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Uusitalo V, Luotolahti M, Pietilä M, Wendelin-Saarenhovi M, Hartiala J, Saraste M, Knuuti J, Saraste A. Two-Dimensional Speckle-Tracking during Dobutamine Stress Echocardiography in the Detection of Myocardial Ischemia in Patients with Suspected Coronary Artery Disease. J Am Soc Echocardiogr 2016; 29:470-479.e3. [DOI: 10.1016/j.echo.2015.12.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Indexed: 11/28/2022]
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Oliveira RKF, Waxman AB, Agarwal M, Badr Eslam R, Systrom DM. Pulmonary haemodynamics during recovery from maximum incremental cycling exercise. Eur Respir J 2016; 48:158-67. [PMID: 27126692 DOI: 10.1183/13993003.00023-2016] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Accepted: 03/17/2016] [Indexed: 02/04/2023]
Abstract
Assessment of cardiac function during exercise can be technically demanding, making the recovery period a potentially attractive diagnostic window. However, the validity of this approach for exercise pulmonary haemodynamics has not been validated.The present study, therefore, evaluated directly measured pulmonary haemodynamics during 2-min recovery after maximum invasive cardiopulmonary exercise testing in patients evaluated for unexplained exertional intolerance. Based on peak exercise criteria, patients with exercise pulmonary hypertension (ePH; n=36), exercise pulmonary venous hypertension (ePVH; n=28) and age-matched controls (n=31) were analysed.By 2-min recovery, 83% (n=30) of ePH patients had a mean pulmonary artery pressure (mPAP) <30 mmHg and 96% (n=27) of ePVH patients had a pulmonary arterial wedge pressure (PAWP) <20 mmHg. Sensitivity of pulmonary hypertension-related haemodynamic measurements during recovery for ePH and ePVH diagnosis was ≤25%. In ePVH, pulmonary vascular compliance (PVC) returned to its resting value by 1-min recovery, while in ePH, elevated pulmonary vascular resistance (PVR) and decreased PVC persisted throughout recovery.In conclusion, we observed that mPAP and PAWP decay quickly during recovery in ePH and ePVH, compromising the sensitivity of recovery haemodynamic measurements in diagnosing pulmonary hypertension. ePH and ePVH had different PVR and PVC recovery patterns, suggesting differences in the underlying pulmonary hypertension pathophysiology.
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Affiliation(s)
- Rudolf K F Oliveira
- Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA Division of Respiratory Diseases, Dept of Medicine, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Aaron B Waxman
- Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Manyoo Agarwal
- Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Roza Badr Eslam
- Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA Dept of Internal Medicine II, Division of Cardiology, Medical University of Vienna, Vienna, Austria
| | - David M Systrom
- Pulmonary and Critical Care Medicine, Dept of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA Heart and Vascular Center, Brigham and Women's Hospital, Boston, MA, USA
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203
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Cardiovascular magnetic resonance in rheumatology: Current status and recommendations for use. Int J Cardiol 2016; 217:135-48. [PMID: 27179903 DOI: 10.1016/j.ijcard.2016.04.158] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 04/25/2016] [Indexed: 01/14/2023]
Abstract
Targeted therapies in connective tissue diseases (CTDs) have led to improvements of disease-associated outcomes, but life expectancy remains lower compared to general population due to emerging co-morbidities, particularly due to excess cardiovascular risk. Cardiovascular magnetic resonance (CMR) is a noninvasive imaging technique which can provide detailed information about multiple cardiovascular pathologies without using ionizing radiation. CMR is considered the reference standard for quantitative evaluation of left and right ventricular volumes, mass and function, cardiac tissue characterization and assessment of thoracic vessels; it may also be used for the quantitative assessment of myocardial blood flow with high spatial resolution and for the evaluation of the proximal coronary arteries. These applications are of particular interest in CTDs, because of the potential of serious and variable involvement of the cardiovascular system during their course. The International Consensus Group on CMR in Rheumatology was formed in January 2012 aiming to achieve consensus among CMR and rheumatology experts in developing initial recommendations on the current state-of-the-art use of CMR in CTDs. The present report outlines the recommendations of the participating CMR and rheumatology experts with regards to: (a) indications for use of CMR in rheumatoid arthritis, the spondyloarthropathies, systemic lupus erythematosus, vasculitis of small, medium and large vessels, myositis, sarcoidosis (SRC), and scleroderma (SSc); (b) CMR protocols, terminology for reporting CMR and diagnostic CMR criteria for assessment and quantification of cardiovascular involvement in CTDs; and (c) a research agenda for the further development of this evolving field.
