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Laia Milà
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Guillem Casas
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- European Reference Network for Rare and Low Prevalence Complex Diseases of the Heart (ERN-GUARDHEART), Amsterdam, The Netherlands
| | - Xavier Durà-Miralles
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Elena Sulleiro
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
- Microbiology Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Rosa Vila-Olives
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Pau Bosch-Nicolau
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Luisa Aznar
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Juan Espinosa-Pereiro
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
| | - Begoña Treviño
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Adrián Sánchez-Montalvá
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Núria Serre-Delcor
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Inés Oliveira-Souto
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Diana Pou
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - José Rodríguez-Palomares
- Cardiology Department, Vall d'Hebron University Hospital, Barcelona, Spain
- Departament de Medicina, Universitat Autònoma de Barcelona; Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Israel Molina
- International Health Unit Vall d'Hebron-Drassanes, Infectious Disease Department, Vall d'Hebron University Hospital, PROSICS Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Mederska E, Stephenson H, Maddox TW, Dukes-McEwan J. Assessment of right ventricular function in healthy Great Danes and in Great Danes with dilated cardiomyopathy. J Vet Cardiol 2024; 54:44-56. [PMID: 39013250 DOI: 10.1016/j.jvc.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Revised: 05/11/2024] [Accepted: 05/15/2024] [Indexed: 07/18/2024]
Abstract
INTRODUCTION Right ventricular (RV) dysfunction is a significant negative prognostic indicator in human dilated cardiomyopathy (DCM). Many RV indices are weight-dependent, and there is a lack of reference values for the right heart in giant breed dogs (over 50 kg), including Great Danes (GDs). This study aimed to compare indices of RV function in echocardiographically normal GDs, those with preclinical DCM (PC-DCM), and those with DCM and congestive heart failure (DCM-CHF). ANIMALS A total of 116 client-owned adult GDs: 74 normal, 31 with PC-DCM, and 11 with DCM-CHF. METHODS A retrospective, single-center cohort study assessed RV function using free-wall RV longitudinal strain (RVLS), strain rate, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and pulsed-wave tissue Doppler imaging-derived systolic myocardial velocity of the lateral tricuspid annulus (TDI S'). Relationships between DCM status and RV function indices were analyzed. RESULTS RV function, measured by TAPSE (P=0.001), FAC (P<0.001), and TDI S' (P<0.001), decreased in dogs with PC-DCM and DCM-CHF compared to healthy dogs, with FAC being lower in DCM-CHF compared to PC-DCM (P=0.048). RVLS impairment was more significant in the DCM-CHF group than in the PC-DCM group (P=0.048). RVLS had the highest area under the curve (0.899) for differentiating between normal and DCM-CHF dogs. CONCLUSION As DCM progresses, echocardiographic variables of RV function, including TAPSE, FAC, TDI S', RVLS, and strain rate, worsen, indicating impaired RV systolic function in GDs affected by DCM.
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Affiliation(s)
- E Mederska
- Small Animal Teaching Hospital, Department of Small Animal Clinical Sciences, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK.
| | - H Stephenson
- Small Animal Teaching Hospital, Department of Small Animal Clinical Sciences, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK; HS Cardiology Ltd, Dalton House, 9 Dalton Square, Lancaster LA1 1WD, UK
| | - T W Maddox
- Small Animal Teaching Hospital, Department of Small Animal Clinical Sciences, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK
| | - J Dukes-McEwan
- Small Animal Teaching Hospital, Department of Small Animal Clinical Sciences, School of Veterinary Science, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Cheshire CH64 7TE, UK
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Moya A, de Oliveira EK, Delrue L, Beles M, Buytaert D, Goethals M, Verstreken S, Dierckx R, Bartunek J, Heggermont W, Wyffels E, Vanderheyden M. Myocardial work and risk stratification in patients with severe aortic valve stenosis referred for transcatheter aortic valve replacement. IJC HEART & VASCULATURE 2024; 53:101474. [PMID: 39156917 PMCID: PMC11327593 DOI: 10.1016/j.ijcha.2024.101474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2024] [Revised: 07/01/2024] [Accepted: 07/18/2024] [Indexed: 08/20/2024]
Abstract
Background Transcatheter aortic valve replacement(TAVR) has shown clear survival benefits in severe aortic valve stenosis(AS). However, patients unable to recover left ventricle function remain at risk with poor long-term survival. This single-center prospective study aims to analyze the supplementary benefits of myocardial work(MW) assessment for baseline risk stratification in patients with severe AS referred for TAVR. Methods A total of 110 patients with severe AS referred for TAVR were included in the study. Baseline ECG data, transthoracic echocardiographic(TTE) images and blood samples were obtained. The TTE examination was repeated one day and one month after valve replacement. The primary outcome of the study was a composite endpoint consisting of all-cause mortality and HF hospitalization. Results During a mean follow-up period of 521 ± 343 days, 29patients(26.4 %) reached the composite endpoint. Baseline troponins, NT-proBNP, sST2, GWI and GCW showed statistically significant differences between groups. Patients with a baseline GWI<2323 mmHg% (sensitivity 0.63 and specificity 0.76)had significantly worse outcome following TAVR. A basic predictive model included QRS-length, TAPSE, LAVI and E/e'. The addition of biomarkers did not yield any further advantages whereas incorporating the GWI cut-off value of 2323 mmHg% significantly enhanced the predictive value. Although there were no significant changes in LVEF and GLS, all patients exhibited a significant reduction in GWI and GCW immediately after TAVR. Conclusion Our findings provide evidence for the enhanced usefulness of MW analysis in the initial risk stratification of patients with severe AS referred for TAVR. Specifically, a baseline GWI<2323 mmHg% demonstrates an independent predictor associated with increased incidence of all-cause mortality and HF hospitalization following TAVR.
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Affiliation(s)
- Ana Moya
- CardioPath PhD Program, Federico II University Hospital, Naples, Italy
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | - Elayne Kelen de Oliveira
- CardioPath PhD Program, Federico II University Hospital, Naples, Italy
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | - Leen Delrue
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | - Monika Beles
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | | | | | | | - Riet Dierckx
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
| | | | | | - Eric Wyffels
- Cardiovascular Center, OLV Hospital, Aalst, Belgium
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173
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Lin CC, Li CI, Liu CS, Lin CH, Yang SY, Li TC. Association of echocardiographic parameters with all-cause and cardiovascular mortality in patients with type 2 diabetes. Int J Cardiol 2024; 408:132136. [PMID: 38714234 DOI: 10.1016/j.ijcard.2024.132136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/11/2024] [Accepted: 05/02/2024] [Indexed: 05/09/2024]
Abstract
BACKGROUND This study aimed to evaluate associations between echocardiography markers and mortality in patients with type 2 diabetes mellitus (T2DM). METHODS Diabetes Care Management Program database of a medical center was used, including 5612 patients with T2DM aged 30 years and older and who underwent echocardiography assessment between 2001 and 2021. Cox proportional hazard regression models were used to evaluate associations of echocardiography abnormalities with all-cause and expanded cardiovascular disease (CVD) mortality. RESULTS During a mean follow-up of 5.8 years, 1273 patients died. Hazard ratios (95% confidence intervals) of all-cause mortality for each standard deviation increase were presented for the cardiac systolic function indicator of left ventricular ejection fraction (0.77, 0.73-0.81), cardiac structural parameters of left ventricular mass index (1.25, 1.19-1.31) and left atrial volume index (1.31, 1.25-1.37), and cardiac diastolic function of E/A ratio (1.10, 1.07-1.13), E/e' ratio (1.37, 1.30-1.45), and TR velocity (1.25, 1.18-1.32); meanwhile, the values of expanded CVD mortality included left ventricular ejection fraction (0.67, 0.62-0.72), left ventricular mass index (1.35, 1.25-1.45), left atrial volume index (1.40, 1.31-1.50), E/A ratio (1.12, 1.08-1.16), E/e' ratio (1.57, 1.46-1.69), and TR velocity (1.29, 1.19-1.39), respectively. CONCLUSIONS Cardiac systolic function indicator of left ventricular ejection fraction, cardiac structural parameters of left ventricular mass index and left atrial volume index, and cardiac diastolic function indicators of E/A ratio, E/e' ratio, and TR velocity are associated with all-cause and expanded CVD mortality in patients with T2DM.
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Affiliation(s)
- Cheng-Chieh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chia-Ing Li
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chiu-Shong Liu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsueh Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan; Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Shing-Yu Yang
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan; Department of Audiology and Speech-Language Pathology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
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Karimi MR, Bischoff AR, Riley E, Zerwic L, McNamara PJ, Hyland RM, Ashwath R. Echocardiographic evaluation of left atrial volume and comparative analysis to left atrial to aortic root ratio in premature neonates and infants with patent ductus arteriosus. Echocardiography 2024; 41:e15890. [PMID: 39043208 DOI: 10.1111/echo.15890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2024] [Revised: 06/19/2024] [Accepted: 07/03/2024] [Indexed: 07/25/2024] Open
Abstract
PURPOSE Left atrium to aortic root ratio (LA/Ao) is an echocardiographic marker of hemodynamically significant patent ductus arteriosus (PDA). Since 2-dimensional measurement of the ratio is geometrically limited, left atrial volume (LAV) which has 3-dimensional characteristics was investigated. The aim of this study was to determine a correlation between LA/Ao ratio and LAV as well as holodiastolic flow reversal in preterm neonates with and without a PDA. METHODS A retrospective evaluation of neonates with and without PDA was performed. Targeted neonatal echocardiography evaluation of LA/Ao and LAV was measured from parasternal long-axis view and the apical 4 and 2-chamber views, respectively. Univariate and linear regression analysis were performed. RESULTS 200 patients were included of whom 158 (79.0%) had a PDA shunt. The median gestational age at the time of echo was 27.4 weeks (IQR: 25.7-29.4 weeks). The median LA/Ao ratio was 1.51 (IQR: 1.26-1.83) and median LAV indexed to weight was .91 mL/kg (IQR: .65-1.18 mL/kg). There was a significant correlation between LA/Ao and LAV indexed to weight in the PDA group (r2 = .080, p = .0003). LA/Ao ratio and LAV indexed to weight differed significantly between those with diastolic flow reversal versus no-flow reversal (LA/Ao, p = .003; LAV, p = .001). CONCLUSIONS This study demonstrated a significant correlation between LA/Ao and LAV in preterm infants with PDA, with greater magnitude of discordance for LAV. The power of LAV versus LA/Ao in monitoring hemodynamically significant PDA requires prospective evaluation.
