201
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Jain SS, Liu Q, Raikhelkar J, Fried J, Elias P, Poterucha TJ, DeFilippis EM, Rosenblum H, Wang EY, Redfors B, Clerkin K, Griffin JM, Wan EY, Abdalla M, Bello NA, Hahn RT, Shimbo D, Weiner SD, Kirtane AJ, Kodali SK, Burkhoff D, Rabbani LE, Schwartz A, Leon MB, Homma S, Di Tullio MR, Sayer G, Uriel N, Anstey DE. Indications for and Findings on Transthoracic Echocardiography in COVID-19. J Am Soc Echocardiogr 2020; 33:1278-1284. [PMID: 32782131 PMCID: PMC7298489 DOI: 10.1016/j.echo.2020.06.009] [Citation(s) in RCA: 69] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/08/2020] [Accepted: 06/09/2020] [Indexed: 01/06/2023]
Abstract
Background Despite growing evidence of cardiovascular complications associated with coronavirus disease 2019 (COVID-19), there are few data regarding the performance of transthoracic echocardiography (TTE) and the spectrum of echocardiographic findings in this disease. Methods A retrospective analysis was performed among adult patients admitted to a quaternary care center in New York City between March 1 and April 3, 2020. Patients were included if they underwent TTE during the hospitalization after a known positive diagnosis for COVID-19. Demographic and clinical data were obtained using chart abstraction from the electronic medical record. Results Of 749 patients, 72 (9.6%) underwent TTE following positive results on severe acute respiratory syndrome coronavirus-2 polymerase chain reaction testing. The most common clinical indications for TTE were concern for a major acute cardiovascular event (45.8%) and hemodynamic instability (29.2%). Although most patients had preserved biventricular function, 34.7% were found to have left ventricular ejection fractions ≤ 50%, and 13.9% had at least moderately reduced right ventricular function. Four patients had wall motion abnormalities suggestive of stress-induced cardiomyopathy. Using Spearman rank correlation, there was an inverse relationship between high-sensitivity troponin T and left ventricular ejection fraction (ρ = −0.34, P = .006). Among 20 patients with prior echocardiograms, only two (10%) had new reductions in LVEF of >10%. Clinical management was changed in eight individuals (24.2%) in whom TTE was ordered for concern for acute major cardiovascular events and three (14.3%) in whom TTE was ordered for hemodynamic evaluation. Conclusions This study describes the clinical indications for use and diagnostic performance of TTE, as well as findings seen on TTE, in hospitalized patients with COVID-19. In appropriately selected patients, TTE can be an invaluable tool for guiding COVID-19 clinical management.
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Affiliation(s)
- Sneha S Jain
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Qi Liu
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jayant Raikhelkar
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Justin Fried
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Pierre Elias
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Timothy J Poterucha
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ersilia M DeFilippis
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Hannah Rosenblum
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elizabeth Y Wang
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Bjorn Redfors
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Kevin Clerkin
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Jan M Griffin
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Elaine Y Wan
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marwah Abdalla
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Natalie A Bello
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Rebecca T Hahn
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Daichi Shimbo
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Shepard D Weiner
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Ajay J Kirtane
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Susheel K Kodali
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Daniel Burkhoff
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - LeRoy E Rabbani
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Allan Schwartz
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Martin B Leon
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Shunichi Homma
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Marco R Di Tullio
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Gabriel Sayer
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
| | - Nir Uriel
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York.
| | - D Edmund Anstey
- Department of Medicine, Division of Cardiology, Columbia University Irving Medical Center, New York, New York
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202
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Sacubitril/Valsartan Improves Autonomic Function and Cardiopulmonary Parameters in Patients with Heart Failure with Reduced Ejection Fraction. J Clin Med 2020; 9:jcm9061897. [PMID: 32560431 PMCID: PMC7356720 DOI: 10.3390/jcm9061897] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/12/2020] [Accepted: 06/15/2020] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Heart rate recovery (HRR) is a marker of vagal tone, which is a powerful predictor of mortality in patients with cardiovascular disease. Sacubitril/valsartan (S/V) is a treatment for heart failure with reduced ejection fraction (HFrEF), which impressively impacts cardiovascular outcome. This study aims at evaluating the effects of S/V on HRR and its correlation with cardiopulmonary indexes in HFrEF patients. METHODS Patients with HFrEF admitted to outpatients' services were screened out for study inclusion. S/V was administered according to guidelines. Up-titration was performed every 4 weeks when tolerated. All patients underwent laboratory measurements, Doppler-echocardiography, and cardiopulmonary exercise stress testing (CPET) at baseline and at 12-month follow-up. RESULTS Study population consisted of 134 HFrEF patients (87% male, mean age 57.9 ± 9.6 years). At 12-month follow-up, significant improvement in left ventricular ejection fraction (from 28% ± 5.8% to 31.8% ± 7.3%, p < 0.0001), peak exercise oxygen consumption (VO2peak) (from 15.3 ± 3.7 to 17.8 ± 4.2 mL/kg/min, p < 0.0001), the slope of increase in ventilation over carbon dioxide output (VE/VCO2 slope )(from 33.4 ± 6.2 to 30.3 ± 6.5, p < 0.0001), and HRR (from 11.4 ± 9.5 to 17.4 ± 15.1 bpm, p = 0.004) was observed. Changes in HRR were significantly correlated to changes in VE/VCO2slope (r = -0.330; p = 0.003). After adjusting for potential confounding factors, multivariate analysis showed that changes in HRR were significantly associated to changes in VE/VCO2slope (Beta (B) = -0.975, standard error (SE) = 0.364, standardized Beta coefficient (Bstd) = -0.304, p = 0.009). S/V showed significant reduction in exercise oscillatory ventilation (EOV) detection at CPET (28 EOV detected at baseline CPET vs. 9 EOV detected at 12-month follow-up, p < 0.001). HRR at baseline CPET was a significant predictor of EOV at 12-month follow-up (B = -2.065, SE = 0.354, p < 0.001). CONCLUSIONS In HFrEF patients, S/V therapy improves autonomic function, functional capacity, and ventilation. Whether these findings might translate into beneficial effects on prognosis and outcome remains to be elucidated.
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203
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Vignon P. Continuous cardiac output assessment or serial echocardiography during septic shock resuscitation? ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:797. [PMID: 32647722 PMCID: PMC7333154 DOI: 10.21037/atm.2020.04.11] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Septic shock is the leading cause of cardiovascular failure in the intensive care unit (ICU). Cardiac output is a primary component of global oxygen delivery to organs and a sensitive parameter of cardiovascular failure. Any mismatch between oxygen delivery and rapidly varying metabolic demand may result in tissue dysoxia, hence organ dysfunction. Since the intricate alterations of both vascular and cardiac function may rapidly and widely change over time, cardiac output should be measured repeatedly to characterize the type of shock, select the appropriate therapeutic intervention, and evaluate patient's response to therapy. Among the numerous techniques commercially available for measuring cardiac output, transpulmonary thermodilution (TPT) provides a continuous monitoring with external calibration capability, whereas critical care echocardiography (CCE) offers serial hemodynamic assessments. CCE allows early identification of potential sources of inaccuracy of TPT, including right ventricular failure, severe tricuspid or left-sided regurgitations, intracardiac shunt, very low flow states, or dynamic left ventricular outflow tract obstruction. In addition, CCE has the unique advantage of depicting the distinct components generating left ventricular stroke volume (large cavity size vs. preserved contractility), providing information on left ventricular diastolic properties and filling pressures, and assessing pulmonary artery pressure. Since inotropes may have deleterious effects if misused, their initiation should be based on the documentation of a cardiac dysfunction at the origin of the low flow state by CCE. Experts widely advocate using CCE as a first-line modality to initially evaluate the hemodynamic profile associated with shock, as opposed to more invasive techniques. Repeated assessments of both the efficacy (amplitude of the positive response) and tolerance (absence of side-effect) of therapeutic interventions are required to best guide patient management. Overall, TPT allowing continuous tracking of cardiac output variations and CCE appear complementary rather than mutually exclusive in patients with septic shock who require advanced hemodynamic monitoring.
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Affiliation(s)
- Philippe Vignon
- Medical-Surgical Intensive Care Unit, Dupuytren Teaching hospital, Limoges, France.,Inserm CIC 1435, Dupuytren Teaching hospital, Limoges, France.,Faculty of Medicine, University of Limoges, Limoges, France
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204
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Blanco P. Left ventricular outflow tract velocity-time integral: A proper measurement technique is mandatory. Vasc Med 2020; 25:283-284. [DOI: 10.1177/1358863x20907700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Pablo Blanco
- Intensive Care Unit, Clínica Cruz Azul, Necochea, Buenos Aires, Argentina
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205
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Ling HZ, Gallardo-Arozena M, Company-Calabuig AM, Nicolaides KH, Kametas NA. Clinical validation of bioreactance for the measurement of cardiac output in pregnancy. Anaesthesia 2020; 75:1307-1313. [PMID: 32469423 DOI: 10.1111/anae.15110] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2020] [Indexed: 11/27/2022]
Abstract
Maternal cardiac dysfunction is associated with pre-eclampsia, fetal growth restriction and haemodynamic instability during obstetric anaesthesia. There is growing interest in the use of non-invasive cardiac output monitoring to guide antihypertensive and fluid therapies in obstetrics. The aim of this study was to validate thoracic bioreactance using the NICOM® instrument against transthoracic echocardiography in pregnant women, and to assess the effects of maternal characteristics on the absolute difference of stroke volume, cardiac output and heart rate. We performed a prospective study involving women with singleton pregnancies in each trimester. We recruited 56 women who were between 11 and 14 weeks gestation, 57 between 20 and 23 weeks, and 53 between 35 and 37 weeks. Cardiac output was assessed repeatedly and simultaneously over 5 min in the left lateral position with NICOM and echocardiography. The performance of NICOM was assessed by calculating bias, 95% limits of agreement and mean percentage difference relative to echocardiography. Multivariate regression analysis evaluated the effect of maternal characteristics on the absolute difference between echocardiography and NICOM. The mean percentage difference of cardiac output measurements between the two methods was ±17%, with mean bias of -0.13 l.min-1 and limits of agreement of -1.1 to 0.84; stroke volume measurements had a mean percentage difference of ±15%, with a mean bias of -0.8 ml (-10.9 to 12.6); and heart rate measurements had a mean percentage difference of ±6%, with a mean bias of -2.4 beats.min-1 (-6.9 to 2.0). Similar results were found when the analyses were confined to each individual trimester. The absolute difference between NICOM and echocardiography was not affected by maternal age, weight, height, race, systolic or diastolic blood pressure. In conclusion, NICOM demonstrated good agreement with echocardiography, and can be used in pregnancy for the measurement of cardiac function.
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Affiliation(s)
- H Z Ling
- Department of Maternal-Fetal Medicine, Fetal Medicine Research Institute, King's College London, UK
| | - M Gallardo-Arozena
- Department of Maternal-Fetal Medicine, Fetal Medicine Research Institute, King's College London, UK
| | - A M Company-Calabuig
- Department of Maternal-Fetal Medicine, Fetal Medicine Research Institute, King's College London, UK
| | - K H Nicolaides
- Department of Maternal-Fetal Medicine, Fetal Medicine Research Institute, King's College London, UK
| | - N A Kametas
- Department of Maternal-Fetal Medicine, Fetal Medicine Research Institute, King's College London, UK
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206
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Lee JY, Fagan KA, Zhou C, Batten L, Cohen MV, Stevens T. Biventricular diastolic dysfunction, thrombocytopenia, and red blood cell macrocytosis in experimental pulmonary arterial hypertension. Pulm Circ 2020; 10:2045894020908787. [PMID: 32518619 PMCID: PMC7252389 DOI: 10.1177/2045894020908787] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Accepted: 02/01/2020] [Indexed: 01/16/2023] Open
Abstract
Pulmonary arterial hypertension is a fatal disease, where death is associated with right heart failure and reduced cardiorespiratory reserve. The Sugen 5416, hypoxia and normoxia Fischer rat model mimics human pulmonary arterial hypertension, although the cause(s) of death remains incompletely understood. Here, we hypothesized that these animals develop biventricular diastolic dysfunction that contributes to tissue hypoperfusion coincident with severe pulmonary arterial hypertension. We performed comprehensive echocardiographic and hematologic assessments. Serial echocardiogram at 3-5 weeks was performed followed by blood sampling via aortic or cardiac puncture. Echocardiogram revealed pulmonary arterial hypertension in pulmonary artery Doppler waves, including notched wave envelopes, and decreased pulmonary artery acceleration time/pulmonary artery ejection time ratio and right ventricular outflow tract velocity time integral. Impaired right ventricular systolic function, assessed by decreased tricuspid annular plane systolic excursion and tricuspid tissue Doppler systolic positive wave velocity, was observed in pulmonary arterial hypertension. Tricuspid and mitral pulsed wave and tissue Doppler findings suggested biventricular diastolic dysfunction, with dynamic changes in early and late diastolic filling waves, their fusion patterns, and a decrease in e' velocity. Heart rate and ejection fraction did not change, but cardiac output, stroke volume, and end-diastolic volume were decreased, and inferior vena cava respiratory variation was decreased. Blood electrolyte values were suggestive of intravascular volume expansion early in the disease followed by volume contraction and tissue hypoperfusion in the latter stages of disease. Complete blood count showed thrombocytopenia and non-anemic macrocytosis with reticulocytosis and an increase in red blood cell distribution width. Thus, pulmonary, cardiac, and hematological findings in Fischer animals with pulmonary arterial hypertension are characteristic of humans and provide an insightful experimental platform to resolve mechanisms of disease progression.