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Combination of single quantitative parameters into multiparametric model for ischemia detection is not superior to visual assessment during dobutamine stress echocardiography. Cardiovasc Ultrasound 2016; 14:13. [PMID: 27066783 PMCID: PMC4828852 DOI: 10.1186/s12947-016-0055-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 04/02/2016] [Indexed: 01/21/2023] Open
Abstract
Background To evaluate if the combination of several quantitative parameters into a mathematical model would enhance the detection of myocardial ischemia during dobutamine stress echocardiography (DSE) when compared to conventional wall motion analysis. Methods In a prospective study design 151 patients (age 61.8 ± 9.2) in test group and 105 patients (age 64.0 ± 10.6) in validation group were selected and underwent DSE between January 2008 and December 2012. In all patients coronary angiography was performed within 6-8 weeks from DSE, considering at least one stenosis ≥50 % per patient as significant coronary artery disease (CAD). Results of DSE visual assessment and myocardial velocity, strain and strain rate parameters derived from speckle tracking imaging were imported automatically to an originally created software. A mathematical model calculating prognosis of at least one stenosis per patient and stenosis in separate arteries was constructed. Results Myocardial ischemia was visually detected in 60 (39.7 %) and in 58 (54.2 %) patients of the test and validation group, respectively. A total of 76 (50.3 %) patients in the test group and 69 patients (65.7 %) in the validation group had ≥50 % coronary stenosis. Sensitivity and specificity of the mathematical model per patient in the test group were 91.6 % and 86.3 % compared to 76.8 % and 89.0 % of the visual assessment, respectively. However, in the validation group the sensitivity, specificity, positive predictive value and negative predictive value dropped down significantly becoming lower to visual assessment. Conclusions Myocardial deformation imaging may potentially replace visual assessment with an automated predictive model for stress-induced ischemia detection. However, a multiparametric mathematical model based on quantitative deformation markers did not demonstrate incremental value to visual assessment of wall motion.
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Vrints CJ, Senior R, Crea F, Sechtem U. Assessing suspected angina: requiem for coronary computed tomography angiography or exercise electrocardiogram? Eur Heart J 2016; 38:1792-1800. [DOI: 10.1093/eurheartj/ehw065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2015] [Accepted: 01/29/2016] [Indexed: 01/19/2023] Open
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206
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Guerra F, Marchesini M, Contadini D, Menditto A, Morelli M, Piccolo E, Battelli N, Pistelli M, Berardi R, Cascinu S, Capucci A. Speckle-tracking global longitudinal strain as an early predictor of cardiotoxicity in breast carcinoma. Support Care Cancer 2016; 24:3139-45. [PMID: 26923461 DOI: 10.1007/s00520-016-3137-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/22/2016] [Indexed: 02/07/2023]
Abstract
PURPOSE Recent development in anticancer therapies for breast carcinoma allowed an improvement in patients' survival, notwithstanding a parallel increase of cardiovascular morbidity. Cardiotoxicity of anticancer therapies represents a relevant problem due to its insidious onset and potentially irreversible cardiac damage. The aim of the present study was to test whether 2D speckle tracking analysis can help in predicting overt systolic dysfunction. METHODS A "real world" cohort of 69 patients with breast carcinoma undergoing adjuvant and/or neo-adjuvant chemotherapy was tested 2D-speckle tracking analysis before the beginning of chemotherapy and every 3 months for 1 year. Clinical data, 12-lead ECGs, and lab tests were collected according to the same visit protocol. RESULTS Over 1-year follow-up, 19 patients (27 %) developed cardiac dysfunction according to the CREC criteria, with an average onset time from enrolment of 6.8 months. A global longitudinal strain (GLS) threshold ≥-16 % at 3 months from chemotherapy was able to predict subsequent systolic dysfunction development with high sensitivity (80 %) and specificity (90 %) and a negative predictive value of 92 %. After the introduction of cardioprotective drugs, left ventricular ejection fraction (LVEF) progressively recovered, while alterations of GLS persisted at 1-year follow-up. CONCLUSIONS Strain imaging with 2D speckle tracking allows the identification of patients at low-risk for chemotherapy-related systolic dysfunction and can help optimizing resources allocations and improving follow-up quality. GLS can also provide a more accurate prognostic index of resolved systolic dysfunction when compared to standard LVEF.