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Affiliation(s)
- Malika R Karimi
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Adrianne R Bischoff
- Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Emily Riley
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Luke Zerwic
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Patrick J McNamara
- Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Rachael M Hyland
- Division of Neonatology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
| | - Ravi Ashwath
- Division of Pediatric Cardiology, University of Iowa Stead Family Children's Hospital, Iowa City, Iowa, USA
- Division of Pediatric Cardiology, Christus Children's Hospital, Baylor College of Medicine, San Antonio, Texas, USA
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Sharifi L, Luzzi C, Vegas A. Perioperative 3D transoesophageal echocardiography. Part 2: clinical applications. BJA Educ 2024; 24:277-287. [PMID: 39099755 PMCID: PMC11293589 DOI: 10.1016/j.bjae.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 08/06/2024] Open
Affiliation(s)
- L. Sharifi
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - C. Luzzi
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | - A. Vegas
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
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176
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Jiménez-González S, Delgado-Valero B, Islas F, Romero-Miranda A, Luaces M, Ramchandani B, Cuesta-Corral M, Montoro-Garrido A, Martínez-Martínez E, Cachofeiro V. The detrimental role of galectin-3 and endoplasmic reticulum stress in the cardiac consequences of myocardial ischemia in the context of obesity. FASEB J 2024; 38:e23818. [PMID: 38989572 DOI: 10.1096/fj.202400747r] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2024] [Revised: 06/18/2024] [Accepted: 07/01/2024] [Indexed: 07/12/2024]
Abstract
The association between cardiac fibrosis and galectin-3 was evaluated in patients with acute myocardial infarction (MI). The role of galectin-3 and its association with endoplasmic reticulum (ER) stress activation in the progression of cardiovascular fibrosis was also evaluated in obese-infarcted rats. The inhibitor of galectin-3 activity, modified citrus pectin (MCP; 100 mg/kg/day), and the inhibitor of the ER stress activation, 4-phenylbutyric acid (4-PBA; 500 mg/kg/day), were administered for 4 weeks after MI in obese rats. Overweight-obese patients who suffered a first MI showed higher circulating galectin-3 levels, higher extracellular volume, and LV infarcted size, as well as lower E/e'ratio and LVEF compared with normal-weight patients. A correlation was observed between galectin-3 levels and extracellular volume. Obese-infarcted animals presented cardiac hypertrophy and reduction in LVEF, and E/A ratio as compared with control animals. They also showed an increase in galectin-3 gene expression, as well as cardiac fibrosis and reduced autophagic flux. These alterations were associated with ER stress activation characterized by enhanced cardiac levels of binding immunoglobulin protein, which were correlated with those of galectin-3. Both MCP and 4-PBA not only reduced cardiac fibrosis, oxidative stress, galectin-3 levels, and ER stress activation, but also prevented cardiac functional alterations and ameliorated autophagic flux. These results show the relevant role of galectin-3 in the development of diffuse fibrosis associated with MI in the context of obesity in both the animal model and patients. Galectin-3 in tandem with ER stress activation could modulate different downstream mechanisms, including inflammation, oxidative stress, and autophagy.
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Affiliation(s)
- Sara Jiménez-González
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Beatriz Delgado-Valero
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Fabian Islas
- Unidad de Imagen Cardíaca, Hospital General Universitario de Talavera de la Reina, Toledo, Spain
| | - Ana Romero-Miranda
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - María Luaces
- Servicio de Cardiología, Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
| | - Bunty Ramchandani
- Servicio de Cirugía Cardiaca Infantil, Hospital La Paz, Madrid, Spain
| | - María Cuesta-Corral
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Alejandro Montoro-Garrido
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
| | - Ernesto Martínez-Martínez
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Majadahonda, Spain
| | - Victoria Cachofeiro
- Departamento de Fisiología, Facultad de Medicina, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Complutense de Madrid, Madrid, Spain
- Ciber de Enfermedades Cardiovasculares (CIBERCV), Instituto de Salud Carlos III, Majadahonda, Spain
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177
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Berg-Hansen CE, Sindre RB, Grymyr LMD, Rogge B, Valeur AE, Urheim S, Hung J, Cramariuc D. Sex differences in left atrial volumes, mechanics, and stiffness in primary mitral regurgitation-a combined 2D and 3D echocardiographic study. Eur Heart J Cardiovasc Imaging 2024; 25:1118-1126. [PMID: 38469654 PMCID: PMC11288747 DOI: 10.1093/ehjci/jeae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 02/27/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024] Open
Abstract
AIMS Mitral regurgitation (MR) causes left atrial (LA) enlargement and impaired reservoir function. We assessed whether changes in LA size, strain, and stiffness in significant (moderate or greater) primary MR are sex-specific. METHODS AND RESULTS In the 3D Echocardiography and Cardiovascular Prognosis in Mitral Regurgitation study, 111 patients with primary MR were prospectively investigated with 2D and 3D echocardiography. MR was severe if the 3D regurgitant fraction was ≥50%. LA size was assessed by maximum, minimum, and pre-A 3D volume (LAV), mechanics by peak reservoir (LASr) and contractile strain, and stiffness by the ratio: mitral peak E-wave divided by the annular e' velocity (E/e')/LASr. Women were older, had higher heart rate, and lower body mass index and MR regurgitant volumes (P < 0.05). 3D LAV indexed for body surface area and LA contractile strain did not differ by sex, while LASr was lower (22.2 vs. 25.0%) and LA stiffness higher in women (0.56 vs. 0.44) (P < 0.05). In linear regression analysis, female sex was associated with higher LA stiffness independent of age, minimum LAV, left ventricular global longitudinal strain, diabetes, and coronary artery disease (R2 = 0.56, all P < 0.05). In logistic regression analysis, women had a four-fold (95% CI 1.2-13.1, P = 0.02) higher adjusted risk of increased LA stiffness than men. CONCLUSION Women with significant primary MR have more impaired LA reservoir mechanics and increased LA stiffness compared with men despite lower MR regurgitant volumes and similar indexed LA size. The findings reveal sex-specific features of LA remodeling in MR. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04442828.
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Affiliation(s)
- Christian E Berg-Hansen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Rasmus Bach Sindre
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Lisa M D Grymyr
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Barbara Rogge
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
| | - Andreas E Valeur
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Stig Urheim
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
| | - Judy Hung
- Division of Cardiology, Cardiac Ultrasound Laboratory, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA 02114, USA
| | - Dana Cramariuc
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
- Department of Clinical Science, University of Bergen, Jonas Lies vei 87, NO-5021 Bergen, Norway
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178
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Esmel-Vilomara R, Dougherty-De Miguel L, Artigas-Baleri A, Turón-Viñas E, Cuscó I, Díaz-Gómez A, Panadés-De Oliveira L, Rocamora R, Boronat S. Cardiovascular abnormalities in patients with SHANK3 pathogenic variants: beyond neurodevelopmental disorders and epilepsy. Eur J Med Genet 2024:104965. [PMID: 39094681 DOI: 10.1016/j.ejmg.2024.104965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/04/2024] [Accepted: 07/30/2024] [Indexed: 08/04/2024]
Abstract
Neurodevelopmental disorders have been linked to numerous genes, particularly pathogenic variants in genes encoding postsynaptic scaffolding proteins, like SHANK3. This study aims to provide insights into the cardiovascular profile of patients with pathogenic SHANK3 variants, expanding beyond the well-established associations with neurodevelopmental disorders and epilepsy. We conducted a prospective study involving patients affected by neurodevelopmental disorders with pathogenic SHANK3 variants. Comprehensive cardiovascular assessments were performed and molecular genetic testing included chromosomal microarray followed by clinical exome sequencing. We identified five patients with de novo SHANK3 variants, all of whom exhibited cardiac involvement, including myocardial dysfunction, congenital heart disease (patent ductus arteriosus), and a case of postictal atrial fibrillation. Our findings emphasize an elevated risk of cardiovascular abnormalities in patients with SHANK3 pathogenic variants compared to prior reports. Despite their young age, these patients displayed significant cardiac abnormalities. The study highlights the necessity of integrating cardiac evaluation and ongoing cardiovascular monitoring into multidisciplinary care, facilitating early detection of heart failure and assessment of the risk of sudden unexpected death in epilepsy (SUDEP). Further research is needed to elucidate the underlying mechanisms of cardiac manifestations in SHANK3 mutation carriers.
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Affiliation(s)
- Roger Esmel-Vilomara
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona (Spain); Pediatric Cardiology Unit, Department of Pediatrics. Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona (Spain).
| | - Lucy Dougherty-De Miguel
- Pediatric Neurology Unit, Department of Pediatrics. Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona (Spain).
| | - Alícia Artigas-Baleri
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona (Spain); Department of Genetics. Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona (Spain).
| | - Eulàlia Turón-Viñas
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona (Spain); Pediatric Neurology Unit, Department of Pediatrics. Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona (Spain).
| | - Ivon Cuscó
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona (Spain); Department of Genetics. Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona (Spain); Centro de Investigación Biomédica en Red de Enfermedades Raras (CIBERER), Instituto de Salud Carlos III (Spain).
| | - Asunción Díaz-Gómez
- Pediatric Neurology Unit, Department of Pediatrics. Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona (Spain).
| | | | - Rodrigo Rocamora
- Epilepsy Monitoring Unit, Department of Neurology. Hospital del Mar, Barcelona (Spain).
| | - Susana Boronat
- Faculty of Medicine, Universitat Autònoma de Barcelona, Barcelona (Spain); Pediatric Neurology Unit, Department of Pediatrics. Hospital de la Santa Creu i Sant Pau, Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona (Spain).