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Affiliation(s)
- Ji Young Lee
- Department of Physiology and Cell Biology, University of South Alabama, Mobile, AL, USA.,Department of Internal Medicine, University of South Alabama, Mobile, AL, USA.,Division of Pulmonary and Critical Care Medicine, University of South Alabama, Mobile, AL, USA.,Center for Lung Biology, University of South Alabama, Mobile, AL, USA
| | - Karen A Fagan
- Department of Internal Medicine, University of South Alabama, Mobile, AL, USA.,Division of Pulmonary and Critical Care Medicine, University of South Alabama, Mobile, AL, USA.,Center for Lung Biology, University of South Alabama, Mobile, AL, USA.,Department of Pharmacology, University of South Alabama, Mobile, AL, USA
| | - Chun Zhou
- Department of Physiology and Cell Biology, University of South Alabama, Mobile, AL, USA.,Center for Lung Biology, University of South Alabama, Mobile, AL, USA
| | - Lynn Batten
- Department of Physiology and Cell Biology, University of South Alabama, Mobile, AL, USA.,Department of Internal Medicine, University of South Alabama, Mobile, AL, USA.,Center for Lung Biology, University of South Alabama, Mobile, AL, USA.,Department of Pediatrics, University of South Alabama, Mobile, AL, USA
| | - Michael V Cohen
- Department of Physiology and Cell Biology, University of South Alabama, Mobile, AL, USA.,Department of Internal Medicine, University of South Alabama, Mobile, AL, USA.,Center for Lung Biology, University of South Alabama, Mobile, AL, USA.,Division of Cardiology, University of South Alabama, Mobile, AL, USA
| | - Troy Stevens
- Department of Physiology and Cell Biology, University of South Alabama, Mobile, AL, USA.,Department of Internal Medicine, University of South Alabama, Mobile, AL, USA.,Center for Lung Biology, University of South Alabama, Mobile, AL, USA
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207
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Borland M, Bergfeldt L, Nordeman L, Bollano E, Andersson L, Rosenkvist A, Jakobsson M, Olsson K, Corin M, Landh L, Grüner Sveälv B, Scharin Täng M, Philip Wigh J, Lundwall A, Cider Å. Exercise‐based cardiac rehabilitation improves physical fitness in patients with permanent atrial fibrillation – A randomized controlled study. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Maria Borland
- Närhälsan Sörhaga Rehabilitation Center Alingsås Sweden
- Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg Boraas Sweden
- Department of Health and Rehabilitation/Physiotherapy Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Lennart Bergfeldt
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Lena Nordeman
- Region Västra Götaland, Research and Development Primary Health Care, Research and Development Center Södra Älvsborg Boraas Sweden
- Department of Health and Rehabilitation/Physiotherapy Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
| | - Entela Bollano
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Cardiology Sahlgrenska University Hospital Gothenburg Sweden
| | | | | | - Marika Jakobsson
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
| | - Kristin Olsson
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
| | | | | | - Bente Grüner Sveälv
- Department of Molecular and Clinical Medicine Institute of Medicine Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | | | - Julia Philip Wigh
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
| | - Adam Lundwall
- Habo Health Center Bra Liv Health Center Habo Sweden
| | - Åsa Cider
- Department of Health and Rehabilitation/Physiotherapy Institute of Neuroscience and Physiology Sahlgrenska AcademyUniversity of Gothenburg Gothenburg Sweden
- Department of Occupational therapy and Physiotherapy Sahlgrenska University Hospital Gothenburg Sweden
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208
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Hughes AD, Park C, Ramakrishnan A, Mayet J, Chaturvedi N, Parker KH. Feasibility of Estimation of Aortic Wave Intensity Using Non-invasive Pressure Recordings in the Absence of Flow Velocity in Man. Front Physiol 2020; 11:550. [PMID: 32528317 PMCID: PMC7260344 DOI: 10.3389/fphys.2020.00550] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 04/30/2020] [Indexed: 01/09/2023] Open
Abstract
Background Wave intensity analysis provides valuable information on ventriculo-arterial function, hemodynamics, and energy transfer in the arterial circulation. Widespread use of wave intensity analysis is limited by the need for concurrent measurement of pressure and flow waveforms. We describe a method that can estimate wave intensity patterns using only non-invasive pressure waveforms (pWIA). Methods Radial artery pressure and left ventricular outflow tract (LVOT) flow velocity waveforms were recorded in 12 participants in the Southall and Brent Revisited (SABRE) study. Pressure waveforms were analyzed using custom-written software to derive the excess pressure (Pxs) which was scaled to peak LVOT velocity and used to calculate wave intensity. These data were compared with wave intensity calculated using the measured LVOT flow velocity waveform. In a separate study, repeat measures of pWIA were performed on 34 individuals who attended two clinic visits at an interval of ≈1 month to assess reproducibility and reliability of the method. Results Pxs waveforms were similar in shape to aortic flow velocity waveforms and the time of peak Pxs and peak aortic velocity agreed closely. Wave intensity estimated using pWIA showed acceptable agreement with estimates using LVOT velocity tracings and estimates of wave intensity were similar to values reported previously in the literature. The method showed fair to good reproducibility for most parameters. Conclusion The Pxs is a surrogate of LVOT flow velocity which, when appropriately scaled, allows estimation of aortic wave intensity with acceptable reproducibility. This may enable wider application of wave intensity analysis to large studies.
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Affiliation(s)
- Alun D Hughes
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Chloe Park
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Anenta Ramakrishnan
- Cardiovascular Division, Faculty of Medicine, Imperial College London, National Heart & Lung Institute, London, United Kingdom.,Department of Bioengineering, Imperial College London, London, United Kingdom
| | - Jamil Mayet
- Cardiovascular Division, Faculty of Medicine, Imperial College London, National Heart & Lung Institute, London, United Kingdom
| | - Nish Chaturvedi
- Medical Research Council Unit for Lifelong Health and Ageing at UCL, Department of Population Science & Experimental Medicine, Faculty of Population Health Sciences, Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Kim H Parker
- Department of Bioengineering, Imperial College London, London, United Kingdom
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209
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Prado Díaz S, Calle M, Valbuena‐López SC, Montoro López N, Merás Colunga P, Bartha JL, Guzmán‐Martínez G. Does the right ventricle experiment morphologic and functional changes similarly to the left ventricle during pregnancy? Echocardiography 2020; 37:850-857. [DOI: 10.1111/echo.14678] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 03/16/2020] [Accepted: 04/17/2020] [Indexed: 12/12/2022] Open
Affiliation(s)
- Susana Prado Díaz
- Cardiology Department Ramón y Cajal University Hospital Madrid Spain
| | - María Calle
- Obstetrics and Gynecology Department La Paz University Hospital Madrid Spain
| | | | | | | | - Jose Luis Bartha
- Obstetrics and Gynecology Department La Paz University Hospital Madrid Spain
| | - Gabriela Guzmán‐Martínez
- Cardiology Department La Paz University Hospital Madrid Spain
- Spanish National Center of Cardiovascular Research (CNIC) Madrid Spain
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210
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Zacchigna S, Paldino A, Falcão-Pires I, Daskalopoulos EP, Dal Ferro M, Vodret S, Lesizza P, Cannatà A, Miranda-Silva D, Lourenço AP, Pinamonti B, Sinagra G, Weinberger F, Eschenhagen T, Carrier L, Kehat I, Tocchetti CG, Russo M, Ghigo A, Cimino J, Hirsch E, Dawson D, Ciccarelli M, Oliveti M, Linke WA, Cuijpers I, Heymans S, Hamdani N, de Boer M, Duncker DJ, Kuster D, van der Velden J, Beauloye C, Bertrand L, Mayr M, Giacca M, Leuschner F, Backs J, Thum T. Towards standardization of echocardiography for the evaluation of left ventricular function in adult rodents: a position paper of the ESC Working Group on Myocardial Function. Cardiovasc Res 2020; 117:43-59. [PMID: 32365197 DOI: 10.1093/cvr/cvaa110] [Citation(s) in RCA: 78] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 01/28/2020] [Accepted: 04/24/2020] [Indexed: 12/11/2022] Open
Abstract
Echocardiography is a reliable and reproducible method to assess non-invasively cardiac function in clinical and experimental research. Significant progress in the development of echocardiographic equipment and transducers has led to the successful translation of this methodology from humans to rodents, allowing for the scoring of disease severity and progression, testing of new drugs, and monitoring cardiac function in genetically modified or pharmacologically treated animals. However, as yet, there is no standardization in the procedure to acquire echocardiographic measurements in small animals. This position paper focuses on the appropriate acquisition and analysis of echocardiographic parameters in adult mice and rats, and provides reference values, representative images, and videos for the accurate and reproducible quantification of left ventricular function in healthy and pathological conditions.
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Affiliation(s)
- Serena Zacchigna
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy.,International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Alessia Paldino
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Inês Falcão-Pires
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Evangelos P Daskalopoulos
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels
| | - Matteo Dal Ferro
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Simone Vodret
- International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy
| | - Pierluigi Lesizza
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Antonio Cannatà
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Daniela Miranda-Silva
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - André P Lourenço
- Cardiovascular Research and Development Center, Faculty of Medicine, University of Porto, Porto, Portugal
| | - Bruno Pinamonti
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Gianfranco Sinagra
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy
| | - Florian Weinberger
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Thomas Eschenhagen
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Lucie Carrier
- Institute of Experimental Pharmacology and Toxicology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lübeck, Germany
| | - Izhak Kehat
- Department of Physiology, Biophysics and System Biology, The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Carlo G Tocchetti
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Interdepartmental Center of Clinical and Translational Research (CIRCET), Federico II University, Naples, Italy
| | - Michele Russo
- Department of Translational Medical Sciences, Federico II University, Naples, Italy.,Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Alessandra Ghigo
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - James Cimino
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Emilio Hirsch
- Department of Molecular Biotechnology and Health Sciences, Molecular Biotechnology Center, University of Torino, Torino, Italy
| | - Dana Dawson
- School of Medicine and Dentistry, University of Aberdeen, Aberdeen, UK
| | | | | | - Wolfgang A Linke
- Institute of Physiology 2, University of Muenster, Muenster, Germany
| | - Ilona Cuijpers
- Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Center of Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Stephane Heymans
- Maastricht University Medical Centre, Maastricht University, Maastricht, The Netherlands.,Center of Molecular and Vascular Biology (CMVB), KU Leuven, Leuven, Belgium
| | - Nazha Hamdani
- Department of Molecular and Experimental Cardiology, Division Cardiology, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany.,Institute of Physiology, Ruhr University Bochum, Bochum, Germany
| | - Martine de Boer
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dirk J Duncker
- Division of Experimental Cardiology, Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Diederik Kuster
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Jolanda van der Velden
- Department of Physiology, Amsterdam UMC, Vrije Universiteit, Amsterdam Cardiovascular Sciences Institute, Amsterdam, The Netherlands
| | - Christophe Beauloye
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels.,Division of Cardiology, Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luc Bertrand
- Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain (UCLouvain), Belgium, Brussels
| | - Manuel Mayr
- King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Mauro Giacca
- Department of Medicine, Surgery and Health Sciences and Cardiovascular Department, Centre for Translational Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina, strada di Fiume 447, 34149 Trieste (TS), Italy.,International Center for Genetic Engineering and Biotechnology (ICGEB), Trieste, Italy.,King's College London, British Heart Foundation Centre of Research Excellence, School of Cardiovascular Medicine & Sciences, London, UK
| | - Florian Leuschner
- Institute of Experimental Cardiology, Department of Cardiology, Angiology & Pulmology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Johannes Backs
- Institute of Experimental Cardiology, Department of Cardiology, Angiology & Pulmology, Heidelberg University Hospital, Heidelberg, Germany.,DZHK (German Centre for Cardiovascular Research), partner site Heidelberg/Mannheim, Heidelberg, Germany
| | - Thomas Thum
- Institute for Molecular and Translational Therapeutic Strategies (IMTTS), Hannover Medical School, Hannover, Germany.,REBIRTH Center for Translational Regenerative Medicine, Hannover Medical School, Hannover, Germany
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211
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Mishra S, Sharma R. Proposed method for evaluation and categorization of functional capacity of children, adolescents, and adults with cardiac diseases to bring them in existing social justice system by creating the cardiac disability criteria. Indian J Thorac Cardiovasc Surg 2020; 36:207-225. [PMID: 33061127 PMCID: PMC7525653 DOI: 10.1007/s12055-019-00895-y] [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: 01/19/2019] [Revised: 08/20/2019] [Accepted: 09/01/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Emerging epidemiological trends in India indicate the rising burden of cardiovascular diseases (CVDs) demanding a need of a social support system. Yet, the list of 21 benchmark disabilities notified by the Department of Empowerment of Persons with Disabilities, Ministry of Social Justice and Empowerment, Government of India, does not include CVDs under the newly enacted Rights of Persons with Disabilities (RPWD) Act, 2016. While the RPWD Act 2016 has acknowledged the dynamic nature of disabilities associated with congenital diseases like thalassemia, it has also provided an opportunity to bring in "cardiac disability" under its tenets. This would allow India to adopt strategies for the benefit of cardiac patients in accordance with policies adopted by developed countries such as the United States of America (USA), the United Kingdom of Great Britain (UK), and Canada. This document is to initiate a thought process of recruitment of cardiac patients in the social justice system. AIMS AND OBJECTIVES (1) To define cardiac disability, (2) to categorize cardiac diseases/defects (groups A-C) according to severity and need for interventions, (3) to identify operated and unoperated patients with normal functional capacity and their eligibility to avail normal opportunities similar to their peer groups, (4) to create a comprehensive cardiac disability scoring (CCDS) system for disability certification based on subjective and objective evaluation of functional capacity and the corresponding heart disease category group, and (5) to create a reference literature for the issues of education, employability, insurability, and vocational counseling based on this document. METHODOLOGY The evolution of this manuscript has been discussed in view of relevant observations made by a team of cardiologists, cardiac surgeons, intensivists, pediatricians, social workers, etc. CONCLUSION This manuscript suggests a CCDS system to lay down criteria for disability status for eligible patients suffering from cardiovascular diseases. It intends to offer a unique scientific tool to address the psychosocial and socio-economic bias against patients with heart diseases of heterogeneous nature.