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179
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Anwer S, Stollenwerk L, Winkler NE, Guastafierro F, Hebeisen M, Akdis D, Saguner AM, Brunckhorst C, Duru F, Tanner FC. Right heart strain in arrhythmogenic right ventricular cardiomyopathy: implications for cardiovascular outcome. Eur Heart J Cardiovasc Imaging 2024; 25:1061-1068. [PMID: 38683812 PMCID: PMC11288757 DOI: 10.1093/ehjci/jeae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular (CV) events. To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS) in patients with definite ARVC and its association with adverse events during follow-up. METHODS AND RESULTS RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint was determined (sustained ventricular arrhythmia and cardiovascular death). Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (-11.5 [-13.3 to -10.2] %) vs. the no-event group (-15.8 [-17.1 to -14.5] %, P < 0.001), and so was RAGLS (22.8 [21.4-27.4] % vs. 31.5 [25.1-39.6] %, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with a higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fitness was improved when RVGLS and RAGLS were applied together rather than alone. CONCLUSION RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC.
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Affiliation(s)
- Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Lauren Stollenwerk
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Neria E Winkler
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Francesca Guastafierro
- Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Monika Hebeisen
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Deniz Akdis
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
- Division of Cardiology, GZO Zurich Regional Health Center Wetzikon, Wetzikon, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
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180
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Cui J, Xia SJ, Tang RB, He L, Guo XY, Li SN, Liu N, Sang CH, Long DY, Du X, Dong JZ, Ma CS. Morphology and location of thrombus and sludge in patients with non-valvular atrial fibrillation. BMC Cardiovasc Disord 2024; 24:398. [PMID: 39085776 PMCID: PMC11290267 DOI: 10.1186/s12872-024-04073-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
BACKGROUND Stroke and thromboembolism in nonvalvular atrial fibrillation (NVAF) primarily arise from thrombi or sludge in the left atrial appendage (LAA). Comprehensive insight into the characteristics of these formations is essential for effective risk assessment and management. METHODS We conducted a single-center retrospective observational of 176 consecutive NVAF patients with confirmed atrial/appendage thrombus or sludge determined by a pre-ablation transesophageal echocardiogram (TEE) from December 2017 to April 2019. We obtained clinical and echocardiographic characteristics, including left atrial appendage emptying velocity (LAAeV) and filling velocity (LAAfV). Data analysis focused on identifying the morphology and location of thrombus or sludge. Patients were divided into the solid thrombus and sludge groups, and the correlation between clinical and echocardiographic variables and thrombotic status was analyzed. RESULTS Morphological classification: In total, thrombi were identified in 78 patients, including 71 (40.3%) mass and 7 (4.0%) lamellar, while sludge was noted in 98 (55.7%). Location classification: 92.3% (72/78) of patients had thrombus confined to the LAA; 3.8% (3/78) had both LA and LAA involvement; 2.7% (2/78) had LA, LAA and RAA extended into the RA, the remained 1.2%(1/78) was isolated to RAA. 98.0% (96/98) of patients had sludge confined to the LAA; the remaining 2.0% (2/98) were present in the atrial septal aneurysm, which protrusion of interatrial septum into the RA. The thrombus and sludge groups showed low LAAeV (19.43 ± 9.59 cm/s) or LAAfV (17.40 ± 10.09 cm/s). Only LA dimension ≥ 40 mm was independently associated with the thrombus state in the multivariable model. CONCLUSION This cohort study identified rare thrombus morphology and systematically summarized the classification of thrombus morphology. The distribution of thrombus and sludge outside limited to LAA was updated, including bilateral atrial and appendage involvement and rare atrial septal aneurysm sludge. LAAeV and LAAfV were of limited value in distinguishing solid thrombus from sludge. CLINICAL TRIAL NUMBER ChiCTR-OCH-13,003,729.
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Affiliation(s)
- Jing Cui
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Shi-Jun Xia
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Liu He
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Xue-Yuan Guo
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Song-Nan Li
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Nian Liu
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - De-Yong Long
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Xin Du
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing AnZhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Chaoyang District, Beijing, Zip, 100029, PR China.
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181
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Artac I, Ilis D, Karakayali M, Omar T, Arslan A, Topaloğlu I, Karabag Y, Karakayon S, Rencuzogullari I. The prognostic value of the MAGGIC risk score in patients with acute pulmonary embolism. Am J Med Sci 2024:S0002-9629(24)01386-7. [PMID: 39094978 DOI: 10.1016/j.amjms.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 07/17/2024] [Accepted: 07/17/2024] [Indexed: 08/04/2024]
Abstract
OBJECTIVES Acute pulmonary embolism (PE) is a potentially life-threatening condition characterized by the sudden blockage of the pulmonary arteries. Although the MAGGIC risk score has emerged as a valuable tool in predicting outcomes in patients with chronic heart failure, it has also been demonstrated and identified as a prognostic model in various cardiac diseases other than heart failure. In this study, we aimed to investigate the relationship between MAGGIC score and adverse outcomes in patients with PE. MATERIALS AND METHODS A total of 302 consecutive patients diagnosed with acute PE were retrospectively included in the present study. For each patient, the MAGGIC score was calculated. The study population was divided into two groups according to the median value of MAGGIC score. RESULTS Patients with high MAGGIC score had a significantly higher proportion of elderly and female individuals, lower BMI, higher presence of CAD, DM, AFib, HF, HT, CKD, COPD, and ACEI/ARB and NOAC usage. Logistic regression analyses was carried out using univariate and multivariate analysis to predict the in-hospital and 30-day mortality predictors in the included PE patients. For in-hospital mortality, diastolic blood pressure, heart rate, RV dilatation, and the MAGGIC score (HR: 1.166, 95 % CI 1.077-1.263, p < 0.001) and for short-term mortality, sPESI and the MAGGIC score (HR: 1.925, 95 % CI 1.243-2.983, p:0.003) were found to be independent predictors for adverse outcomes in patients with acute PE. CONCLUSION Our study demonstrates that the MAGGIC score can be applied as a valuable prognostic tool for acute pulmonary embolism.
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Affiliation(s)
- Inanc Artac
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey.
| | - Dogan Ilis
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Muammer Karakayali
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Timor Omar
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Ayca Arslan
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Ihsan Topaloğlu
- Kafkas University Faculty of Medicine Department of Pulmonary Medicine Kars Turkey
| | - Yavuz Karabag
- Kafkas University Faculty of Medicine Department of Cardiology Kars Turkey
| | - Suleyman Karakayon
- Kocaeli Health and Technology University Department of Health Science Kocaeli Turkey
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182
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Shechter A, Hong GJ, Kaewkes D, Patel V, Visrodia P, Tacon PR, Koren O, Koseki K, Nagasaka T, Skaf S, Makar M, Chakravarty T, Makkar RR, Siegel RJ. Prognostic value of left ventricular global longitudinal strain in transcatheter edge-to-edge repair for chronic primary mitral regurgitation. Eur Heart J Cardiovasc Imaging 2024; 25:1164-1176. [PMID: 38531070 DOI: 10.1093/ehjci/jeae083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 02/28/2024] [Accepted: 03/08/2024] [Indexed: 03/28/2024] Open
Abstract
AIMS Left ventricular global longitudinal strain (LVGLS) is a known outcome predictor in transcatheter edge-to-edge repair (TEER) for functional mitral regurgitation (MR). We aimed to assess its prognostic yield in the setting of TEER for chronic primary MR. METHODS AND RESULTS We conducted a single-centre, retrospective analysis of 323 consecutive patients undergoing isolated, first-time procedures. Stratified by baseline LVGLS quartiles (≤-19%, -18.9% to -16%, -15.9% to -12%, >-12%), the cohort was evaluated for the primary composite outcome of all-cause mortality or heart failure hospitalizations, as well as secondary endpoints consisting of mitral reinterventions and the persistence of significant residual MR and/or functional disability-all along the first year after intervention. Subjects with worse (i.e. less negative) LVGLS exhibited higher comorbidity, more advanced HF, and elevated procedural risk. Post-TEER, those belonging to the worst LVGLS quartile group sustained increased mortality (16.9% vs. 6.3%, Log-Rank P = 0.005, HR 1.75, 95% CI 1.08-4.74, P = 0.041) and, when affected by LV dysfunction/dilatation, more primary outcome events (21.1% vs. 11.5%, Log-Rank P = 0.037, HR 1.68, 95% CI 1.02-5.46, P = 0.047). No association was demonstrated between baseline LVGLS and other endpoints. Upon exploratory analysis, 1-month post-procedural LVGLS directly correlated with and was worse than its baseline counterpart by 1.6%, and a more impaired 1-month value-but not the presence/extent of deterioration-conferred heightened risk for the primary outcome. CONCLUSION TEER for chronic primary MR is feasible, safe, and efficacious irrespective of baseline LVGLS. Yet, worse baseline LVGLS forecasts a less favourable post-procedural course, presumably reflecting a higher-risk patient profile.
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Affiliation(s)
- Alon Shechter
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiology, Rabin Medical Center, 39 Jabotinsky St, Petach Tikva 4941492, Israel
- Faculty of Medicine, Tel Aviv University, 35 Klachkin St, Tel Aviv 6997801, Israel
| | - Gloria J Hong
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Danon Kaewkes
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Medicine, Faculty of Medicine, Khon Kaen University, Thailand
| | - Vivek Patel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Parth Visrodia
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - P Ryan Tacon
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Ofir Koren
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Keita Koseki
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Takashi Nagasaka
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Gunma, Japan
| | - Sabah Skaf
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Moody Makar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Tarun Chakravarty
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Raj R Makkar
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
| | - Robert J Siegel
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, 127 S San Vicente Blvd A3100, Los Angeles, CA 90048, USA
- David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095, USA
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Cantinotti M, Di Salvo G, Voges I, Raimondi F, Greil G, Ortiz Garrido A, Bharucha T, Grotenhuis HB, Köstenberger M, Bonnello B, Miller O, McMahon CJ. Standardization in paediatric echocardiographic reporting and critical interpretation of measurements, functional parameters, and prediction scores: a clinical consensus statement of the European Association of Cardiovascular Imaging of the European Society of Cardiology and the Association for European Paediatric and Congenital Cardiology. Eur Heart J Cardiovasc Imaging 2024; 25:1029-1050. [PMID: 38833586 DOI: 10.1093/ehjci/jeae147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 05/23/2024] [Indexed: 06/06/2024] Open
Abstract
This document has been developed to provide a guide for basic and advanced reporting in paediatric echocardiography. Furthermore, it aims to help clinicians in the interpretation of echocardiographic measurements and functional data for estimating the severity of disease in different paediatric age groups. The following topics will be reviewed and discussed in the present document: (i) the general principle in constructing a paediatric echocardiographic report, (ii) the basic elements to be included, and (iii) the potential and limitation of currently employed tools used for disease severity quantification during paediatric reporting. A guide for the interpretation of Z-scores will be provided. Use and interpretation of parameters employed for quantification of ventricular systolic function will be discussed. Difficulties in the adoption of adult parameters for the study of diastolic function and valve defects at different ages and pressure and loading conditions will be outlined, with pitfalls for the assessment listed. A guide for careful use of prediction scores for complex congenital heart disease will be provided. Examples of basic and advanced (disease-specific) formats for reporting in paediatric echocardiography will be provided. This document should serve as a comprehensive guide to (i) structure a comprehensive paediatric echocardiographic report; (ii) identify the basic morphological details, measures, and functional parameters to be included during echocardiographic reporting; and (iii) correctly interpret measurements and functional data for estimating disease severity.
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Affiliation(s)
- Massimiliano Cantinotti
- Department of Pediatric Cardiology and Congenital Heart Disease, National Research Council-Tuscany Region G. Monasterio Foundation (FTGM), Massa, Pisa 54100, Italy
| | - Giovanni Di Salvo
- Paediatric Cardiology and Congenital Heart Disease, Woman and Children's Health Department, University of Padua; Experimental Cardiology, Paediatric Research Institute (IRP), Padua, Italy
| | - Inga Voges
- Department of Congenital Heart Disease and Pediatric Cardiology, DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, University Hospital Schleswig-Holstein, Kiel, Germany
| | | | - Gerald Greil
- Division Pediatric Cardiology, UT Southwestern, Dallas, TX, USA
| | | | - Tara Bharucha
- Department of Paediatric Cardiology, University Hospital Southampton, Southampton, UK
| | - Heynric B Grotenhuis
- Department Pediatric Cardiology, Wilhelmina Children's Hospital/UMCU, Utrecht, The Netherlands
| | - Martin Köstenberger
- Department of Pediatrics, Division of Pediatric Cardiology, Medical University of Gratz, Gratz, Austria
| | | | - Owen Miller
- Department Pediatric Cardiology, Evelina London Children's Hospital, London, UK
| | - Colin J McMahon
- Department Paediatric Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland
- School of Medicine, University College Dublin, Belfield, Dublin, Ireland
- Maastricht School of Health Professions Education, Maastricht, The Netherlands
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184
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Luo L, Xie Z, Wu Q, Liu Q, Hou H, Wang Y, Shu X. Transesophageal echocardiography guidance for percutaneous closure of PFO and a new method to improve the diagnosis and safety during the procedures. Front Cardiovasc Med 2024; 11:1428380. [PMID: 39145278 PMCID: PMC11321958 DOI: 10.3389/fcvm.2024.1428380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 07/24/2024] [Indexed: 08/16/2024] Open
Abstract
Purpose Percutaneous patent foramen ovale (PFO) closure is becoming more and more common for the treatment or prevention of PFO-associated right-to-left shunt (RLS). This study aims to investigate the value of transesophageal echocardiography (TEE) in percutaneous PFO closure, and to explore a new method that can improve intraoperative diagnosis and surgical safety. Materials and methods Based on our inclusion and exclusion criteria, we enrolled 73 patients between 16 and 70 years old (average age 43.25 ± 14.87 years) who underwent percutaneous PFO closure at the Department of Cardiac Surgery, Zhongshan Hospital (Xiamen), Fudan University, from January 2022 to December 2023. Out of the 73 enrolled patients, there were 28 males (38.36%) and 45 females (61.64%), 29 migraine patients (39.73%), 14 patients (19.19%) with headache and dizziness, 14 patients (19.18%) with a history of cerebral infarction (CI), and 25 patients (34.25%) with CI, lacunar infarction or ischemic focus on magnetic resonance imaging (MRI). All patients received routine transthoracic echocardiography (TTE) and agitated saline contrast echocardiography (ASCE) before operations. Percutaneous closure of PFO was completed under the guidance of TEE. In 12 patients, the method of "injection of heparinized sterile saline through the delivery sheath" was used to observe their RLS, and the anatomical characteristics of the PFO according to the shunt path were monitored and evaluated. This method was also applied to some patients to guide the conveyor to pass through the foramen ovale (FO) channel safely and effectively, thereby improving the success rate of PFO closure. Results The application of TEE during the procedure of percutaneous PFO closure, including preoperative evaluation, intraoperative guidance, and postoperative reevaluation, can offer further details about the anatomical and shunt characteristics of PFO, improve the diagnosis rate, and confirm the safety of the surgical path. It ensures the safety and reliability of the whole operation, greatly improving the success rate and reducing postoperative complications. Conclusions TEE guidance of percutaneous PFO closure has the advantages of minimal trauma, no radiation and real-time visualization, while injecting heparinized sterile saline through the delivery sheath is safer and more effective in improving the success rate and reducing postoperative complications.
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Affiliation(s)
- Limin Luo
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Zehan Xie
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Qiaoyan Wu
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Qiang Liu
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Huiping Hou
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
| | - Yongshi Wang
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital (Xiamen), Fudan University, Xiamen, Fujian, China
- Department of Echocardiography, Zhongshan Hospital, Fudan University, Shanghai, China
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185
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Chong A, Sen J, Reyaldeen R, Wahi S, Huynh Q, Wang WYS, Marwick TH. Prognostication and Interventional Guidance Using Acceleration-Ejection Time Ratio in Undifferentiated Paradoxical Low-Flow Low-Gradient Aortic Stenosis. JACC Cardiovasc Imaging 2024:S1936-878X(24)00227-4. [PMID: 39152958 DOI: 10.1016/j.jcmg.2024.05.015] [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: 03/04/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 08/19/2024]
Abstract
BACKGROUND Studies in paradoxical low-flow low-gradient aortic stenosis (PLFAS) have demonstrated conflicting outcomes with variable survival advantage from aortic valve replacement (AVR). PLFAS is a heterogeneous composition of patients with uncertainty regarding true stenosis severity that continues to confound decision-making for AVR. OBJECTIVES The purpose of this study was to investigate the utility of the Doppler acceleration (AT) to ejection (ET) time ratio (AT:ET) for prediction of prognosis and benefit from AVR in undifferentiated PLFAS. METHODS Patients with echocardiographic findings of PLFAS (aortic valve area <1.0 cm2 or indexed aortic valve area <0.6 cm2/m2, mean gradient <40 mm Hg, indexed stroke volume <35 mL/m2, and left ventricular ejection fraction ≥50%) were identified and grouped according to an AT:ET cutoff of 0.35. The primary outcome was a 5-year composite of cardiac mortality or AVR. Secondary outcomes included the individual components of the primary endpoint and all-cause mortality at 5 years. Effect of AVR was analyzed in the AT:ET <0.35 and ≥0.35 groups. RESULTS A total of 171 PLFAS patients (median age 77.0 years, 57% women) were followed for a median of 8.9 years. AT:ET ≥0.35 was an independent predictor of the primary outcome (HR: 4.77 [95% CI: 2.94-7.75]; P < 0.001) with incremental value over standard indices of stenosis severity (net reclassification improvement: 0.57 [95% CI: 0.14-0.84]). AT:ET ≥0.35 also remained predictive of increased cardiac death (HR: 2.91 [95% CI: 1.47-5.76]; P = 0.002) and AVR (HR: 8.45 [95% CI: 4.16-17.1]; P < 0.001), respectively, following competing risk analysis. No difference in all-cause mortality was observed. AVR in the AT:ET ≥0.35 group was associated with significant reductions in 5-year cardiac (HR: 0.09 [95% CI: 0.02-0.36]; P < 0.001) and all-cause mortality (HR: 0.16 [95% CI: 0.07-0.38]; P < 0.001). No improvement in survival from AVR was demonstrated in AT:ET <0.35 patients. CONCLUSIONS AT:ET ≥0.35 in PLFAS predicts poorer outcomes and/or need for AVR. In undifferentiated PLFAS patients, AT:ET may have a potential role in improving patient selection for prognostic AVR.
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Affiliation(s)
- Adrian Chong
- Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Jonathan Sen
- Princess Alexandra Hospital, Brisbane, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia
| | | | - Sudhir Wahi
- Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Quan Huynh
- Baker Heart and Diabetes Institute, Melbourne, Australia; Monash University Alfred Health, Melbourne, Australia
| | - William Y S Wang
- Princess Alexandra Hospital, Brisbane, Australia; Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Thomas H Marwick
- Baker Heart and Diabetes Institute, Melbourne, Australia; Department of Cardiometabolic Health, University of Melbourne, Melbourne, Australia.