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Affiliation(s)
- Smita Mishra
- Department of Pediatric Cardiology, Manipal Hospital, Dwarka Sector 6, Delhi, India
| | - Rajesh Sharma
- Paediatric Cardiac Surgery, Jaypee Hospital, Sector 128, Noida, UP India
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212
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Mele D, Pestelli G, Dini FL, Dal Molin D, Smarrazzo V, Trevisan F, Luisi GA, Ferrari R. Novel Echocardiographic Approach to Hemodynamic Phenotypes Predicts Outcome of Patients Hospitalized With Heart Failure. Circ Cardiovasc Imaging 2020; 13:e009939. [PMID: 32312116 DOI: 10.1161/circimaging.119.009939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Although in clinical practice heart failure (HF) patients are classified using left ventricular ejection fraction (LVEF), this categorization is insufficient for prognosis, especially when LVEF is preserved or there is a concomitant right ventricular (RV) dysfunction. We hypothesized that a combined noninvasive evaluation of LV forward flow, filling pressure, and RV function would be better than LVEF in predicting all-cause mortality of hospitalized patients with HF. METHODS Transthoracic echocardiographic examinations of 603 patients hospitalized with HF were analyzed. In a subsample of 200 patients with HF, LV stroke volume index, LV filling pressure estimation, tricuspid annular plane systolic excursion, and systolic pulmonary artery pressure were combined to determine 4 hemodynamic profiles: normal flow-normal pressure, normal flow-high pressure, low flow without RV dysfunction, and low flow with RV dysfunction profile. This model was then applied in a validation cohort (n=403). RESULTS Prognosis worsened from the normal flow-normal pressure profile to the low flow with right ventricular dysfunction profile. At the multivariate survival analysis, the model showed independent high risk-stratification capability (P<0.001), even in subgroups of patients with LVEF < or ≥50% (P=0.011 and P<0.001, respectively) and < or ≥40% (P=0.044 and P<0.001, respectively). LVEF and HF classification based on LVEF did not predict outcome. CONCLUSIONS Echocardiographic-derived profiling of LV forward flow, filling pressure, and RV function allowed categorization of patients hospitalized with HF and predicted all-cause mortality independently of LVEF. This model is based on conventional echocardiography, is easy to apply, and is, therefore, suggested for clinical practice.
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Affiliation(s)
- Donato Mele
- Cardiology Unit and LTTA Centre, University of Ferrara, Italy (D.M., G.P., D.D.M., V.S., F.T., G.A.L., R.F.)
| | - Gabriele Pestelli
- Cardiology Unit and LTTA Centre, University of Ferrara, Italy (D.M., G.P., D.D.M., V.S., F.T., G.A.L., R.F.)
| | - Frank Lloyd Dini
- Cardiovascular Diseases Unit 1, Cardiovascular and Thoracic Department, University of Pisa, Italy (F.L.D.)
| | - Davide Dal Molin
- Cardiology Unit and LTTA Centre, University of Ferrara, Italy (D.M., G.P., D.D.M., V.S., F.T., G.A.L., R.F.)
| | - Vittorio Smarrazzo
- Cardiology Unit and LTTA Centre, University of Ferrara, Italy (D.M., G.P., D.D.M., V.S., F.T., G.A.L., R.F.)
| | - Filippo Trevisan
- Cardiology Unit and LTTA Centre, University of Ferrara, Italy (D.M., G.P., D.D.M., V.S., F.T., G.A.L., R.F.)
| | - Giovanni Andrea Luisi
- Cardiology Unit and LTTA Centre, University of Ferrara, Italy (D.M., G.P., D.D.M., V.S., F.T., G.A.L., R.F.)
| | - Roberto Ferrari
- Cardiology Unit and LTTA Centre, University of Ferrara, Italy (D.M., G.P., D.D.M., V.S., F.T., G.A.L., R.F.).,Maria Cecilia Hospital, GVM Care & Research, E.S. Health Science Foundation, Cotignola (RA), Italy (R.F.)
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213
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Spampinato RA, Jahnke C, Paetsch I, Hilbert S, Löbe S, Lindemann F, Strotdrees E, Hindricks G, Borger MA. Grading of aortic regurgitation by cardiovascular magnetic resonance and pulsed Doppler of the left subclavian artery: harmonizing grading scales between imaging modalities. Int J Cardiovasc Imaging 2020; 36:1517-1526. [PMID: 32306157 PMCID: PMC7381459 DOI: 10.1007/s10554-020-01844-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 04/06/2020] [Indexed: 11/30/2022]
Abstract
Transthoracic echocardiography (TTE) and cardiac magnetic resonance (CMR) are current standard for assessing aortic regurgitation (AR). Regurgitant fraction (RF) can also be estimated by Doppler examination of the left subclavian artery (LSA-Doppler). However, a comparison of AR grading scales using these methods and a TTE multiparametric approach as reference is lacking. We evaluated the severity of AR in 73 patients (58 ± 15 years; 57 men), with a wide spectrum of AR of the native valve. Using a recommended TTE multiparametric approach the AR was divided in none/trace (n = 12), mild (n = 23), moderate (n = 12), and severe (n = 26). RF was evaluated by LSA-Doppler (ratio between diastolic and systolic velocity–time integrals) and by CMR phase-contrast imaging (performed in the aorta 1 cm above the aortic valve); the grading scales were then calculated. There were a good correlation between all methods, but mean RF values were greater with TTE compared with LSA-Doppler and CMR (39 ± 16% vs. 35 ± 18% vs. 32 ± 20%, respectively; p < 0.037). Mean differences in RF values between methods were significant in the groups with mild and moderate AR. Grading scales that best defined the TTE derived AR severity using CMR were: mild, < 21%; moderate, 22 to 41%; and severe, > 42%; and using LSA-Doppler: mild, < 29%; moderate, 30 to 44%; and severe, > 45%. RF values for AR grading using TTE, LSA-Doppler and CMR correlate well but differ in groups with mild and moderate AR when using a recognized multiparametric echocardiographic approach. Clinical prospective studies should validate these proposed modality adjusted grading scales.
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Affiliation(s)
- Ricardo A Spampinato
- Department of Cardiac Surgery, University of Leipzig - HELIOS Heart Center, Strümpellstraße 39, 04289, Leipzig, Germany.
| | - Cosima Jahnke
- Department of Cardiology/Rhythmology, University Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Ingo Paetsch
- Department of Cardiology/Rhythmology, University Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Sebastian Hilbert
- Department of Cardiology/Rhythmology, University Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Susanne Löbe
- Department of Cardiology/Rhythmology, University Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Frank Lindemann
- Department of Cardiology/Rhythmology, University Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Elfriede Strotdrees
- Department of Cardiac Surgery, University of Leipzig - HELIOS Heart Center, Strümpellstraße 39, 04289, Leipzig, Germany
| | - Gerhard Hindricks
- Department of Cardiology/Rhythmology, University Leipzig - HELIOS Heart Center, Leipzig, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, University of Leipzig - HELIOS Heart Center, Strümpellstraße 39, 04289, Leipzig, Germany
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Daimon A, Goda A, Masai K, Soyama Y, Asakura M, Ishihara M, Masuyama T, Mano T. Clinical Significance and Prognostic Value of Novel Echocardiographic Index for the Severity of Mitral Regurgitation. Circ Rep 2020; 2:330-338. [PMID: 33693248 PMCID: PMC7925328 DOI: 10.1253/circrep.cr-20-0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background:
Recently, the left ventricular early inflow-outflow index (LVEIO), calculated by dividing mitral E-wave velocity by the left ventricular outflow velocity time integral, has been proposed as a simple method for evaluating mitral regurgitation (MR). This study determined the optimal LVEIO threshold to assess severe MR with different etiologies and assessed its prognostic value. Methods and Results:
The records of 18,692 consecutive patients who underwent echocardiography were reviewed. MR was classified into 4 groups: Grade 0/1, no, trivial, or mild MR; Grade 2, moderate MR; Grade 3, moderate to severe MR; and Grade 4, severe MR. The mean (±SD) LVEIO of Grades 0/1, 2, 3, and 4 was 3.6±1.4, 6.0±2.5, 7.4±3.1, and 9.5±2.8, respectively. An optimal LVEIO threshold of 5.4 was determined to distinguish moderate to severe or severe MR from non-severe MR (sensitivity 84%, specificity 91%). Kaplan-Meier survival analysis revealed high mortality in the group with LVEIO ≥5.4 (P=0.009, hazard ratio 1.833). This was found only in primary MR when separate analyses were performed according to etiology. Multivariate analysis revealed that LVEIO was an independent predictor for all-cause death only in primary MR. Conclusions:
Using appropriate thresholds, LVEIO is a simple and useful method to diagnose severe MR regardless of etiology. LVEIO can also be useful for predicting prognosis in primary MR.
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Affiliation(s)
- Aika Daimon
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
| | - Akiko Goda
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
| | - Kumiko Masai
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
| | - Yuko Soyama
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
| | - Masanori Asakura
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
| | - Masaharu Ishihara
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
| | - Tohru Masuyama
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
| | - Toshiaki Mano
- Department of Internal Medicine, Cardiovascular Division, Hyogo College of Medicine Nishinomiya Japan
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Usalp S, Kemal H, Yüksek Ü, Yaman B, Günsel A, Edebal O, Akpınar O, Cerit L, Duygu H. Is there any link between vitamin D deficiency and vasovagal syncope? J Arrhythm 2020; 36:371-376. [PMID: 32256891 PMCID: PMC7132194 DOI: 10.1002/joa3.12309] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 01/06/2020] [Accepted: 01/20/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND This study aimed to investigate serum 25[OH]D levels between patients with vasovagal syncope (VVS) diagnosed with head-up tilt table test (HUTT) and age-matched healthy people. METHODS The study included 75 consecutive patients (32.3 ± 10.7 years), who presented with syncope and underwent HUTT and 52 healthy controls (32.9 ± 14.1 years). HUTT patients were divided into two groups according to whether there was syncope response to the test. Patients underwent cardiac, psychiatric, and neurological investigation. Serum 25[OH]D levels were measured by chemiluminescent microparticle immunoassay method. RESULTS There was no difference between the two groups in terms of age, gender, body mass index (BMI), echocardiographic findings (P > .05). Mean serum 25[OH]D (24.5 ± 6.3 vs 20.1 ± 8.8 ng/mL, P = .003) and vitamin B12 levels (436.4 ± 199.2 vs 363.1 ± 107.6 pg/mL, P = .009) was lower in syncope patients when compared to the control group. In correlation analyses, syncope was shown as correlated with the vitamin D (r = -264, P = .003) and vitamin B12 levels (r = -233, P = .009). But, multivariate regression analyses showed that only vitamin D increased risk of syncope [OR: 0.946, 95% CI (0.901-0.994)]. There was no difference in terms of age, gender, BMI, echocardiographic findings between the in HUTT positive (n = 45) and negative groups (n = 29). Only vitamin D level was significantly lower in HUTT positive group (17.5 ± 7.7 vs 24.4 ± 9.1 ng/mL, P = .002). There was no difference among in the vasovagal subgroups in terms of vitamin D level and other features. CONCLUSION Vitamin D and B12 levels were reasonably low in syncope patients, but especially low Vitamin D levels were associated with VVS diagnosed in HUTT.
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Affiliation(s)
- Songül Usalp
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
| | - Hatice Kemal
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
| | - Ümit Yüksek
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
| | - Belma Yaman
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
| | - Aziz Günsel
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
| | - Oğuzhan Edebal
- Department of Clinical BiochemistryNear East University Faculty of MedicineNicosiaCyprus
| | - Onur Akpınar
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
| | - Levent Cerit
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
| | - Hamza Duygu
- Department of CardiologyNear East University Faculty of MedicineNicosiaCyprus
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216
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Duran M, Ziyrek M. Effect of Obesity on Pulmonary Vascular Hemodynamics. J Cardiovasc Echogr 2020; 30:75-81. [PMID: 33282644 PMCID: PMC7706374 DOI: 10.4103/jcecho.jcecho_70_19] [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: 12/15/2019] [Revised: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 11/28/2022] Open
Abstract
CONTEXT Obesity-related pulmonary arterial hypertension (PAH) is associated with hypoxia and metabolic abnormalities. Although right heart catheterization is the gold standard method for the diagnosis of PAH, Doppler echocardiography is more common. On the other hand, there is no definite echocardiographic parameter for PAH diagnosis. Novel echocardiographic parameter, pulmonary pulse transit time (pPTT), is assumed to be a surrogate marker for the assessment of PAH. AIMS The aim was to evaluate whether pPTT might be valuable for evaluating pulmonary vascular hemodynamics in obese patients. SETTINGS AND DESIGN A cross-sectional observational study. METHODS A total of 130 consecutive obese patients and 50 controls were included. Obese patients were divided into three groups according to body mass index (BMI): 25 < BMI <30 kg/m2 formed Group 1, 30 < BMI <35 kg/m2 formed Group 2, and 35 STATISTICAL ANALYSIS USED Intergroup differences were analyzed with analysis of variance or Kruskal-Wallis test. Pearson's or Spearman's correlation analysis was used for correlation, multivariate logistic regression analysis, and regression. RESULTS Statistically significant reduction in pPTT was detected as early as in the first group (361.24 ± 25.54 vs. 391.26 ± 15.07; P = 0.015) and continued throughout Groups 2 and 3 (299.92 ± 35.10 vs. 391.26 ± 15.07; P < 0.0001, and 245.46 ± 11.25 vs. 391.26 ± 15.07; P < 0.0001, respectively). There was a strong negative correlation between pPTT and BMI (r = -0.848, P = 0.001). On linear regression analysis, BMI was found to be an independent risk factor for pPTT (confidence interval: -9.164-6.379, β = -0.525, P = 0.0001). CONCLUSION The results of this study suggest that obesity leads to an increase in PAH, and pPTT allows noninvasive determination of the pulmonary hemodynamics in obese patients. pPTT might be a useful parameter in terms of predicting pulmonary hemodynamics and vascular alterations in obese patients. Further studies are warranted to evaluate the association between obesity and PAH.