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186
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Guo X, Huang M, Song C, Nie C, Zheng X, Zhou Z, Wang S, Huang X. MYH7 mutation is associated with mitral valve leaflet elongation in patients with obstructive hypertrophic cardiomyopathy. Heliyon 2024; 10:e34727. [PMID: 39130421 PMCID: PMC11315070 DOI: 10.1016/j.heliyon.2024.e34727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 06/20/2024] [Accepted: 07/15/2024] [Indexed: 08/13/2024] Open
Abstract
Mitral valve (MV) leaflet elongation is recognized as a primary phenotypic expression of hypertrophic cardiomyopathy (HCM) that contributes to obstruction. This study investigates the correlation between MV length and genotype mutations in the two predominant genes, myosin-binding protein C (MYBPC3), and the β-myosin heavy chain (MYH7) in patients with obstructive HCM (OHCM). Among the 402 OHCM patients, there were likely pathogenic or pathogenic variations in MYH7 (n = 94) and MYBPC3 (n = 76), along with a mutation-negative group (n = 212). Compared to genotype-negative patients, genotype-positive individuals exhibited elongated MV length, thicker interventricular septum, and increased instances of late gadolinium enhancement. Notably, MYH7 mutations were associated with a more severe disease trajectory than MYBPC3 mutations. After adjusting for potential confounders, multivariate linear regression analysis revealed that MYH7 gene mutations and left ventricular volume were independently associated with MV leaflet elongation. The study indicates that mutations in MYH7 and hemodynamics factors are significant risk factors for elongated MV leaflet. Consequently, regular assessment of MV length, especially in patients with MYH7 mutation and enlarged LV volume, is crucial for timely preoperative strategic planning and improved prognosis.
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Affiliation(s)
- Xinli Guo
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishilu, Beijing, 100037, China
| | - Manyun Huang
- Department of Heart Failure, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, 200120, China
| | - Changpeng Song
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishilu, Beijing, 100037, China
| | - Changrong Nie
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishilu, Beijing, 100037, China
| | - Xinxin Zheng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishilu, Beijing, 100037, China
| | - Zhou Zhou
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishilu, Beijing, 100037, China
| | - Shuiyun Wang
- Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishilu, Beijing, 100037, China
| | - Xiaohong Huang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences, Peking Union Medical College, 167 Beilishilu, Beijing, 100037, China
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187
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Amano M, Izumi C, Ito S, Kitakaze M. Sex-based differences in left ventricular mass reduction across angiotensin II receptor blockers in patients with heart failure with preserved or mildly reduced ejection fraction. Heart Vessels 2024:10.1007/s00380-024-02446-x. [PMID: 39078503 DOI: 10.1007/s00380-024-02446-x] [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: 04/27/2024] [Accepted: 07/24/2024] [Indexed: 07/31/2024]
Abstract
Although angiotensin II receptor blockers (ARBs) are more effective in women for either reduction of blood pressure or heart failure (HF), the gender disparities and the impact of class/drug effects on ARBs in relation to cardiac hypertrophy and HF remain unclear. We aimed to investigate the sex-based and drug-specific differences in left ventricular (LV) mass reduction with ARBs. We employed the cohort of 193 hypertensive patients with HF and an LV ejection fraction of ≥ 45% treated with azilsartan or candesartan once daily for 48 weeks as a sub-analysis of the J-TASTE trial. After exclusion of patients without LV mass data nor the drugs, 170 patients were finally enrolled (azilsartan: male, n = 43, female, n = 39 and candesartan: male, n = 52; female, n = 36). We investigated the sex-based differences of the primary endpoint of the change in LV mass as assessed by echocardiography from baseline to the end of the study (48 weeks), and the secondary endpoint of the incidence of the composite cardiovascular endpoint (death from cardiovascular disease or hospitalization for heart failure). In the male stratum, the ratio of patients with > 10% LV mass reduction at 48 weeks was higher in the azilsartan group than candesartan group (40 vs. 19%, p = 0.029). There was no significant difference in LV mass reduction between two groups in the female stratum. There were no differences of the onset of the secondary endpoints between male and female groups, and azilsartan and candesartan groups. The event-free survival rate of the composite cardiovascular endpoints tended to be lower in patients with ≤ 10% than > 10% LV mass reduction (95.3 vs. 100% at 48 weeks, log-rank p = 0.11). In patients with HF, the effectiveness of either azilsartan or candesartan in achieving > 10% LV mass reduction depends on sex. Male is more sensitive to azilsartan than candesartan to achieve cardiac hypertrophy in HF patients.
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Affiliation(s)
- Masashi Amano
- Department of Heart Failure and Transplant, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
| | - Chisato Izumi
- Department of Heart Failure and Transplant, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
| | - Shin Ito
- Department of Heart Failure and Transplant, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Clinical Medicine and Development, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Masafumi Kitakaze
- Department of Heart Failure and Transplant, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan
- Department of Cardiovascular Medicine, Hanwa Memorial Hospital, Osaka, Japan
- The Osaka Medical Research Foundation for Intractable Diseases, Osaka, Japan
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188
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Egbe AC, Miranda WR, Jain CC, Burchill LJ, Young KA, Rose CH, Karnakoti S, Ahmed MH, Connolly HM. Cardiac remodelling during pregnancy in women with congenital heart disease and systemic left ventricle. Eur Heart J Cardiovasc Imaging 2024:jeae173. [PMID: 39073413 DOI: 10.1093/ehjci/jeae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 07/30/2024] Open
Abstract
AIMS Women with congenital heart disease (CHD) are at risk of pregnancy-related adverse outcomes (PRAO). The purpose of this study was to assess temporal changes in cardiac structure and function (cardiac remodelling) during pregnancy, and the association with PRAO in women with CHD. METHODS AND RESULTS Retrospective study of pregnant women with CHD and serial echocardiograms (2003-2021). Cardiac structure and function were assessed at pre-specified time points: prepregnancy, early pregnancy, late pregnancy, and postnatal period. PRAO was defined as the composite of maternal cardiovascular, obstetric, and neonatal complications. The study comprised 81 women with CHD (age, 29 ± 5 years). Compared to the baseline echocardiogram, there was a relative increase in right ventricular systolic pressure (RVSP) (relative change 13 ± 5%, P < 0.001, in early pregnancy; and 18 ± 5%, P < 0.001, in late pregnancy). There was a relative decrease in right ventricle free wall strain (RVFWS) (relative change -11 ± 3%, P < 0.001, in late pregnancy; and -11 ± 4%, P = 0.003, in postnatal period), and a relative decrease in RVFWS/RVSP (relative change, -10 ± 5%, P = 0.02 in early pregnancy, -26 ± 7%, P < 0.001, in late pregnancy, and -14 ± 5%, P < 0.001, in postnatal period). Baseline right ventricular to pulmonary arterial (RV-PA) coupling, and temporal change in RV-PA coupling were associated with PRAO, after adjustment for maternal age and severity of cardiovascular disease. CONCLUSION Women with CHD had a temporal decrease in RV systolic function and RV-PA coupling, and these changes were associated with PRAO. Further studies are required to delineate the aetiology of deterioration in RV-PA coupling during pregnancy, and the long-term implications of right heart dysfunction observed in the postnatal period.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Luke J Burchill
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Carl H Rose
- Department of Obstetrics and Gynaecology, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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189
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Witarto AP, Witarto BS, Pramudito SL, Ratri LC, Candra DA, Wirakasa S, Novida H, Susilo H, Wungu CDK, Kusumawati M. Unusual Presentations of Thyrotoxic Tricuspid and Mitral Regurgitations in 62 Adults: A Systematic Review of Case Reports with In-depth Pathophysiological Review. Eur Cardiol 2024; 19:e13. [PMID: 39144378 PMCID: PMC11322951 DOI: 10.15420/ecr.2024.05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 03/22/2024] [Indexed: 08/16/2024] Open
Abstract
Background Thyrotoxicosis is related to cardiovascular mortality. This can be caused by several clinical manifestations involving the rare provocation of tricuspid regurgitation (TR) and mitral regurgitation (MR). However, there are still no clear data on thyrotoxic TR and/or MR. This study examines the progression of TR, MR, heart failure (HF) and pulmonary hypertension (PH) in response to the thyrotoxic heart manifestations, clinical characteristics and treatment approaches. Methods A PRISMA-based systematic search was conducted using PubMed and other databases up to 17 June 2023. The outcomes of this study were TR, MR, HF and PH with their progression on follow-up, clinical characteristics and treatment approaches. Results A total of 57 case reports involving 62 patients (45.77 ± 13.41 years) were included in this study. They were predominantly women (n=50; 80.65%) and diagnosed with Graves' disease (n=41; 75.81%). All patients were diagnosed with thyrotoxicosis, and this included 23 (37.10%) cases of thyroid storm. From echocardiographic studies, several patients improved clinically within the first 6 months of follow-up, including 20 TR patients (83.33%) in 6 months, nine MR patients (69.23%) in 3 months, eight HF patients (66.67%) in 2 months and 16 PH patients (76.19%) in 6 months. Conclusion Several mechanisms are involved in thyrotoxic TR and/or MR, including the direct thyroid hormone effect and the indirect effect of other hyperthyroidism-associated factors. Patients with thyrotoxic TR and/or MR, including those with HF and PH, can experience clinical and structural improvements following hyperthyroidism treatment in the first 6 months.