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Affiliation(s)
- Mustafa Duran
- Department of Cardiology, Konya Education and Research Hospital, Konya, Turkey
| | - Murat Ziyrek
- Department of Cardiology, Konya Education and Research Hospital, Konya, Turkey
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217
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Haberman D, Chernin G, Meledin V, Zikry M, Shuvy M, Gandelman G, Goland S, George J, Shimoni S. Urea level is an independent predictor of mortality in patients with severe aortic valve stenosis. PLoS One 2020; 15:e0230002. [PMID: 32160250 PMCID: PMC7065786 DOI: 10.1371/journal.pone.0230002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Accepted: 02/19/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction Severe aortic stenosis (AS) is the most common valvular heart disease in the western world. Various factors are related to severe AS prognosis, including chronic kidney disease. The aim of this study was to evaluate the prognostic value of urea level in patients with severe AS. Methods We prospectively enrolled 142 patients (79.1±9.4 years, 88 women) with severe AS (mean valve area 0.67± 0.17 cm2). Clinical assessment, blood tests and echocardiography were performed at enrollment and follow up. The patient population was divided into low and high urea level groups, according to the median urea level at enrollment (72 patients, mean urea 35.5±6.2 mg/dL and 70 patients, mean urea 61.1±17.8 mg/dL, respectively). Hundred and twelve patients (79%) underwent aortic valve intervention. The primary endpoint was all-cause and cardiovascular mortality. Outcomes During follow-up of 37±19.5 months, 56 (37.1%) patients died, 39 due to cardiovascular causes. In univariate analysis, age, urea level, creatinine, New York Heart Association (NYHA) class and aortic valve intervention were associated with all-cause mortality. However, in multivariate analysis only aortic valve intervention and blood urea were independent predictors of all-cause mortality (HR 0.494; 95% CI 0.226–0.918, P = 0.026 and HR 1.015; 95% CI 1.003–1.029, P = 0.046 respectively). Urea level, NYHA class and age were also significant predictors of cardiovascular mortality. Whereas, in multivariate analysis, only urea level predicted cardiovascular mortality in these patients (HR 1.017; CI 1.003–1.031 P = 0.019). Conclusions Blood urea, a generally readily available and routinely determined marker of renal function, is an independent prognostic factor in patients with severe AS.
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Affiliation(s)
- Dan Haberman
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
- * E-mail:
| | - Gil Chernin
- Nephrology Department Kaplan Medical Center, Rehovot, Israel
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel
| | - Valery Meledin
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Meital Zikry
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Mony Shuvy
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
- Heart Institute, Hadassah Medical Center, Jerusalem, Israel
| | - Gera Gandelman
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Sorel Goland
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Jacob George
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
| | - Sara Shimoni
- The Heart Institute, Kaplan Medical Center, Rehovot, Israel
- Hebrew University and Hadassah Medical School, Jerusalem, Israel
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218
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Canada JM, Thomas GK, Trankle CR, Carbone S, Billingsley H, Van Tassell BW, Evans RK, Garten R, Weiss E, Abbate A. Increased C-reactive protein is associated with the severity of thoracic radiotherapy-induced cardiomyopathy. CARDIO-ONCOLOGY (LONDON, ENGLAND) 2020; 6:2. [PMID: 32154028 PMCID: PMC7048115 DOI: 10.1186/s40959-020-0058-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 02/03/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Irradiation of the heart during cancer radiotherapy is associated with a dose-dependent risk of heart failure. Animal studies have demonstrated that irradiation leads to an inflammatory response within the heart as well as a reduction in cardiac reserve. In the current study we aimed to evaluate whether inflammatory biomarkers correlated with changes in cardiac function and reserve after radiotherapy for breast or lung cancer. METHODS AND RESULTS We studied 25 subjects with a history of breast or lung cancer without a prior diagnosis of cardiovascular disease or heart failure, 1.8 years [0.4-3.6] post-radiotherapy involving at least 5 Gray (Gy) to at least 10% of the heart. High-sensitivity C-reactive protein (CRP) was abnormal (≥2 mg/L) in 16 (64%) subjects. Cardiac function and reserve was measured with Doppler echocardiography before and after exercise and defined as left-ventricular ejection fraction (LVEF), early diastolic mitral annulus velocity (e'), and increase in LV outflow tract velocity time integral cardiac output (cardiac reserve) with exercise. Subjects with abnormal CRP had significantly lower LVEF (51 [44-59] % vs 61 [52-64] %, P = 0.039), lower e' (7.4 [6.6-7.9] cm/sec vs 9.9 [8.3-12.0] cm/sec, P = 0.010), and smaller cardiac reserve (+ 1.5 [1.2-1.7] L/min vs + 1.9 [1.7-2.2] L/min, P = 0.024). CONCLUSION Elevated systemic inflammation is associated with impaired left-ventricular systolic and diastolic function both at rest and during exercise in subjects who have received radiotherapy with significant incidental heart dose for the treatment of cancer.
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Affiliation(s)
- Justin M. Canada
- VCU Pauley Heart Center, Virginia Commonwealth University, P.O. Box 980335, 1200 E. Broad Street, Richmond, Virginia, 23298 USA
| | - Georgia K. Thomas
- VCU Pauley Heart Center, Virginia Commonwealth University, P.O. Box 980335, 1200 E. Broad Street, Richmond, Virginia, 23298 USA
| | - Cory R. Trankle
- VCU Pauley Heart Center, Virginia Commonwealth University, P.O. Box 980335, 1200 E. Broad Street, Richmond, Virginia, 23298 USA
| | - Salvatore Carbone
- VCU Pauley Heart Center, Virginia Commonwealth University, P.O. Box 980335, 1200 E. Broad Street, Richmond, Virginia, 23298 USA
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Hayley Billingsley
- VCU Pauley Heart Center, Virginia Commonwealth University, P.O. Box 980335, 1200 E. Broad Street, Richmond, Virginia, 23298 USA
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Benjamin W. Van Tassell
- VCU Pauley Heart Center, Virginia Commonwealth University, P.O. Box 980335, 1200 E. Broad Street, Richmond, Virginia, 23298 USA
- Department of Pharmacotherapy and Outcome Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ronald K. Evans
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Ryan Garten
- Department of Kinesiology & Health Sciences, College of Humanities & Sciences, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Elisabeth Weiss
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Antonio Abbate
- VCU Pauley Heart Center, Virginia Commonwealth University, P.O. Box 980335, 1200 E. Broad Street, Richmond, Virginia, 23298 USA
- C. Kenneth and Dianne Wright Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, Virginia, USA
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Nijst P, Martens P, Verbrugge FH, Dupont M, Tang WHW, Mullens W. Cardiovascular Volume Reserve in Patients with Heart Failure and Reduced Ejection Fraction. J Cardiovasc Transl Res 2020; 13:519-527. [DOI: 10.1007/s12265-020-09973-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 02/13/2020] [Indexed: 12/17/2022]
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Buddeberg BS, Fernandes NL, Vorster A, Cupido BJ, Lombard CJ, Swanevelder JL, Girard T, Dyer RA. Cardiac Structure and Function in Morbidly Obese Parturients: An Echocardiographic Study. Anesth Analg 2020; 129:444-449. [PMID: 29878938 DOI: 10.1213/ane.0000000000003554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The increasing prevalence of obesity worldwide is a major threat to global health. Cardiac structural and functional changes are well documented for obesity as well as for pregnancy, but there is limited literature on morbidly obese parturients. We hypothesized that there are both cardiac structural and functional differences between morbidly obese pregnant women and pregnant women of normal body mass index (BMI). METHODS This prospective cross-sectional study was performed in 2 referral maternity units in Cape Town, South Africa, over a 3-month period. Forty morbidly obese pregnant women of BMI ≥40 kg·m (group O) were compared to 45 pregnant women of BMI ≤30 kg·m (group N). Cardiac structure and function were assessed by transthoracic echocardiography, according to the recommendations of the British Society of Echocardiography. The 2-sample t-test with unequal variances was used for the comparison of the mean values between the groups. RESULTS Acceptable echocardiographic images were obtained in all obese women. Statistical significance was defined as P < .0225 after applying the Benjamini-Hochberg correction for multiple testing. Mean (standard deviation) mean arterial pressure was higher in group O (91 [8.42] vs 84 [9.49] mm Hg, P < .001). There were no between-group differences in heart rate, stroke volume, or cardiac index (84 [12] vs 79 [13] beats·minute, P = .103; 64.4 [9.7] vs 59.5 [13.5] mL, P = .069; 2551 [474] vs 2729 [623] mL·minute·m, P = .156, for groups O and N, respectively). Stroke volume index was lower, and left ventricular mass was higher in group O (30.14 [4.51] vs 34.25 [7.00] mL·m, P = .003; 152 [24] vs 115 [29] g, P < .001). S' septal was lower in group O (8.43 [1.20] vs 9.25 [1.64] cm·second, P = .012). Considering diastolic function, isovolumetric relaxation time was significantly prolonged in group O (73 [15] vs 61 [15] milliseconds, P < .001). The septal tissue Doppler index E' septal was lower in group O (9.08 [1.69] vs 11.28 [3.18], P < .001). There were no between-group differences in E' average (10.7 [2.3] vs 12.0 [2.7], P = .018, O versus N) or E/E' average (7.85 [1.77] vs 7.27 [1.68], P = .137, O versus N). Right ventricular E'/A' was lower in group O (1.07 [0.47] vs 1.29 [0.32], P = .016). CONCLUSIONS Cardiac index did not differ between obese pregnant women and those with normal BMI. Their increased left ventricular mass and lower stroke volume index could indicate a limited adaptive reserve. Obese women had minor decreases in septal left ventricular tissue Doppler velocity, but the E/E' average values did not suggest clinically significant diastolic dysfunction.
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Affiliation(s)
- Bigna S Buddeberg
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.,Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
| | - Nicole L Fernandes
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Adri Vorster
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Blanche J Cupido
- Department of Cardiology, University of Cape Town and Groote Schuur Hospital, Hatter Institute for Cardiovascular Research in Africa, Cape Town, South Africa
| | - Carl J Lombard
- Biostatistics Unit, South African Medical Research Council, Cape Town, South Africa
| | - Justiaan L Swanevelder
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Thierry Girard
- Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
| | - Robert A Dyer
- From the Department of Anaesthesia and Perioperative Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
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221
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Pan L, Du J, Zhu J, Qiao Z, Ren Y, Huang X, Guo S, Gao N. Elevated antistreptolysin O titer is closely related to cardiac mitral insufficiency in untreated patients with Takayasu arteritis. BMC Cardiovasc Disord 2020; 20:52. [PMID: 32013899 PMCID: PMC6996160 DOI: 10.1186/s12872-020-01364-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 01/28/2020] [Indexed: 02/07/2023] Open
Abstract
Background The etiology of Takayasu arteritis (TA) is unknown; however, a possible relationship between streptococcal infection and TA has been proposed. This study aimed to identify the clinical features and cardiac valvular involvement in untreated TA patients with an elevated antistreptolysin O (ASO) titer. Methods In this retrospective study, the clinical characteristics and features of valvular involvement were compared in TA patients with or without an elevated ASO titer. Results Of the 74 untreated TA patients, 13 patients were found have elevated ASO titers (17.6%). Mitral insufficiency was the most common in patients with elevated ASO (69.2%, 9/13), followed by aortic valve insufficiency (46.2%, 5/13) and tricuspid insufficiency (46.2%, 5/13), which were no significantly different than that in normal ASO group. The proportions of moderate to severe mitral (30.8% vs 1.6%, p = 0.000) and tricuspid valve (15.4% vs 1.64%, p = 0.023) insufficiency in the ASO positive group were significantly higher than those in the ASO negative group. The odds of mitral regurgitation in patients with elevated ASO titers were 3.9 times higher than those in the group with normal ASO titers (p = 0.053, OR = 3.929, 95% confidence interval [CI]: 0.983–15.694). Furthermore, the risk of moderate to severe mitral insufficiency in patients with elevated ASO titers was 41.6 times higher than that in patients with normal ASO titers (p = 0.002, OR = 41.600, 95% CI: 3.867–447.559). Conclusions An increase in ASO titer is related to valvular involvement in TA and is closely linked to mitral insufficiency.
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Affiliation(s)
- Lili Pan
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Juan Du
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China
| | - Junming Zhu
- Department of Cardiovascular surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Zhiyu Qiao
- Department of Cardiovascular surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yanlong Ren
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinsheng Huang
- Department of Cardiovascular surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shichao Guo
- Department of Cardiovascular surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Na Gao
- Department of Rheumatology and Immunology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, China.
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Allometric versus ratiometric normalization of left ventricular stroke volume by Doppler-echocardiography for outcome prediction in severe aortic stenosis with preserved ejection fraction. Int J Cardiol 2020; 301:235-241. [DOI: 10.1016/j.ijcard.2019.09.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 08/16/2019] [Accepted: 09/25/2019] [Indexed: 01/11/2023]
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Mele D, Pestelli G, Molin DD, Trevisan F, Smarrazzo V, Luisi GA, Fucili A, Ferrari R. Echocardiographic Evaluation of Left Ventricular Output in Patients with Heart Failure: A Per-Beat or Per-Minute Approach? J Am Soc Echocardiogr 2020; 33:135-147.e3. [DOI: 10.1016/j.echo.2019.09.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/03/2019] [Accepted: 09/09/2019] [Indexed: 12/28/2022]
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Bhattacharyya S, Goswami DP, Sengupta A. Spatial velocity of the dynamic vectorcardiographic loop provides crucial insight in ventricular dysfunction. Med Hypotheses 2020; 135:109484. [DOI: 10.1016/j.mehy.2019.109484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 11/08/2019] [Indexed: 11/28/2022]
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Li Y, Wang YB, Zhang Y, Zhao S, Jin P, Li L, Du H, Sun YX. Endothelial function and plasma matrix metalloproteinase-2 levels and their association with the size and elastic properties of the ascending aorta in first-degree relatives of bicuspid aortic valve patients. Echocardiography 2020; 37:207-214. [PMID: 32003075 DOI: 10.1111/echo.14594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/05/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To explore endothelial function and plasma matrix metalloproteinase-2 levels and their association with the size and elastic properties of the ascending aorta in the first-degree relatives (FDRs) with tricuspid aortic valve (TAV) of individuals with bicuspid aortic valve (BAV). METHODS Twenty-six patients with BAV without significant valvular dysfunction, 35 FDRs with TAV, and 29 matched healthy controls were analyzed. Two-dimensional echocardiography and high-resolution ultrasound were applied to evaluate the size and elasticity of the ascending aorta and the flow-mediated vasodilation (FMD) of the brachial artery in response to hyperemia. RESULTS The aortic diameter was larger in the BAV patients than in the FDRs and controls, and the aortic elastic properties showed larger decreases in the BAV patients. The FDRs had a larger aortic diameter and more impaired elastic properties than the controls. The BAV patients had a significantly lower FMD than the FDRs and controls (P < .001), while the FMD was lower in the FDRs than in the controls (P < .001). The plasma MMP-2 levels were significantly higher in the BAV patients than in the FDRs (P = .001) and controls (P < .001). Additionally, the FDRs had higher plasma MMP-2 levels than the controls (P < .001). Pearson correlation analysis revealed that the aortic diameter, distensibility, stiffness index, and strain were significantly associated with FMD and plasma MMP-2 levels. CONCLUSION Aortic enlargement and impaired elasticity in the FDRs with TAV were associated with impaired endothelial function and increased plasma MMP-2 concentrations.
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Affiliation(s)
- Yang Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yi-Bin Wang
- Department of Medical Ultrasound, Xiangya Hospital, Central South University, Changsha, China
| | - Ying Zhang
- Department of Laboratory, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Shuai Zhao
- Department of Medical Ultrasound, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Peng Jin
- Department of Medical Ultrasound, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Lin Li
- Department of Medical Ultrasound, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Huan Du
- Department of Medical Ultrasound, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yi-Xue Sun
- Department of Medical Ultrasound, The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Wang W, Wang Z, Li J, Gong K, Zhao L, Tang G, Fu X. The impact of different geometric assumption of mitral annulus on the assessment of mitral regurgitation volume by Doppler method. Cardiovasc Ultrasound 2020; 18:5. [PMID: 32005178 PMCID: PMC6995243 DOI: 10.1186/s12947-020-0187-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background Mitral regurgitation volume (MRvol) by quantitative pulsed Doppler (QPD) method previously recommended suffers from geometric assumption error because of circular geometric assumption of mitral annulus (MA). Therefore, the aim of this study was to evaluate the impact of different geometric assumption of MA on the assessment of MRvol by two-dimensional transthoracic echocardiographic QPD method. Methods This study included 88 patients with varying degrees of mitral regurgitation (MR). The MRvol was evaluated by QPD method using circular or ellipse geometric assumption of MA. MRvol derived from effective regurgitant orifice area by real time three-dimensional echocardiography (RT3DE) multiplied by MR velocity-time integral was used as reference method. Results Assumption of a circular geometry of MA, QPD-MAA4C and QPD-MAPLAX overestimated the MRvol by a mean difference of 10.4 ml (P < 0.0001) and 22.5 ml (P < 0.0001) compared with RT3DE. Assumption of an ellipse geometry of MA, there was no significant difference of MRvol (mean difference = 1.7 ml, P = 0.0844) between the QPD-MAA4C + A2C and the RT3DE. Conclusions Assuming that the MA was circular geometry previously recommended, the MRvol by QPD-MAA4C was overestimated compared with the reference method. However, assuming that the MA was ellipse geometry, the MRvol by the QPD-MAA4C + A2C has no significant difference with the reference method.
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Affiliation(s)
- Wugang Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Zhibin Wang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Junfang Li
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Kun Gong
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Liang Zhao
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Guozhang Tang
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China
| | - Xiuxiu Fu
- Department of Echocardiography, The Affiliated Hospital of Qingdao University, No.16 Jiangsu Road, Qingdao, 266003, China.
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Abstract
OBJECTIVE The aim of this study was to evaluate the influence of sex on left ventricular mechanics in hypertensive individuals. METHODS This cross-sectional study included 171 untreated hypertensive patients and 112 normotensive controls who underwent a 24-h ambulatory blood pressure monitoring and comprehensive echocardiographic examination including strain assessment. RESULTS Hypertensive women and men had significantly lower left ventricular global longitudinal and circumferential strains than their normotensive counterparts. Left ventricular global longitudinal strain was lower in hypertensive men than in women (-19.8 ± 2.2 vs. -17.9 ± 2.1%; P < 0.01). Left ventricular global circumferential strain was also reduced in hypertensive men in comparison with women (-21.0 ± 2.5 vs. -18.7 ± 2.3%; P < 0.01). The difference in left ventricular radial strain was not discovered between hypertensive women and men. Furthermore, left ventricular twist was significantly higher in hypertensive women than in hypertensive men (21.9 ± 4.1° vs. 20.6 ± 3.8°; P = 0.034). Female sex and arterial hypertension, and also their interaction, were associated with lower left ventricular mass index, increased left ventricular global longitudinal, and circumferential strains and increased left ventricular twist compared with hypertensive men. CONCLUSION Left ventricular longitudinal and circumferential strains were significantly reduced in hypertensive patients. However, the changes are more pronounced in hypertensive men than in women. Sex has a significant effect on the association between hypertension, and longitudinal and circumferential strain.
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229
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Cai G, Liang S, Li C, Meng X, Yu J. Left Ventricular Systolic Dysfunction Is a Possible Independent Risk Factor of Radiation Pneumonitis in Locally Advanced Lung Cancer Patients. Front Oncol 2020; 9:1511. [PMID: 32039006 PMCID: PMC6992641 DOI: 10.3389/fonc.2019.01511] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 12/16/2019] [Indexed: 12/25/2022] Open
Abstract
Objectives: To assess the association between left ventricular (LV) systolic and diastolic dysfunction and grade ≥2 radiation pneumonitis (RP) for locally advanced lung cancer patients receiving definitive radiotherapy. Materials and Methods: A retrospective analysis was carried out for 260 lung cancer patients treated with definitive radiotherapy between 2015 and 2017. RP was evaluated according to Radiation Therapy Oncology Group (RTOG) toxicity criteria. Logistic regression analysis, 10-fold cross validation, and external validation were performed. The prediction model's discriminative performance was evaluated using the area under the receiver operating characteristic curve (AUC), and calibration of the model was assessed by the Hosmer-Lemeshow test and the calibration curve. Results: Within the first 6 months after radiotherapy, 70 patients (26.9%) developed grade ≥2 RP. Reduced left ventricular ejection fraction (LVEF) before radiotherapy was detected in 53 patients (20.4%). The odds ratio (OR) of developing RP for patients with LVEF <50% was 3.42 [p < 0.001, 95% confidence interval (CI), 1.85-6.32]. Multivariate analysis showed that forced expiratory volume in the first second/forced vital capacity (FEV1/FVC), LVEF, Eastern Cooperative Oncology Group (ECOG) performance status, chemotherapy, and mean lung dose (MLD) were significantly associated with grade ≥2 RP. The AUC of a model including the above five variables was 0.835 (95% CI, 0.778-0.891) on 10-fold cross validation and 0.742 (95% CI, 0.633-0.851) on the external validation set. The p-value for the Hosmer-Lemeshow test was 0.656 on 10-fold cross validation and 0.534 on the external validation set. Conclusion: LV systolic dysfunction is a possible independent risk factor for RP in locally advanced lung cancer patients receiving definitive radiotherapy.
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Affiliation(s)
- Guoxin Cai
- Department of Radiation Oncology, School of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, China
| | - Shuai Liang
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, China
| | - Chuanbao Li
- Department of Emergency, Chest Pain Center, Qilu Hospital of Shandong University, Jinan, China
| | - Xue Meng
- Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, China
| | - Jinming Yu
- Department of Radiation Oncology, School of Medicine, Shandong University, Jinan, China.,Department of Radiation Oncology, Shandong Cancer Hospital Affiliated to Shandong First Medical University, Shandong Academy of Medical Science, Jinan, China
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230
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Echo is a good, not perfect, measure of cardiac output in critically ill surgical patients. J Trauma Acute Care Surg 2020; 87:379-385. [PMID: 31349350 DOI: 10.1097/ta.0000000000002304] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Compared with a pulmonary artery catheter (PAC), transthoracic echocardiography (TTE) has been shown to have good agreement in cardiac output (CO) measurement in nonsurgical populations. Our hypothesis is that the feasibility and accuracy of CO measured by TTE (CO-TTE), relative to CO measured by PAC thermodilution (CO-PAC), is different in surgical intensive care unit patients (SP) and nonsurgical patients (NSP). METHODS Surgical patients with PAC for hemodynamic monitoring and NSP undergoing right heart catheterization were prospectively enrolled. Cardiac output was measured by CO-PAC and CO-TTE. Pearson coefficients were used to assess correlation. Bland-Altman analysis was used to determine agreement. RESULTS Over 18 months, 84 patients were enrolled (51 SP, 33 NSP). Cardiac output TTE could be measured in 65% (33/51) of SP versus 79% (26/33) of NSP; p = 0.17. Inability to measure the left ventricular outflow tract diameter was the primary reason for failure in both groups; 94% (17/18) in SP versus 86% (6/7) NSP; p = 0.47. Velocity time integral could be measured in all patients. In both groups, correlation between PAC and TTE measurement was strong; SP (r = 0.76; p < 0.0001), NSP (r = 0.86; p < 0.0001). Bland-Altman analysis demonstrated bias of -0.1 L/min, limits of agreement of -2.5 and +2.3 L/min, percentage error (PE) of 40% for SP, and bias of +0.4 L/min, limits of agreement of -1.8 and +2.5 L/min, and PE of 40% for NSP. CONCLUSION There was strong correlation and moderate agreement between TTE and PAC in both SP and NSP. In both patient populations, inability to measure the left ventricular outflow tract diameter was a limiting factor. LEVEL OF EVIDENCE Diagnostic tests or criteria, level III.
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Thompson LC, Walsh L, Martin BL, McGee J, Wood C, Kovalcik K, Pancras JP, Haykal-Coates N, Ledbetter AD, Davies D, Cascio WE, Higuchi M, Hazari MS, Farraj AK. Ambient Particulate Matter and Acrolein Co-Exposure Increases Myocardial Dyssynchrony in Mice via TRPA1. Toxicol Sci 2020; 167:559-572. [PMID: 30351402 DOI: 10.1093/toxsci/kfy262] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Air pollution is a complex mixture of particulate matter and gases linked to adverse clinical outcomes. As such, studying responses to individual pollutants does not account for the potential biological responses resulting from the interaction of various constituents within an ambient air shed. We previously reported that exposure to high levels of the gaseous pollutant acrolein perturbs myocardial synchrony. Here, we examined the effects of repeated, intermittent co-exposure to low levels of concentrated ambient particulates (CAPs) and acrolein on myocardial synchrony and the role of transient receptor potential cation channel A1 (TRPA1), which we previously linked to air pollution-induced sensitization to triggered cardiac arrhythmia. Female B6129 and Trpa1-/- mice (n = 6/group) were exposed to filtered air (FA), CAPs (46 µg/m3 of PM2.5), Acrolein (0.42 ppm), or CAPs+Acrolein for 3 h/day, 2 days/week for 4 weeks. Cardiac ultrasound was conducted to assess cardiac synchronicity and function before and after the first exposure and after the final exposure. Heart rate variability (HRV), an indicator of autonomic tone, was assessed after the final exposure. Strain delay (time between peak strain in adjacent cardiac wall segments), an index of myocardial dyssynchrony, increased by 5-fold after the final CAPs+Acrolein exposure in B6129 mice compared with FA, CAPs, or Acrolein-exposed B6129 mice, and CAPs+Acrolein-exposed Trpa1-/- mice. Only exposure to acrolein alone increased the HRV high frequency domain (5-fold) in B6129 mice, but not in Trpa1-/- mice. Thus, repeated inhalation of pollutant mixtures may increase risk for cardiac responses compared with single or multiple exposures to individual pollutants through TRPA1 activation.