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Affiliation(s)
- Andro Pramana Witarto
- Medical Program, Faculty of Medicine, Universitas AirlanggaSurabaya, East Java, Indonesia
| | - Bendix Samarta Witarto
- Medical Program, Faculty of Medicine, Universitas AirlanggaSurabaya, East Java, Indonesia
| | - Shidi Laras Pramudito
- Medical Program, Faculty of Medicine, Universitas AirlanggaSurabaya, East Java, Indonesia
| | | | - Della Anastasia Candra
- Medical Program, Faculty of Medicine, Universitas AirlanggaSurabaya, East Java, Indonesia
| | - Stephanie Wirakasa
- Medical Program, Faculty of Medicine, Universitas SurabayaSurabaya, East Java, Indonesia
| | - Hermina Novida
- Department of Internal Medicine, Faculty of Medicine, Dr Soetomo General Hospital, Universitas AirlanggaSurabaya, East Java, Indonesia
| | - Hendri Susilo
- Department of Cardiovascular Medicine, Faculty of Medicine, Universitas Airlangga Hospital, Universitas AirlanggaSurabaya, East Java, Indonesia
| | - Citrawati Dyah Kencono Wungu
- Department of Physiology and Medical Biochemistry, Universitas AirlanggaSurabaya, East Java, Indonesia
- Institute of Tropical Disease, Universitas AirlanggaSurabaya, East Java, Indonesia
| | - Maya Kusumawati
- Department of Internal Medicine, Faculty of Medicine, Dr Hasan Sadikin General Hospital, Universitas PadjadjaranBandung, West Java, Indonesia
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190
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Higuchi K, Manne M, Tchou P, Baranowski B, Bhargava M, Callahan T, Chung M, Dresing T, Hussein A, Kanj M, Mayuga K, Nakhla S, Saliba W, Rickard J, Wazni O, Santangeli P, Sroubek J, Varma N. Left ventricular mass as a modulator of ventricular arrhythmia risk and sex differences after CRT for nonischemic cardiomyopathy and LBBB. Heart Rhythm 2024:S1547-5271(24)03084-4. [PMID: 39084586 DOI: 10.1016/j.hrthm.2024.07.106] [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: 03/18/2024] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND The risk of ventricular arrhythmias (VAs) after cardiac resynchronization therapy (CRT) has been associated with ischemic disease/scar, sex, and possibly left ventricular mass (LVM). OBJECTIVE The purpose of this study was to evaluate sex differences and baseline/postimplant change in LVM on VA risk after CRT implantation in patients with nonischemic cardiomyopathy and left bundle branch block. METHODS In patients meeting the criteria, baseline and follow-up echocardiographic images were obtained for LVM assessment. VA events were reported from device diagnostics and therapies. VA risk was stratified by receiver operating characteristic (Youden index cutoff point) for baseline LVM and baseline/postimplant change in LVM, and baseline patient characteristics by using a multivariable Cox regression model. RESULTS One hundred eighteen patients (71 female [60.2%]; mean age 60.5 ± 11.3 years; left ventricular ejection fraction 19.2% ± 7.0%; QRS duration 165.6 ± 20 ms; LVM 313.9 ± 108.8 g) were enrolled and followed up for a median of 90 months (interquartile range 44-158 months). Thirty-five patients (29.6%) received appropriate shocks or antitachycardia pacing at a median of 73.5 months (interquartile range 25-130 months) postimplantation. Males had a higher VA incidence (male 18 of 47 [38.3%] vs female 17 of 71 [23.9%]; P = .02). Baseline LVM > 308.9 g separated patients with higher VA risk (P = .001). Less than a 20% decrease in LVM increased VA risk (P < .001). Baseline LVM was the only baseline characteristic predicting VA events in the Cox regression model (hazard ratio 1.01; 95% confidence interval 1.001-1.009; log-rank, P = .003). Sex differences in VA risk were eliminated by the baseline LVM parameters. CONCLUSION VA risk after CRT in nonischemic cardiomyopathy was associated with baseline LV > 308.9 g and a decrease in LVM ≤ 20%, without sex differences.
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Affiliation(s)
- Koji Higuchi
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio.
| | - Mahesh Manne
- Department of Hospital Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Patrick Tchou
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Bryan Baranowski
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mandeep Bhargava
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Callahan
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mina Chung
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas Dresing
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ayman Hussein
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Mohamed Kanj
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Kenneth Mayuga
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Shady Nakhla
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Walid Saliba
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - John Rickard
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Oussama Wazni
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Pasquale Santangeli
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Jakub Sroubek
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Niraj Varma
- Cardiac Electrophysiology and Pacing Section, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
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191
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Han Z, Wang L, Wang H, He H, Song Y, Wang M, Zhao N, Chen Z, Sun Z, Zhang S. Evaluation of the effect of kidney transplantation on left ventricular myocardial work by noninvasive pressure-strain loops. Front Cardiovasc Med 2024; 11:1370307. [PMID: 39119188 PMCID: PMC11306143 DOI: 10.3389/fcvm.2024.1370307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 07/17/2024] [Indexed: 08/10/2024] Open
Abstract
Purpose Kidney transplantation (KT) has the potential to reverse the cardiac changes caused by end-stage renal disease, and it may be inaccurate to analysis the left ventricular function by conventional echocardiography due to afterload. This study aimed to investigate the utility of pressure strain loops (PSLs) in evaluating left ventricular performance in patients underwent KT. Methods We enrolled 60 patients with end-stage renal disease who underwent KT between January 2022 and July 2023, and 60 healthy controls with a similar distribution of gender and age to the patients. All participants underwent conventional echocardiography and three-dimensional speckle tracking echocardiography (3D-STE). Long axis, short axis, and four cavity images were collected and cardiac parameters were measured. The echocardiographic changes of cardiac structure and function of all patients before KT and about 12 months after KT were recorded. Left ventricular myocardial work parameters were acquired by PSLs, including the global work index (GWI), global constructive work (GCW), global wasted work (GWW), global work efficiency (GWE) and global longitudinal strain (GLS). In addition, the correlation between PSLs and clinical data were explored. Results Compared with controls, the conventional echocardiographic parameters, myocardial function indicators GWI and GCW appeared no difference in post-KT group, while the GWE and GLS decreased (p < 0.05), and the GWW increased (p < 0.05). Compared with pre-KT, the GLS, GWI, GCW and GWE increased in post-KT group, while the GWW decreased (all p < 0.05). The above indicators were correlated with left ventricular GLS and left ventricular ejection fraction. Conclusion PSLs were more sensitive than traditional echocardiographic indicators in detecting changes in myocardial work and predicting left ventricular myocardial damage. This indicator could quantitatively evaluate myocardial work and provide a new and reliable non-invasive reference for clinical diagnosis and treatment of patients underwent KT.
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Affiliation(s)
- Zhengyang Han
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Lingyun Wang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Honghu Wang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Hongying He
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Yi Song
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Menghe Wang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Na Zhao
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhengguang Chen
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
| | - Zhenxing Sun
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Shan Zhang
- Department of Ultrasound, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, Henan, China
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Zhai Y, Li A, Tao X, Gao Q, Xie W, Zhang Y, Chen A, Wang C, Lei J, Ding S, Cai Y, Zhai Z. Predicting high-risk pre-capillary pulmonary hypertension: an echocardiographic multiparameter scoring index. BMC Cardiovasc Disord 2024; 24:384. [PMID: 39054410 PMCID: PMC11271058 DOI: 10.1186/s12872-024-04053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The risk stratification of pulmonary arterial hypertension proposed by the European Society of Cardiology /European Respiratory Society guidelines in 2015 and 2022 included two to three echocardiographic indicators. However, the specific value of echocardiography in risk stratification of pre-capillary pulmonary hypertension (pcPH) has not been efficiently demonstrated. Given the complex geometry of the right ventricular (RV) and influencing factors of echocardiographic parameter, there is no single echocardiographic parameter that reliably informs about PH status. We hypothesize that a multi-parameter comprehensive index can more accurately evaluate the severity of the pcPH. The purpose of this study was to develop and validate an echocardiographic risk score model to better assist clinical identifying high risk of pcPH during initial diagnosis and follow-up. METHODS We studied 197 consecutive patients with pcPH. A multivariable echocardiographic model was constructed to predict the high risk of pcPH in the training set. Points were assigned to significant risk factors in the final model based on β-coefficients. We validated the model internally and externally. RESULTS The echocardiographic score was constructed by multivariable logistic regression, which showed that pericardial effusion, right atrial (RA) area, RV outflow tract proximal diameter (RVOT-Prox), the velocity time integral of the right ventricular outflow tract (TVIRVOT) and S' were predictors of high risk of pcPH. The area under curve (AUC) of the training set of the scoring model was 0.882 (95%CI: 0.809-0.956, p < 0.0001). External validation was tested in a test dataset of 77 patients. The AUC of the external validation set was 0.852. A 10-point score risk score was generated, with scores ranging from 0 to 10 in the training cohort. The estimate risk of high risk of pcPH ranged from 25.1 to 94.6%. CONCLUSIONS The echocardiographic risk score using five echocardiographic parameters could be comprehensive and useful to predict the high risk of pcPH for initial assessment and follow-up.
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Affiliation(s)
- Yanan Zhai
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Aili Li
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
- National Clinical Research Center for Respiratory Diseases, Beijing, China.
| | - Xincao Tao
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qian Gao
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Wanmu Xie
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yu Zhang
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Aihong Chen
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Chi Wang
- Heart Health Research Center, Beijing, China
| | - Jieping Lei
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Shangwei Ding
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yantong Cai
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zhenguo Zhai
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
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193
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Tomii D, Okuno T, Nakase M, Praz F, Stortecky S, Reineke D, Windecker S, Lanz J, Pilgrim T. Renin-Angiotensin System Inhibition and Cardiac Damage in Patients Who Have Undergoing Transcatheter Aortic Valve Replacement. Can J Cardiol 2024:S0828-282X(24)00577-4. [PMID: 39067618 DOI: 10.1016/j.cjca.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/23/2024] [Accepted: 07/21/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND The optimal medical treatment strategy after transcatheter aortic valve replacement (TAVR) has not been established, and might be affected by the extent of extravalvular cardiac damage. We aimed to investigate the prognostic association of renin-angiotensin system (RAS) inhibitors in TAVR patients stratified according to the extent of extravalvular cardiac damage. METHODS In a prospective TAVR registry, patients were retrospectively evaluated for baseline cardiac damage and classified into 5 stages of cardiac damage (0-4) according to established criteria. Clinical outcomes at 1 year were compared according to RAS inhibitor prescription at discharge. RESULTS Among 2247 eligible patients who underwent TAVR between August 2007 and June 2021, 1634 (72.7%) were prescribed RAS inhibitors at discharge. Eighty-three patients (3.7%) were classified as stage 0, 276 (12.3%) as stage 1, 889 (39.6%) as stage 2, 489 (21.8%) as stage 3, and 510 (22.7%) as stage 4. RAS inhibitor prescription after TAVR was associated with a reduced risk of 1-year mortality (adjusted hazard ratio [HRadjusted], 0.59; 95% confidence interval [CI], 0.45-0.77). The protective association was accentuated among patients with cardiac stages 3 and 4 (HRadjusted, 0.54 [95% CI, 0.32-0.92]; and HRadjusted, 0.58 [95% CI, 0.36-0.92], respectively), but not statistically significant in for those with stage 2 (HRadjusted, 0.70; 95% CI, 0.43-1.14). CONCLUSIONS In patients who underwent TAVR, we found a strong association of RAS inhibitor prescription and improved clinical outcome in the overall population, and there were no signs of heterogeneity across stages of cardiac damage. CLINICAL TRIAL REGISTRATION NCT01368250.