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Affiliation(s)
- Leslie C Thompson
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Leon Walsh
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Brandi L Martin
- Oak Ridge Institute for Science and Education, Oak Ridge, TN 37830
| | - John McGee
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Charles Wood
- Integrated Systems Toxicology Division, National Health and Environmental Effects Research Laboratory
| | - Kasey Kovalcik
- Exposure Methods & Measurements Division, National Exposure Research Laboratory, United States Environmental Protection Agency, Research Triangle Park, North Carolina 27711
| | - Joseph Patrick Pancras
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Najwa Haykal-Coates
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Allen D Ledbetter
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - David Davies
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Wayne E Cascio
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Mark Higuchi
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Mehdi S Hazari
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
| | - Aimen K Farraj
- Environmental Public Health Division, National Health and Environmental Effects Research Laboratory
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232
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Giovanardi P, Tincani E, Maioli M, Tondi S. The Prognostic Importance of TAPSE in Early and in Stable Cardiovascular Diseases. J Cardiovasc Dev Dis 2020; 7:jcdd7010004. [PMID: 31952140 PMCID: PMC7151306 DOI: 10.3390/jcdd7010004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/28/2019] [Accepted: 01/05/2020] [Indexed: 11/20/2022] Open
Abstract
The identification of predictors of major cardiovascular events (MACES) represents a big challenge, especially in early and stable cardiovascular diseases. This prospective study comparatively evaluated the prognostic importance of left ventricular (LV) and right ventricular (RV) systolic and diastolic function, pulmonary artery pressure (PAP) and pulmonary vascular resistance (PVR) in a stable patient’s cohort with cardiovascular risk factors. The LV ejection fraction, mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), functional mitral regurgitation (FMR), doppler tissue imaging of mitral and tricuspid annulus with systolic and diastolic peaks estimation, tricuspid regurgitation velocity (TRV), pulmonary velocity outflow time integral (PVTI), mean pulmonary artery pressure (MPAP) and PVR were estimated at enrollment. During the follow-up, MACES and all-cause mortality were recorded. 369 subjects with or without previous MACES were enrolled. Bivariate analysis revealed LVEF, TAPSE, MPAP, TRV, PVR, LV diastolic function, and FMR were associated with the endpoints. When computing the influence of covariates to the primary endpoint (all-cause mortality and MACES) through Cox analysis, only LV diastolic function and TAPSE entered the final model; for the secondary endpoint (MACES) only TAPSE entered. TAPSE was able to predict MACES and all-cause mortality in early and stable cardiovascular diseases. The use of TAPSE should be implemented.
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Affiliation(s)
- Paolo Giovanardi
- Cardiology Service, Department of Primary Care, Azienda USL, Via del Pozzo N 71, 41100 Modena, Italy
- Cardiology Division, Ospedale S. Agostino–Estense, Azienda Ospedaliero-Universitaria, Via Giardini 1355, 41126 Baggiovara, Modena, Italy;
- Correspondence: ; Tel.: +39-059-437410 or +39-059-3961111; Fax: +39-053-6886684
| | - Enrico Tincani
- Internal Medicine Division, Ospedale S. Agostino–Estense, Azienda Ospedaliero-Universitaria, 41100 Modena, Italy;
| | - Marco Maioli
- Department of Physics, Informatics, and Mathematics, University of Modena and Reggio Emilia, 41100 Modena, Italy;
| | - Stefano Tondi
- Cardiology Division, Ospedale S. Agostino–Estense, Azienda Ospedaliero-Universitaria, Via Giardini 1355, 41126 Baggiovara, Modena, Italy;
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Rabozzi R, Oricco S, Meneghini C, Bucci M, Franci P. Evaluation of the caudal vena cava diameter to abdominal aortic diameter ratio and the caudal vena cava respiratory collapsibility for predicting fluid responsiveness in a heterogeneous population of hospitalized conscious dogs. J Vet Med Sci 2020; 82:337-344. [PMID: 31932519 PMCID: PMC7118484 DOI: 10.1292/jvms.19-0028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Fluid responsiveness, defined as the response of stroke volume to fluid loading, is a tool to individualize fluid administration in order to avoid the deleterious effects of hypovolemia or hypervolemia in hospitalized patients. To evaluate the accuracy of two ultrasound indices, the caudal vena cava to abdominal aorta ratio (CVC/Ao) and the respiratory collapsibility of the caudal vena cava (cCVC), as independent predictors of fluid responsiveness in a heterogeneous population of spontaneously breathing, conscious, hospitalized dogs. A prospective, multicenter, observational, cross-sectional study was designed in twenty-five dogs. The accuracy of CVC/Ao and cCVC in predicting fluid responsiveness was evaluated by the area under the receiver operating characteristic curve (AUROC) in a group of hospitalized dogs after receiving a mini-fluid bolus of 4 ml/kg of Hartmann's solution. Dogs with an increased aortic velocity time integral >15% were classified as fluid responders. Twenty-two dogs were finally included. Ten were classified as responders and 12 as non-responders. The AUROC curves were 0.88 for the CVC/Ao ratio (95% confidence interval, CI, 0.67-0.98; P=0.0001) and 0.54 for cCVC (95% CI 0.32-0.75; P=0.75). The CVC/Ao threshold optimized for best sensitivity (SE) and specificity (SP) values was 0.83 (SE 100%; SP 75%). In spontaneously breathing hospitalized dogs, the CVC/Ao measurement predicted stroke volume increase after a fluid bolus, while the respiratory variations in the cCVC did not discriminate between fluid responders and non-responders.
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Affiliation(s)
- Roberto Rabozzi
- CVRS-Policlinico Veterinario Roma Sud, 00173 Rome (RM), Italy
| | | | | | - Massimo Bucci
- Department of Animal Medicine, Production and Health School of Agriculture and Veterinary Medicine, Padua University, 35020 Legnaro (PD), Italy
| | - Paolo Franci
- Department of Veterinary Science, University of Turin, 10095 Grugliasco (TO), Italy
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234
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Samy M, El Awady WS, Al-Daydamony MM, Abd El Samei MM, Shokry KAEA. Echocardiographic assessment of left ventricular function recovery post percutaneous coronary intervention of chronic total occlusions in patients with low and mid-range left ventricular ejection fractions. Echocardiography 2020; 37:239-246. [PMID: 31913538 DOI: 10.1111/echo.14582] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 11/30/2019] [Accepted: 12/15/2019] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Coronary chronic total occlusion (CTO) is a frequent condition encountered in cardiac catheterization laboratory with a prevalence of about 20%. Through literature, data are scarcely reported regarding the left ventricular (LV) function recovery post CTO percutaneous coronary intervention (PCI) in patients with low (<40%) and mid-range (40%-49%) LV ejection fraction (LVEF). The aim of this study was to assess the echocardiographic outcomes of CTO patients with low and mid-range LVEF successfully revascularized at 6-month follow-up. METHODS This prospective study included 75 patients with at least one CTO of an epicardial coronary artery proved by previous diagnostic coronary angiography with PCI attempt indication, and successfully revascularized. They were equally divided according to LVEF into three groups, and echocardiographic remodeling indices were assessed at baseline and 6 months post PCI. RESULTS Our study showed significant improvement of LVEF, S-wave velocity by tissue doppler imaging (TDI), LV wall-motion score (LVWMS), and LV systolic sphericity index (LVSIS) 6 months post CTO PCI in low LVEF group, and a significant improvement in LVEF, S-wave velocity, and LVWMS in mid-range LVEF group (P < .05). The delta change in LVEF was significantly more in low LVEF group, compared to the other two groups (F = 4.739, P < .05). CONCLUSION Successful CTO PCI in patients with low and mid-range LVEF is associated with significant improvement of LVEF and other indices of myocardial remodeling after 6 months of follow-up.
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Affiliation(s)
- Mohamed Samy
- Department of Cardiology, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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235
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Koster G, Kaufmann T, Hiemstra B, Wiersema R, Vos ME, Dijkhuizen D, Wong A, Scheeren TWL, Hummel YM, Keus F, van der Horst ICC. Feasibility of cardiac output measurements in critically ill patients by medical students. Ultrasound J 2020; 12:1. [PMID: 31912438 PMCID: PMC6946766 DOI: 10.1186/s13089-020-0152-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/01/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Critical care ultrasonography (CCUS) is increasingly applied also in the intensive care unit (ICU) and performed by non-experts, including even medical students. There is limited data on the training efforts necessary for novices to attain images of sufficient quality. There is no data on medical students performing CCUS for the measurement of cardiac output (CO), a hemodynamic variable of importance for daily critical care. OBJECTIVE The aim of this study was to explore the agreement of cardiac output measurements as well as the quality of images obtained by medical students in critically ill patients compared to the measurements obtained by experts in these images. METHODS In a prospective observational cohort study, all acutely admitted adults with an expected ICU stay over 24 h were included. CCUS was performed by students within 24 h of admission. CCUS included the images required to measure the CO, i.e., the left ventricular outflow tract (LVOT) diameter and the velocity time integral (VTI) in the LVOT. Echocardiography experts were involved in the evaluation of the quality of images obtained and the quality of the CO measurements. RESULTS There was an opportunity for a CCUS attempt in 1155 of the 1212 eligible patients (95%) and in 1075 of the 1212 patients (89%) CCUS examination was performed by medical students. In 871 out of 1075 patients (81%) medical students measured CO. Experts measured CO in 783 patients (73%). In 760 patients (71%) CO was measured by both which allowed for comparison; bias of CO was 0.0 L min-1 with limits of agreement of - 2.6 L min-1 to 2.7 L min-1. The percentage error was 50%, reflecting poor agreement of the CO measurement by students compared with the experts CO measurement. CONCLUSIONS Medical students seem capable of obtaining sufficient quality CCUS images for CO measurement in the majority of critically ill patients. Measurements of CO by medical students, however, had poor agreement with expert measurements. Experts remain indispensable for reliable CO measurements. Trial registration Clinicaltrials.gov; http://www.clinicaltrials.gov; registration number NCT02912624.
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Affiliation(s)
- Geert Koster
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Thomas Kaufmann
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Bart Hiemstra
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Renske Wiersema
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Madelon E. Vos
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Devon Dijkhuizen
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Adrian Wong
- Department of Anaesthesia and Intensive Care, Royal Surrey Hospital, Guildford, UK
| | - Thomas W. L. Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Yoran M. Hummel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Frederik Keus
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
| | - Iwan C. C. van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, P.O. Box 30.001, 9700 RB Groningen, The Netherlands
- Department of Intensive Care, Maastricht University Medical Center+, University Maastricht, Maastricht, The Netherlands
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236
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The Forgotten Hemodynamic (PCO2 Gap) in Severe Sepsis. Crit Care Res Pract 2020; 2020:9281623. [PMID: 32377433 PMCID: PMC7199542 DOI: 10.1155/2020/9281623] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 11/25/2019] [Indexed: 12/24/2022] Open
Abstract
Background Central venous-arterial carbon dioxide difference (PCO2 gap) can be a marker of cardiac output adequacy in global metabolic conditions that are less affected by the impairment of oxygen extraction capacity. We investigated the relation between the PCO2 gap, serum lactate, and cardiac index (CI) and prognostic value on admission in relation to fluid administration in the early phases of resuscitation in sepsis. We also investigated the chest ultrasound pattern A or B. Method We performed a prospective observational study and recruited 28 patients with severe sepsis and septic shock in a mixed ICU. We determined central venous PO2, PCO2, PCO2 gap, lactate, and CI at 0 and 6 hours after critical care unit (CCU) admission. The population was divided into two groups based on the PCO2 gap (cutoff value 0.8 kPa). Results The CI was significantly lower in the high PCO2 gap group (P=0.001). The high PCO2 gap group, on admission, required more administered fluid and vasopressors (P=0.01 and P=0.009, respectively). There was also a significant difference between the two groups for low mean pressure (P=0.01), central venous O2 (P=0.01), and lactate level (P=0.003). The mean arterial pressure was lower in the high PCO2 gap group, and the lactate level was higher, indicating global hypoperfusion. The hospital mortality rate for all patients was 24.5% (7/28). The in-hospital mortality rate was 20% (2/12) for the low gap group and 30% (5/16) for the high gap group; the odds ratio was 1.6 (95% CI 0.5–5.5; P=0.53). Patients with a persistent or rising PCO2 gap larger than 0.8 kPa at T = 6 and 12 hours had a higher mortality change (n = 6; in-hospital mortality was 21.4%) than patients with a PCO2 gap of less than 0.8 kPa at T = 6 (n = 1; in-hospital mortality was 3%); this odds ratio was 5.3 (95% CI 0.9–30.7; P=0.08). The PCO2 gap had no relation with the chest ultrasound pattern. Conclusion The PCO2 gap is an important hemodynamic variable in the management of sepsis-induced circulatory failure. The PCO2 gap can be a marker of the adequacy of the cardiac output status in severe sepsis. A high PCO2 gap value (>0.8 kPa) can identify situations in which increasing CO can be attempted with fluid resuscitation in severe sepsis. The PCO2 gap carries an important prognostic value in severe sepsis.