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Affiliation(s)
- Daijiro Tomii
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Taishi Okuno
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Masaaki Nakase
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Stefan Stortecky
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - David Reineke
- Department of Cardiac Surgery, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Jonas Lanz
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, University of Bern, Bern, Switzerland.
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194
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Bagherzadeh SP, Celestin BE, Santana EJ, Salerno M, Nadeau KC, Sweatt AJ, Zamanian RT, Haddad F. Novel Reference Equations for Pulmonary Artery Size and Pulsatility Using Echocardiography and Their Diagnostic Value in Pulmonary Hypertension. Chest 2024:S0012-3692(24)04615-4. [PMID: 39025204 DOI: 10.1016/j.chest.2024.06.3805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Revised: 06/17/2024] [Accepted: 06/19/2024] [Indexed: 07/20/2024] Open
Abstract
BACKGROUND According to the most recent pulmonary hypertension (PH) guidelines, a main pulmonary artery (MPA) diameter > 25 mm on transthoracic echocardiography supports the diagnosis of PH. However, the size of the pulmonary artery (PA) may vary according to body size, age, and cardiac phases. RESEARCH QUESTION (1) What are the reference limits for PA size on transthoracic echocardiography, considering differences in body size, sex, and age? (2) What is the diagnostic value of the PA size for classifying PH? (3) How does the selection of different reference groups (healthy volunteers vs patients referred for right heart catheterization [RHC]) influence the diagnostic OR (DOR)? STUDY DESIGN AND METHODS The study included a reference cohort of 248 healthy individuals as control patients, 693 patients with PH proven by RHC, and 156 non-PH patients proven by RHC. In the PH cohort, 300 had group 1 PH, 207 had group 2 PH, and 186 had group 3 PH. MPA and right PA diameters and areas were measured in the upper sternal short-axis and suprasternal notch views. Reference limits (5th-95th percentile) were based on absolute values and height-indexed measures. Quantile regression analysis was used to derive median and 95th quantile reference equations for the PA measures. DORs and probability diagnostic plots for PH were then determined using healthy control and non-PH cohorts. RESULTS The 95th percentile for indexed MPA diameter was 15 mm/m in diastole and 19 mm/m in systole in both sexes. Quantile regression analysis revealed a weak age effect (pseudo-R2 of 0.08-0.10 for MPA diameters). Among measures, the MPA size in diastole had the highest DOR (156.2; 95% CI, 68.3-357.5) for detection of group 1 PH. Similarly, the DORs were also high for groups 2 and 3 PH when compared with the control cohort but significantly lower compared with the non-PH cohort. INTERPRETATION This study presents novel reference limits for MPA based on height indexing and quantile regression.
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Affiliation(s)
- Shadi P Bagherzadeh
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA.
| | - Bettia E Celestin
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Sean N. Parker Center of Allergy and Asthma Research, Stanford, CA
| | - Everton J Santana
- Stanford Cardiovascular Institute, Stanford University, Stanford, CA
| | - Michael Salerno
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA
| | - Kari C Nadeau
- Sean N. Parker Center of Allergy and Asthma Research, Stanford, CA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew J Sweatt
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA
| | - Roham T Zamanian
- Division of Pulmonary and Critical Care Medicine, Stanford University, Stanford, CA; Vera Moulton Wall Center for Pulmonary Vascular Disease, Stanford, CA
| | - Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA; Stanford Cardiovascular Institute, Stanford University, Stanford, CA.
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195
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Dhont S, Verbrugge FH, Verwerft J, Bertrand PB. Non-invasive imaging in acute decompensated heart failure with preserved ejection fraction. EUROPEAN HEART JOURNAL. ACUTE CARDIOVASCULAR CARE 2024; 13:575-582. [PMID: 38683589 DOI: 10.1093/ehjacc/zuae041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/28/2024] [Accepted: 03/24/2024] [Indexed: 05/01/2024]
Abstract
Non-invasive imaging plays an increasingly important role in emergency medicine, given the trend towards smaller, portable ultrasound devices, the integration of ultrasound imaging across diverse medical disciplines, and the growing evidence supporting its clinical benefits for the patient. Heart failure with preserved ejection fraction (HFpEF) provides a compelling illustration of the impactful role that imaging plays in distinguishing diverse clinical presentations of heart failure with numerous associated comorbidities, including pulmonary, renal, or hepatic diseases. While a preserved left ventricular ejection fraction might misguide the clinician away from diagnosing cardiac disease, there are several clues provided by cardiac, vascular, and lung ultrasonography, as well as other imaging modalities, to rapidly identify (decompensated) HFpEF. Congestion remains the primary reason why patients with heart failure (irrespective of ejection fraction) seek emergency care. Furthermore, comprehensive phenotyping is becoming increasingly important, considering the development of targeted treatments for conditions exhibiting HFpEF physiology, such as cardiac amyloidosis. Timely recognition in such cases has lasting implications for long-term outcomes.
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Affiliation(s)
- Sebastiaan Dhont
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
| | - Frederik H Verbrugge
- Centre for Cardiovascular Diseases, University Hospital Brussels, Jette, Belgium
- Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Jan Verwerft
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Philippe B Bertrand
- Faculty of Medicine and Life Sciences, Hasselt University, LCRC, Agoralaan, Diepenbeek 3590, Belgium
- Department of Cardiology, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
- Department of Future Health, Ziekenhuis Oost-Limburg, Synaps Park 1, Genk 3600, Belgium
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Navarro-Saez MDC, Feijoo-Massó C, Berenguer Sánchez A, Parra Parente T, Guillamon Toran L, Marcano-Fernández F, Camara-Cabrera J, Bravo Ferrer ZDC, Comet Monte R, Calvet Calvo X. Early Diagnosis of Amyloidosis and Cardiac Involvement through Carpal Tunnel Surgery and Predictive Factors. J Clin Med 2024; 13:4328. [PMID: 39124595 PMCID: PMC11313137 DOI: 10.3390/jcm13154328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2024] [Revised: 07/15/2024] [Accepted: 07/23/2024] [Indexed: 08/12/2024] Open
Abstract
Background/Objectives: To determine the prevalence of amyloidosis through the analysis of synovial tissue and transverse carpal ligament (TCL) in patients undergoing surgery for carpal tunnel syndrome (CTS), detect predictive factors for the presence of amyloid, and assess cardiac involvement degree. Methods: A prospective study with longitudinal cohort follow-up at a teaching hospital. Patients undergoing CTS surgery from 1 January 2019 to 31 May 2021 were included. Samples from synovial and TCL tissues were examined for amyloid presence. Multivariate analysis was used to detect predictive factors of the presence of amyloid. Patients with amyloid underwent echocardiography, laboratory analyses, and scintigraphy. Results: Two hundred and forty-six patients were included. The prevalence of amyloid was 11.4% in TCL and 12.6% in synovial tissues. Age (p = 0.035; OR 1.123), bilateral CTS symptoms (p = 0.022; OR 3.647), and trigger finger (p < 0.001; OR 3.537) were predictors of the presence of amyloid. Seventeen patients were diagnosed with transthyretin amyloidosis (ATTR) located in the carpus (no scintigraphic cardiac uptake or grade 0), one with light chain amyloidosis, eight with ATTR with cardiac involvement (grades 2-3), and five with ATTR in the carpus and scintigraphic uptake grade 1 (with normal echocardiogram and blood and urine tests). Conclusions: We detected amyloid in 12.6% of unselected consecutive patients who underwent CTS surgery. Biopsy in patients with CTS for amyloid detection, especially in elderly patients with bilateral symptoms and trigger finger, may be useful for the early diagnosis of amyloidosis, primarily due to transthyretin.
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Affiliation(s)
- María del Carmen Navarro-Saez
- Acute Geriatric Unit and Infectious Diseases Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain;
| | - Carlos Feijoo-Massó
- Internal Medicine Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain;
| | - Alex Berenguer Sánchez
- Hand Surgery Unit, Orthopaedic Surgery Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain; (A.B.S.); (F.M.-F.); (J.C.-C.)
| | - Tamara Parra Parente
- Pathology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain;
| | - Laura Guillamon Toran
- Cardiology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain;
| | - Francesc Marcano-Fernández
- Hand Surgery Unit, Orthopaedic Surgery Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain; (A.B.S.); (F.M.-F.); (J.C.-C.)
| | - Jaume Camara-Cabrera
- Hand Surgery Unit, Orthopaedic Surgery Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain; (A.B.S.); (F.M.-F.); (J.C.-C.)
| | - Zully del Carmen Bravo Ferrer
- Nuclear Medicine Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain;
| | - Ricard Comet Monte
- Internal Medicine Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain;
| | - Xavier Calvet Calvo
- Gastroenterology Department, Parc Taulí Hospital Universitari, Institut d’Investigació i Innovació Parc Taulí (I3PT), 08208 Sabadell, Spain;
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Ladányi Z, Eltayeb A, Fábián A, Ujvári A, Tolvaj M, Tokodi M, Choudhary KA, Kovács A, Merkely B, Vriz O, Lakatos BK. The effects of mitral stenosis on right ventricular mechanics assessed by three-dimensional echocardiography. Sci Rep 2024; 14:17112. [PMID: 39048660 PMCID: PMC11269591 DOI: 10.1038/s41598-024-68126-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 07/19/2024] [Indexed: 07/27/2024] Open
Abstract
Mitral stenosis (MS) is a complex valvular pathology with significant clinical burden even today. Its effect on the right heart is often overlooked, despite it playing a considerable part in the symptomatic status. We enrolled 39 mitral valve stenosis patients and 39 age- and gender-matched healthy controls. They underwent conventional, speckle-tracking and 3D echocardiographic examinations. The 3D data was analyzed using the ReVISION software to calculate RV functional parameters. In the MS group, 3D RV ejection fraction (EF) (49 ± 7% vs. 61 ± 4%; p < 0.001), global circumferential (GCS) (- 21.08 ± 5.64% vs. - 25.07 ± 4.72%; p = 0.001) and longitudinal strain (GLS) (- 16.60% ± 4.07% vs. - 23.32 ± 2.82%; p < 0.001) were reduced. When comparing RV contraction patterns between controls, MS patients in sinus rhythm and those with atrial fibrillation, radial (REF) (32.06 ± 5.33% vs. 23.62 ± 7.95% vs. 20.89 ± 6.92%; p < 0.001) and longitudinal ejection fraction (LEF) (24.85 ± 4.06%; 17.82 ± 6.16% vs. 15.91 ± 4.09%; p < 0.001) were decreased in both MS groups compared to controls; however, they were comparable between the two MS subgroups. Anteroposterior ejection fraction (AEF) (29.16 ± 4.60% vs. 30.87 ± 7.71% vs. 21.48 ± 6.15%; p < 0.001) showed no difference between controls and MS patients in sinus rhythm, while it was lower in the MS group with atrial fibrillation. Therefore, utilizing 3D echocardiography, we found distinct morphological and functional alterations of the RV in MS patients.