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237
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Bektaş O, Karagöz A, Bayramoğlu A, Günaydın ZY, Kaya A. Triphasic mitral flow pattern may indicate subclinical left ventricular systolic dysfunction. Echocardiography 2020; 37:29-33. [DOI: 10.1111/echo.14549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/05/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022] Open
Affiliation(s)
- Osman Bektaş
- Department of Cardiology Ordu University Ordu Turkey
| | - Ahmet Karagöz
- Department of Cardiology Giresun University Giresun Turkey
| | | | | | - Ahmet Kaya
- Department of Cardiology Ordu University Ordu Turkey
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238
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Porter T, Shillcutt S, Adams M, Desjardins G, Glas K, Olson J, Troughton R. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the american society of echocardiography. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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239
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Captur G, Heywood WE, Coats C, Rosmini S, Patel V, Lopes LR, Collis R, Patel N, Syrris P, Bassett P, O'Brien B, Moon JC, Elliott PM, Mills K. Identification of a Multiplex Biomarker Panel for Hypertrophic Cardiomyopathy Using Quantitative Proteomics and Machine Learning. Mol Cell Proteomics 2020; 19:114-127. [PMID: 31243064 PMCID: PMC6944230 DOI: 10.1074/mcp.ra119.001586] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 06/24/2019] [Indexed: 12/22/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is defined by pathological left ventricular hypertrophy (LVH). It is the commonest inherited cardiac condition and a significant number of high risk cases still go undetected until a sudden cardiac death (SCD) event. Plasma biomarkers do not currently feature in the assessment of HCM disease progression, which is tracked by serial imaging, or in SCD risk stratification, which is based on imaging parameters and patient/family history. There is a need for new HCM plasma biomarkers to refine disease monitoring and improve patient risk stratification. To identify new plasma biomarkers for patients with HCM, we performed exploratory myocardial and plasma proteomics screens and subsequently developed a multiplexed targeted liquid chromatography-tandem/mass spectrometry-based assay to validate the 26 peptide biomarkers that were identified. The association of discovered biomarkers with clinical phenotypes was prospectively tested in plasma from 110 HCM patients with LVH (LVH+ HCM), 97 controls, and 16 HCM sarcomere gene mutation carriers before the development of LVH (subclinical HCM). Six peptides (aldolase fructose-bisphosphate A, complement C3, glutathione S-transferase omega 1, Ras suppressor protein 1, talin 1, and thrombospondin 1) were increased significantly in the plasma of LVH+ HCM compared with controls and correlated with imaging markers of phenotype severity: LV wall thickness, mass, and percentage myocardial scar on cardiovascular magnetic resonance imaging. Using supervised machine learning (ML), this six-biomarker panel differentiated between LVH+ HCM and controls, with an area under the curve of ≥ 0.87. Five of these peptides were also significantly increased in subclinical HCM compared with controls. In LVH+ HCM, the six-marker panel correlated with the presence of nonsustained ventricular tachycardia and the estimated five-year risk of sudden cardiac death. Using quantitative proteomic approaches, we have discovered six potentially useful circulating plasma biomarkers related to myocardial substrate changes in HCM, which correlate with the estimated sudden cardiac death risk.
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Affiliation(s)
- Gabriella Captur
- UCL MRC Unit for Lifelong Health and Ageing, 1-19 Torrington Place, Fitzrovia, London WC1E 7HB, UK; Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Wendy E Heywood
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK; Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Caroline Coats
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK; Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Stefania Rosmini
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK
| | - Vimal Patel
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Luis R Lopes
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Richard Collis
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Nina Patel
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK; Institute of Child Health, University College London, London, WC1N 1EH, UK
| | - Petros Syrris
- Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Paul Bassett
- Biostatistics Joint Research Office, University College London, Gower Street, London, WC1E 6BT, UK
| | - Ben O'Brien
- Department of Perioperative Medicine, St. Bartholomew's Hospital and Barts Heart Center, West Smithfield, London, EC1A 7BE, UK; William Harvey Research Institute, Charterhouse Square, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, EC1M 6BQ, UK
| | - James C Moon
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Perry M Elliott
- Barts Heart Center, The Cardiovascular Magnetic Resonance Imaging Unit and The Inherited Cardiovascular Diseases Unit, St. Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK; Institute of Cardiovascular Science, University College London, Gower Street, London, WC1E 6BT, UK
| | - Kevin Mills
- Translational Mass Spectrometry Research Group, UCL Institute of Child Health and Great Ormond Street Hospital, 30 Guilford Street, London WC1N 1EH, UK; Institute of Child Health, University College London, London, WC1N 1EH, UK.
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240
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Özmen Ç, Kaya B, Eker Akıllı R, Tepe Ö, Deniz A, Kanadaşı M, Demir M, Usal A. Hemodiyaliz hastalarında subklinik sol ventrikül diyastolik disfonksiyonu tanısında prestostolik dalga yetersiz kalmıştır. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.623583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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241
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Shenouda R, Bytyçi I, Sobhy M, Henein MY. Early Recovery of Left Ventricular Function After Revascularization in Acute Coronary Syndrome. J Clin Med 2019; 9:E24. [PMID: 31861949 PMCID: PMC7019788 DOI: 10.3390/jcm9010024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 12/07/2019] [Accepted: 12/16/2019] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to assess the accuracy of echocardiographic techniques in detecting the early recovery of left ventricular (LV) function after revascularization in acute coronary syndrome (ACS). In 80 consecutive patients with ACS (age 55.7 ± 9.4 years, 77% male, 15% with CCS Angina III), an echocardiographic examination of left ventricle regional wall motion abnormalities (LV RWMA), peak systolic strain rate (PSSR), peak systolic strain (PSS) and end systolic strain (ESS) was performed before and after percutaneous intervention (PCI). Of the 80 patients, one vessel stenosis (>70%) was present in 53 (66%), two vessel disease in 12 (15%) and multivessel disease in 15 patients (19%). In total, 51% of patients had hypertension, 40% diabetes and 23% dyslipidemia. After PCI, regional PSS, ESS and PSSR of their segments subtended by the culprit vessel improved; left anterior descending-LAD, circumflex-LCx and right coronary-RCA (p<0.05 for all) as well as global S and SR (p < 0.05 for all). In univariate analysis, hypertension (HTN) (β = -0.294 (-0.313-0.047), p = 0.009, smoking β = -0.244 (-0.289-0.015) =0.03, WMA β = -0.317 (-0.284-0.014), p = 0.004 and the number of diseased vessels β = -0.256 (-0.188- 0.054) p=0.03 were predictors of delta global SR. In multivariate analysis, only HTN β = 0.263 (0.005-3.159) and the number of diseased vessels β =0.263 (0.005 - 3.159), p=0.04) predicted delta global SR. In ACS, the echocardiographic regional myocardial deformation is accurate in detecting early recovery of LV myocardial function after culprit lesion revascularization. Also, the findings of this study support the current practice regarding the crucial importance of proximal epicardial vessel PCI treatment on LV function compared to more distal lesions.
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Affiliation(s)
- Rafik Shenouda
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
- International Cardiac Centre—ICC and Alexandria University, Alexandria 21500, Egypt
| | - Ibadete Bytyçi
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
| | - Mohamed Sobhy
- International Cardiac Centre—ICC and Alexandria University, Alexandria 21500, Egypt
- Cardiology Department, Faculty of Medicine, Alexandria University, Alexandria 21500, Egypt
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, 90187 Umea, Sweden
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242
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Tadic M, Cuspidi C, Celic V, Pencic B, Mancia G, Grassi G, Stankovic G, Ivanovic B. The Prognostic Effect of Circadian Blood Pressure Pattern on Long-Term Cardiovascular Outcome is Independent of Left Ventricular Remodeling. J Clin Med 2019; 8:jcm8122126. [PMID: 31810363 PMCID: PMC6947325 DOI: 10.3390/jcm8122126] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 11/14/2019] [Accepted: 11/28/2019] [Indexed: 01/19/2023] Open
Abstract
We aimed to investigate the predictive value of 24 h blood pressure (BP) patterns on adverse cardiovascular (CV) outcome in the initially untreated hypertensive patients during long-term follow-up. This study included 533 initially untreated hypertensive patients who were involved in this study in the period between 2007 and 2012. All participants underwent laboratory analysis, 24 h BP monitoring, and echocardiographic examination at baseline. The patients were followed for a median period of nine years. The adverse outcome was defined as the hospitalization due to CV events (atrial fibrillation, myocardial infarction, myocardial revascularization, heart failure, stroke, or CV death). During the nine-year follow-up period, adverse CV events occurred in 85 hypertensive patients. Nighttime SBP, non-dipping BP pattern, LV hypertrophy (LVH), left atrial enlargement (LAE), and LV diastolic dysfunction (LV DD) were risk factors for occurrence of CV events. However, nighttime SBP, non-dipping BP pattern, LVH, and LV DD were the only independent predictors of CV events. When all four BP pattern were included in the model, non-dipping and reverse dipping BP patterns were associated with CV events, but only reverse-dipping BP pattern was independent predictor of CV events. The current study showed that reverse-dipping BP pattern was predictor of adverse CV events independently of nighttime SBP and LV remodeling during long-term follow-up. The assessment of BP patterns has very important role in the long-time prediction in hypertensive population.
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Affiliation(s)
- Marijana Tadic
- Department of Internal Medicine and Cardiology, Charité—Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburgerplatz 1, 13353 Berlin, Germany
- Correspondence: ; Tel.: +49-1763-236-0011; Fax: +49-3045-066-5111
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano IRCCS, Viale della Resistenza 23, 20036 Meda, Italy
| | - Vera Celic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Biljana Pencic
- Department of Cardiology, University Clinical Hospital Center “Dr. Dragisa Misovic—Dedinje”, Heroja Milana Tepica 1, 11000 Belgrade, Serbia
| | - Giuseppe Mancia
- Department of Medicine and Surgery, Clinica Medica, University Milano-Bicocca, 20126 Milan, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, Clinica Medica, University Milano-Bicocca, 20126 Milan, Italy
| | - Goran Stankovic
- Clinic of Cardiology, Clinical Center of Serbia, Koste Todorovic 8, 11000 Belgrade, Serbia
| | - Branislava Ivanovic
- Clinic of Cardiology, Clinical Center of Serbia, Koste Todorovic 8, 11000 Belgrade, Serbia
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243
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Forbregd TR, Aloyseus MA, Berg A, Greve G. Cardiopulmonary Capacity in Children During Exercise Testing: The Differences Between Treadmill and Upright and Supine Cycle Ergometry. Front Physiol 2019; 10:1440. [PMID: 31849698 PMCID: PMC6897055 DOI: 10.3389/fphys.2019.01440] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 11/07/2019] [Indexed: 11/30/2022] Open
Abstract
Background/Hypothesis: Cardiopulmonary exercise testing (CPET) is used in the assessment of function and prognosis of cardiopulmonary health in children with cardiac and pulmonary diseases. Techniques, such as cardiac MRi, and PET-scan, can be performed simultaneously with exercise testing. Thus, it is desirable to have a broader knowledge about children’s normal cardiopulmonary function in different body postures and exercise modalities. The aim of this study was to investigate the effect of different body positions on cardiopulmonary function in healthy subjects performing CPETs. Materials and Methods: Thirty-one healthy children aged 9, 12, and 15 years did four CPETs: one treadmill test with a modified Bruce protocol and three different bicycle tests with different body postures, sitting, tilted 45°, and lying flat (0°). For the bicycle tests, a 20-watt ramp protocol with a pedal frequency of 60 ± 5 rotations per minute was used. Continous ECG and breath-by-breath V.O2 measurements was done throughout the tests. Cardiac structure and function including aortic diameter were evaluated by transthoracic echocardiography prior to the tests. Doppler measurements of the blood velocity in the ascending aorta were measured prior to and during the test. Prior to every test, the participants performed pulmonary function tests with maximum voluntary ventilation test. Results: There is a significantly (p < 0.05) lower peak V.O2 in all bicycle tests compared with the treadmill test. There is lower corrected peak V.O2 (ml kg−0.67 min−1), but not relative peak V.O2 (ml kg−1 min−1), in the supine compared with the upright bicycle test. There are no differences in peak stroke volume or cardiac output between the bicycle modalities when calculated from aortic blood flow. Peak heart rate decreases from both treadmill to upright bicycle and from upright bicycle to the supine test (0°). Conclusion: There are no differences in peak cardiac output between the upright bicycle test and supine bicycle tests. Heart rate and corrected peak V.O2 are lower in the supine test (0°) than the upright bicycle test. In the treadmill test, it is a higher absolute and relative peak V.O2. Despite the latter differences, we are convinced that both upright and supine bicycle tests are apt in the clinical setting when needed.
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Affiliation(s)
| | | | - Ansgar Berg
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Pediatrics and Adolescents Medicine, Haukeland University Hospital, Bergen, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Diseases, Haukeland University Hospital, Bergen, Norway
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244
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Chan IP, Weng MC, Hsueh T, Lin YC, Lin SL. Prognostic value of right pulmonary artery distensibility in dogs with pulmonary hypertension. J Vet Sci 2019; 20:e34. [PMID: 31364319 PMCID: PMC6669208 DOI: 10.4142/jvs.2019.20.e34] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/19/2019] [Accepted: 05/20/2019] [Indexed: 11/20/2022] Open
Abstract
The right pulmonary artery distensibility (RPAD) index has been used in dogs with pulmonary hypertension (PH) caused by heartworm infection, myxomatous mitral valve disease, or patent ductus arteriosus. We hypothesized that this index correlates with the tricuspid regurgitation pressure gradient (TRPG) assessed by echocardiography and could predict survival in dogs with PH secondary to various causes. To assess this hypothesis, the medical records of 200 client-owned dogs at a referral institution were retrospectively reviewed. The RPAD index and the ratios of acceleration time to peak pulmonary artery flow (AT) and to the ejection time of pulmonary artery flow (ET) were recorded for each dog. The owners were contacted for follow-up assessments. The findings indicated that the RPAD index was correlated with the TRPG (R² = 0. 362, p < 0.001). The survival time was significantly shorter in dogs with an RPAD index ≤ 21% that were followed up for 3 months and in dogs with an RPAD index ≤ 24% that were followed up for 1 year. Thus, the RPAD index was correlated with the TRPG and could predict the clinical outcome in dogs with PH caused by various diseases. This index could be used to evaluate the severity of PH in dogs without tricuspid regurgitation.