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Affiliation(s)
- Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary.
| | - Abdalla Eltayeb
- King Faisal Specialist Hospital and Research Center Hospital, Riyadh, Saudi Arabia
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Máté Tolvaj
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
- Department of Surgical Research and Techniques, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
| | - Olga Vriz
- King Faisal Specialist Hospital and Research Center Hospital, Riyadh, Saudi Arabia
- Ospedale Sant'Antonio, San Daniele del Friuli, Italy
| | - Bálint Károly Lakatos
- Heart and Vascular Center, Semmelweis University, Varosmajor Utca 68, Budapest, 1122, Hungary
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198
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Avcı Demir F, Bingöl G, Uçar M, Özden Ö, Özmen E, Tüner H, Nasifov M, Ünlü S. Left Atrial Coupling Index Predicts Heart Failure in Patients with End Stage Renal Disease. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1195. [PMID: 39202477 PMCID: PMC11356076 DOI: 10.3390/medicina60081195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 07/17/2024] [Accepted: 07/22/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: We aimed to ascertain the predictive power of the left atrial coupling index (LACI) in patients with end stage renal disease (ESRD) for heart failure with preserved ejection fraction (HFpEF). Materials and Methods: This is a retrospective study including 100 subjects between 18 and 65 years of age with ESRD and not on dialysis treatment. Patients were divided into groups with and without HFpEF. The LACI was defined as the ratio of the left atrial volume index (LAVI) to the a' wave in tissue Doppler imaging (TDI). Statistical analyses were performed, including univariate and multivariate regression analyses. Results: The mean age of the participants was 47 ± 13.3 years. Individuals with HFpEF exhibited a higher LACI. Univariate and multivariate regression analyses demonstrated that the predictive capacity of the LACI for HFpEF was considerably higher than that of the LAVI and other echocardiographic parameters. Conclusions: Higher LACI levels were consistently related to the presence of HFpEF in ESRD patients. The LACI can be easily obtained in daily practice using conventional Doppler echocardiographic measurements during left atrial functional assessments.
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Affiliation(s)
- Fulya Avcı Demir
- Department of Cardiology, Medical Park Hospital, 07160 Antalya, Turkey
- Department of Cardiology, Istinye University, 34010 Istanbul, Turkey
| | - Gülsüm Bingöl
- Department of Cardiology, Istanbul Arel University, 34537 Istanbul, Turkey;
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Mustafa Uçar
- Department of Cardiology, Celal Bayar University, 45140 Manisa, Turkey;
| | - Özge Özden
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Emre Özmen
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Haşim Tüner
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Muharrem Nasifov
- Department of Cardiology, Bahcelievler Memorial Hospital, 34180 Istanbul, Turkey; (Ö.Ö.); (E.Ö.); (H.T.); (M.N.)
| | - Serkan Ünlü
- Department of Cardiology, Gazi University, 06570 Ankara, Turkey;
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199
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Naser JA, Harada T, Tada A, Doi S, Tsaban G, Pislaru SV, Nkomo VT, Scott CG, Kennedy AM, Eleid MF, Reddy YNV, Lin G, Pellikka PA, Borlaug BA. Prevalence, Incidence, and Outcomes of Diastolic Dysfunction in Isolated Tricuspid Regurgitation: Perhaps Not Really "Isolated"? JACC Cardiovasc Imaging 2024:S1936-878X(24)00231-6. [PMID: 39066743 DOI: 10.1016/j.jcmg.2024.05.019] [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: 10/19/2023] [Revised: 05/15/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024]
Abstract
BACKGROUND In the absence of left-sided cardiac/pulmonary disease, functional tricuspid regurgitation (FTR) is referred to as isolated or idiopathic. Relationships between left ventricular diastolic dysfunction (DD) and FTR remain unknown. OBJECTIVES The purpose of this study was to investigate the prevalence, incidence, and outcome of DD in patients with idiopathic FTR. METHODS Adults without structural heart disease were identified. Severe DD was defined by ≥3 of 4 abnormal DD parameters (medial e', medial E/e', TR velocity, left atrial volume index) and ≥ moderate DD by ≥2. Propensity-score matching was performed (3:1) between each less-than-severe TR group and severe TR based on age, sex, body mass index, and comorbidities. RESULTS Among 30,428 patients, FTR was absent in 73%, mild in 22%, moderate in 4%, and severe in 0.4%. In the propensity-matched sample, severe DD was present in 2%, 6%, 9%, and 13% patients, and ≥ moderate DD in 11%, 18%, 28%, and 48%, respectively (P < 0.001). The probability of heart failure with preserved ejection fraction using the H2FPEF score increased with increasing FTR (median 29.7%, 45.5%, 61.4%, and 88.7%, respectively), as did the prevalence of impaired left atrial strain <24% (35%, 48%, and 69% in mild, moderate, and severe TR). Incident severe and ≥ moderate DD developed more frequently with increasing FTR (HR: 8.45 [95% CI: 2.60-27.50] and HR: 2.82 [95% CI: 1.40-5.69], respectively for ≥ moderate vs no FTR) over a median of 3.0 years. Findings were confirmed in patients without lung disease or right ventricular enlargement. Over a median of 5.0 years, patients with ≥ moderate FTR and DD had the greatest risk of worse outcomes (multivariable P < 0.001). The association between TR and adverse outcomes was significantly diminished in the absence of DD. CONCLUSIONS Diastolic dysfunction, increased heart failure with preserved ejection fraction probability, and impaired left atrial strain are commonly present in patients with idiopathic FTR, suggesting that the latter may not be truly isolated. Patients with FTR without DD or heart failure are at increased risk of incident DD. Patients with FTR and DD display worse outcomes.
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Affiliation(s)
- Jwan A Naser
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tomonari Harada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Atsushi Tada
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Shunichi Doi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Gal Tsaban
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Vuyisile T Nkomo
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher G Scott
- Department of Quantitative Health Sciences and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Austin M Kennedy
- Department of Quantitative Health Sciences and Biostatistics, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Yogesh N V Reddy
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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200
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Rodríguez-López C, Balaguer Germán J, Venegas Rodríguez A, Carda Barrio R, Gaebelt Slocker HP, Pello Lázaro AM, López Castillo M, Soler Bonafont B, Recio Vázquez M, Taibo Urquía M, González Piña M, González Parra E, Tuñón J, Aceña Á. Bioimpedance analysis predicts worsening events in outpatients with heart failure and reduced ejection fraction. ESC Heart Fail 2024. [PMID: 39044354 DOI: 10.1002/ehf2.14908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Revised: 06/03/2024] [Accepted: 06/05/2024] [Indexed: 07/25/2024] Open
Abstract
AIMS Heart failure (HF) with reduced left ventricle ejection fraction (LVEF) is an entity with poor prognosis characterized by decompensations. Bioelectrical impedance analysis (BIA) is used to assess volume overload (VO) and may be useful to identify apparently stable HF outpatients at risk of decompensation. The aim of this study is to analyse whether VO assessed by BIA is associated with worsening heart failure (WHF) in stable outpatients with HF and reduced LVEF (HFrEF). METHODS AND RESULTS This is a prospective single-centre observational study. Consecutive stable HF outpatients with LVEF below 40% underwent BIA, transthoracic echocardiography, blood sampling, and physical examination and were followed up for 3 months. VO was defined as the difference between the measured weight and the dry weight assessed by BIA. Demographic, clinical, anthropometric, echocardiographic, and analytical parameters were recorded. The primary endpoint was WHF, defined by visits to the emergency department for HF or hospitalization for HF. A total of 100 patients were included. The median VO was 0.5 L (interquartile range 0-1.6 L). Eleven patients met the primary endpoint. Univariate binary logistic regression analysis showed that left ventricle filling pressures assessed by E/e', N-terminal pro B-type natriuretic peptide, inferior vena cava dilatation (≥21 mm), signs of congestion, and VO were associated with the primary endpoint. Binary logistic regression multivariate analysis showed that VO was the only independent predictor for the primary endpoint (adjusted OR 2.7; 95% CI 1.30-5.63, P = 0.008). Multivariate Cox regression analysis also showed an adjusted hazard ratio (HR) for VO of 2.03; 95% CI 1.37-3.02, P < 0.001. Receiver-operating characteristic curve analysis showed an area under the curve for VO of 0.88 (95% CI 0.79-0.97, P < 0.001) with an optimal cut-off of 1.2 L. CONCLUSIONS VO assessed by BIA is independently associated with WHF in stable outpatients with HFrEF at 3 months.
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Affiliation(s)
| | | | | | - Rocío Carda Barrio
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | | | | | - Marta López Castillo
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Bárbara Soler Bonafont
- Department of Internal Medicine, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Mónica Recio Vázquez
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Mikel Taibo Urquía
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - María González Piña
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
| | - Emilio González Parra
- Department of Nephrology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
| | - José Tuñón
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Álvaro Aceña
- Department of Cardiology, Fundación Jiménez Díaz University Hospital, Madrid, Spain
- Universidad Autónoma de Madrid, Madrid, Spain
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