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Affiliation(s)
- I Ping Chan
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung 40227, Taiwan.,Department of Veterinary Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Min Chieh Weng
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Tung Hsueh
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung 40227, Taiwan.,Department of Veterinary Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Yun Chang Lin
- Department of Veterinary Medicine, National Chung Hsing University, Taichung 40227, Taiwan
| | - Shiun Long Lin
- Veterinary Medical Teaching Hospital, National Chung Hsing University, Taichung 40227, Taiwan.,Department of Veterinary Medicine, National Chung Hsing University, Taichung 40227, Taiwan.
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245
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He T, Tian Z, Liu YT, Li J, Zhou DB, Fang Q. Evaluating heart function in patients with POEMS syndrome. Echocardiography 2019; 36:1997-2003. [PMID: 31693226 DOI: 10.1111/echo.14516] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 09/25/2019] [Accepted: 10/02/2019] [Indexed: 01/20/2023] Open
Abstract
AIMS Our aim is to investigate the characterized echocardiographic cardiac measurements of POEMS syndrome and determine its relationship with clinical manifestations. METHODS AND RESULTS The cross-sectional study included 27 treatment-naïve patients with newly diagnosed POEMS syndrome and 26 age- and sex-matched healthy volunteers. Information of clinical manifestations, serological tests, pulmonary function tests, and both conventional echocardiograph and tissue Doppler imaging (TDI) were collected and analyzed. Pearson's correlation coefficient was used for determining the related clinical and echocardiographic parameters. Compared to healthy people, left ventricular (LV) mass index (LVMI) was elevated in patients with POEMS syndrome (41.3 ± 11.0 g/m2.7 , P < .05). LV systolic dysfunction was found by decreased mitral S' (9.0 ± 2.2 m/sec, P < .01), and diastolic dysfunction by mitral E'/A' (1.10 ± 0.42, P < .05), E/E' (8.69 ± 4.06, P < .001) on lateral, and E/E' (7.90 ± 3.28, P = .133) on septal mitral annulus. The presence of decreased tricuspid annular plane systolic excursion (TAPSE) (22.2 ± 3.5 mm, P < .01) and lateral tricuspid S' (11.1 ± 1.8 m/sec, P < .05) suggested deterioration of right ventricular (RV) systolic function. Parameters obtained from standard echocardiograph (tricuspid E/A ratio and DT) and TDI ((lateral tricuspid annulus E'/A' and E/E') indicated reduced RV diastolic function. Pulmonary hypertension (PH) was presented in six patients. Correlation analysis suggested that PH was related to total lung capacity (TLC) and diffusion capacity of carbon monoxide (DLCO). CONCLUSION Echocardiographic measurements found that there was elevation of LVMI, pulmonary artery hypertension, and subclinical impairment of systolic and diastolic functions of both the right and left heart in patients with POEMS syndrome.
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Affiliation(s)
- Tianhua He
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuang Tian
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yong-Tai Liu
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jian Li
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dao-Bin Zhou
- Department of Hematology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Quan Fang
- Department of Cardiology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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246
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Inci S, Gül M, Alsancak Y, Ozkan N. Short- and mid-term effects of sleeve gastrectomy on left ventricular function with two-dimensional speckle tracking echocardiography in obese patients. Echocardiography 2019; 36:2019-2025. [PMID: 31682047 DOI: 10.1111/echo.14522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 11/27/2022] Open
Abstract
AIM This study aimed to investigate left ventricular functions of obese patients with no known heart disease who underwent laparoscopic sleeve gastrectomy by speckle tracking echocardiography in their early and medium-term postoperative follow-up. PATIENTS AND METHOD Thirty-seven obese patients (10 M, 27 F) without coronary artery disease or heart failure who had undergone LSG were included in the study. Apical four-, three-, and two-chamber images were analyzed longitudinally by conventional methods and speckle tracking echocardiography (STE) for left ventricle functions preoperatively, at the postoperative Month 1 and at the postoperative Month 6 (QLAB 6.0), using current software. RESULTS No difference was found between standard echocardiography and Doppler parameters in terms of the 1-month versus 6-month follow-up values compared to baseline. Left ventricular STE longitudinal measurements demonstrated significantly higher longitudinal strain and strain velocity parameters in the follow-up values at Month 6 compared to the values at Month 1 and at baseline. Global longitudinal strain (GLS) was -17.48 ± 1.09% in 6-month follow-up, -16.16 ± 1.26% in 1-month follow-up, and -16.06 ± 1.25% at baseline (P < .001). A significant correlation was found between delta GLS, which represents patients' GLS change in 6 months, and delta weight, which represents patients' body weight change in 6 months. CONCLUSION Obese patients who had undergone LSG were observed to have improved left ventricular function in the mid-term.
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Affiliation(s)
- Sinan Inci
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Murat Gül
- Department of Cardiology, Faculty of Medicine, Aksaray University, Aksaray, Turkey
| | - Yakup Alsancak
- Department of Cardiology, Faculty of Medicine, Necmettin Erbakan University, Konya, Turkey
| | - Namık Ozkan
- Department of General Surgery, Faculty of Medicine, Aksaray University, Aksaray, Turkey
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247
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Hong A, Joachim J, Buxin C, Levé C, Le Gall A, Millasseau S, Mateo J, Civelli V, Serrano J, Mebazaa A, Gayat E, Vallée F. Using velocity-pressure loops in the operating room: a new approach of arterial mechanics for cardiac afterload monitoring under general anesthesia. Am J Physiol Heart Circ Physiol 2019; 317:H1354-H1362. [PMID: 31674813 DOI: 10.1152/ajpheart.00362.2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Cardiac afterload is usually assessed in the ascending aorta and can be defined by the association of peripheral vascular resistance (PVR), total arterial compliance (Ctot), and aortic wave reflection (WR). We recently proposed the global afterload angle (GALA) and β-angle derived from the aortic velocity-pressure (VP) loop as continuous cardiac afterload monitoring in the descending thoracic aorta. The aim of this study was to 1) describe the arterial mechanic properties by studying the velocity-pressure relations according to cardiovascular risk (low-risk and high-risk patients) in the ascending and descending thoracic aorta and 2) analyze the association between the VP loop (GALA and β-angle) and cardiac afterload parameters (PVR, Ctot, and WR). PVR, Ctot, WR, and VP loop parameters were measured in the ascending and descending thoracic aorta in 50 anesthetized patients. At each aortic level, the mean arterial pressure (MAP), cardiac output (CO), and PVR were similar between low-risk and high-risk patients. In contrast, Ctot, WR, GALA, and β-angle were strongly influenced by cardiovascular risk factors regardless of the site of measurement along the aorta. The GALA angle was inversely related to aortic compliance, and the β-angle reflected the magnitude of wave reflection in both the ascending and descending aortas (P < 0.001). Under general anesthesia, the VP loop can provide new visual insights into arterial mechanical properties compared with the traditional MAP and CO for the assessment of cardiac afterload. Further studies are necessary to demonstrate the clinical utility of the VP loop in the operating room.NEW & NOTEWORTHY Our team recently proposed the global afterload angle (GALA) and β-angle derived from the aortic velocity-pressure (VP) loop as continuous cardiac afterload monitoring in the descending thoracic aorta under general anesthesia. However, the evaluation of cardiac afterload at this location is unusual. The present study shows that VP loop parameters can describe the components of cardiac afterload both in the ascending and descending thoracic aorta in the operating room. Aging and cardiovascular risk factors strongly influence VP loop parameters. The VP loop could provide continuous visual additional information on the arterial system than the traditional mean arterial pressure and cardiac output during the general anesthesia.
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Affiliation(s)
- A Hong
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France.,Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - J Joachim
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France.,Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - C Buxin
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France
| | - C Levé
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France
| | - A Le Gall
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France.,Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine, Inria, Université Paris-Saclay, Palaiseau, France.,Solid Mechanics Laboratory, Ecole Polytechnique, Centre National de la Recherche Scientifique, Palaiseau, France
| | - S Millasseau
- Pulse Wave Consulting, Saint-Leu-La-Forêt, France
| | - J Mateo
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France
| | - V Civelli
- Department of Neuroradiology, Lariboisière Hospital, Paris, France
| | - J Serrano
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France
| | - A Mebazaa
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France.,Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - E Gayat
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France.,Inserm, UMRS-942, Paris Diderot University, Paris, France
| | - F Vallée
- Department of Anesthesiology and Intensive Care, Lariboisière-Saint Louis Hospitals, Paris, France.,Inserm, UMRS-942, Paris Diderot University, Paris, France.,Mathematical and Mechanical Modeling with Data Interaction in Simulations for Medicine, Inria, Université Paris-Saclay, Palaiseau, France.,Solid Mechanics Laboratory, Ecole Polytechnique, Centre National de la Recherche Scientifique, Palaiseau, France
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248
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Pagoulatou SZ, Bikia V, Trachet B, Papaioannou TG, Protogerou AD, Stergiopulos N. On the importance of the nonuniform aortic stiffening in the hemodynamics of physiological aging. Am J Physiol Heart Circ Physiol 2019; 317:H1125-H1133. [DOI: 10.1152/ajpheart.00193.2019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Mathematical models of the arterial tree constitute a valuable tool to investigate the hemodynamics of aging and pathology. Rendering such models as patient specific could allow for the assessment of central hemodynamic variables of clinical interest. However, this task is challenging, particularly with respect to the tuning of the local area compliance that varies significantly along the arterial tree. Accordingly, in this study, we demonstrate the importance of taking into account the differential effects of aging on the stiffness of central and peripheral arteries when simulating a person’s hemodynamic profile. More specifically, we propose a simple method for effectively adapting the properties of a generic one-dimensional model of the arterial tree based on the subject’s age and noninvasive measurements of aortic flow and brachial pressure. A key element for the success of the method is the implementation of different mechanisms of arterial stiffening for young and old individuals. The designed methodology was tested and validated against in vivo data from a population of n = 20 adults. Carotid-to-femoral pulse wave velocity was accurately predicted by the model (mean error = 0.14 m/s, SD = 0.77 m/s), with the greatest deviations being observed for older subjects. In regard to aortic pressure, model-derived systolic blood pressure and augmentation index were both in good agreement (mean difference of 2.3 mmHg and 4.25%, respectively) with the predictions of a widely used commercial device (Mobil-O-Graph). These preliminary results encourage us to further validate the method in larger samples and consider its potential as a noninvasive tool for hemodynamic monitoring. NEW & NOTEWORTHY We propose a technique for adapting the parameters of a validated one-dimensional model of the arterial tree using noninvasive measurements of aortic flow and brachial pressure. Emphasis is given on the adjustment of the arterial tree distensibility, which incorporates the nonuniform effects of aging on central and peripheral vessel elasticity. Our method could find application in the derivation of important hemodynamic indices, paving the way for novel diagnostic tools.
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Affiliation(s)
- Stamatia Z. Pagoulatou
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Vasiliki Bikia
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Bram Trachet
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
- Institute of Biomedical Technology, IBiTech-bioMMeda, Ghent University, Ghent, Belgium
| | - Theodore G. Papaioannou
- Biomedical Engineering Unit, First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanase D. Protogerou
- Cardiovascular Prevention and Research Unit, Department of Pathophysiology, National and Kapodistrian University Athens School of Medicine, Athens, Greece
| | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Institute of Bioengineering, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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249
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Do reverse dippers have the highest risk of right ventricular remodeling? Hypertens Res 2019; 43:213-219. [DOI: 10.1038/s41440-019-0351-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 09/25/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
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250
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Moon I, Lee SY, Lee E, Lee SR, Cha MJ, Choi EK, Oh S. Extensive left atrial ablation was associated with exacerbation of left atrial stiffness and dyspnea. J Cardiovasc Electrophysiol 2019; 30:2782-2789. [PMID: 31637795 DOI: 10.1111/jce.14241] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 10/08/2019] [Accepted: 10/09/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The left atrium (LA), including the pulmonary vein antrum, is the main target of catheter ablation for atrial fibrillation (AF). However, there is a lack of data on the effect of extensive LA ablation on LA stiffness. This study sought to investigate the impact of extensive LA ablation on LA stiffness and dyspnea after the restoration of sinus rhythm. METHODS In total, 97 patients with AF (80 patients who only underwent pulmonary vein isolation [PVI] and 17 patients who underwent extensive LA ablation) were investigated. Extensive LA ablation was defined as PVI plus at least two sets of LA linear-line ablation. LA stiffness was estimated using the ratio of E/e' to global longitudinal LA strain, as measured by echocardiography. The clinical outcomes we evaluated were AF recurrence and composite dyspnea, which we defined as newly prescribed diuretics or hospitalization for heart failure. RESULTS Patients were 59.3 ± 10.0 years old on average, and 68 (70.1%) were male. There were no significant differences in baseline characteristics or echocardiographic parameters before ablation between the two groups. After ablation, LA stiffness was higher in the extensive ablation group compared with that in the PVI group (0.9 ± 0.6 vs 0.5 ± 0.3, respectively, P = .017). Multivariable linear regression analysis showed that extensive ablation increased LA stiffness (ß = 0.363, P < .001). AF recurrence was similar in both groups; however, composite dyspnea outcomes were worse in the extensive ablation group (P = .003). CONCLUSION Extensive LA ablation was associated with a worsening of LA stiffness. This might explain dyspnea despite the successful restoration of sinus rhythm.
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Affiliation(s)
- Inki Moon
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seo-Young Lee
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Division of Cardiology, Seoul National University Hospital, Seoul, Republic of Korea
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