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Affiliation(s)
- Federico Guerra
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy.
| | - Marco Marchesini
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Daniele Contadini
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Alessio Menditto
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Marco Morelli
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Elisa Piccolo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Nicola Battelli
- Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Mirco Pistelli
- Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Rossana Berardi
- Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Stefano Cascinu
- Oncology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
| | - Alessando Capucci
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, University Hospital "Ospedali Riuniti", Via Conca 71, Ancona, Italy
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Essandoh M, Otey AJ, Dalia A, Dewhirst E, Springer A, Henry M. Refractory Hypotension after Liver Allograft Reperfusion: A Case of Dynamic Left Ventricular Outflow Tract Obstruction. Front Med (Lausanne) 2016; 3:3. [PMID: 26909349 PMCID: PMC4754394 DOI: 10.3389/fmed.2016.00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 01/14/2016] [Indexed: 12/14/2022] Open
Abstract
Hypotension after reperfusion is a common occurrence during liver transplantation following the systemic release of cold, hyperkalemic, and acidic contents of the liver allograft. Moreover, the release of vasoactive metabolites such as inflammatory cytokines and free radicals from the liver and mesentery, compounded by the hepatic uptake of blood, may also cause a decrement in systemic perfusion pressures. Thus, the postreperfusion syndrome (PRS) can materialize if hypotension and fibrinolysis occur concomitantly within 5 min of reperfusion. Treatment of the PRS may require the administration of inotropes, vasopressors, and intravenous fluids to maintain hemodynamic stability. However, the occurrence of the PRS and its treatment with inotropes and calcium chloride may lead to dynamic left ventricular outflow tract obstruction (DLVOTO) precipitating refractory hypotension. Expedient diagnosis of DLVOTO with transesophageal echocardiography is extremely vital in order to avoid potential cardiovascular collapse during this critical period.
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Affiliation(s)
- Michael Essandoh
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Andrew Joseph Otey
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Adam Dalia
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Elisabeth Dewhirst
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Andrew Springer
- Department of Anesthesiology, The Ohio State University Wexner Medical Center , Columbus, OH , USA
| | - Mitchell Henry
- Department of Surgery, The Ohio State University Wexner Medical Center , Columbus, OH , USA
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208
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Vamvakidou A, Gurunathan S, Senior R. Novel techniques in stress echocardiography: a focus on the advantages and disadvantages. Expert Rev Cardiovasc Ther 2016; 14:477-94. [DOI: 10.1586/14779072.2016.1135054] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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209
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Zoppellaro G, Venneri L, Khattar RS, Li W, Senior R. Simultaneous Assessment of Myocardial Perfusion, Wall Motion, and Deformation during Myocardial Contrast Echocardiography: A Feasibility Study. Echocardiography 2016; 33:889-95. [PMID: 26833555 DOI: 10.1111/echo.13190] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIMS Ultrasound contrast agents may be used for the assessment of regional wall motion and myocardial perfusion, but are generally considered not suitable for deformation analysis. The aim of our study was to assess the feasibility of deformation imaging on contrast-enhanced images using a novel methodology. METHODS AND RESULTS We prospectively enrolled 40 patients who underwent stress echocardiography with continuous intravenous infusion of SonoVue for the assessment of myocardial perfusion imaging with flash replenishment technique. We compared longitudinal strain (Lε) values, assessed with a vendor-independent software (2D CPA), on 68 resting contrast-enhanced and 68 resting noncontrast recordings. Strain analysis on contrast recordings was evaluated in the first cardiac cycles after the flash. Tracking of contrast images was deemed feasible in all subjects and in all views. Contrast administration improved image quality and increased the number of segments used for deformation analysis. Lε of noncontrast and contrast-enhanced images were statistically different (-18.8 ± 4.5% and -22.8 ± 5.4%, respectively; P < 0.001), but their correlation was good (ICC 0.65, 95%CI 0.42-0.78). Patients with resting wall-motion abnormalities showed lower Lε values on contrast recordings (-18.6 ± 6.0% vs. -24.2 ± 5.5%, respectively; P < 0.01). Intra-operator and inter-operator reproducibility was good for both noncontrast and contrast images with no statistical differences. CONCLUSIONS Our study shows that deformation analysis on postflash contrast-enhanced images is feasible and reproducible. Therefore, it would be possible to perform a simultaneous evaluation of wall-motion abnormalities, volumes, ejection fraction, perfusion defects, and cardiac deformation on the same contrast recording.
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Affiliation(s)
- Giacomo Zoppellaro
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Lucia Venneri
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Rajdeep S Khattar
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom
| | - Wei Li
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom
| | - Roxy Senior
- Department of Echocardiography, Royal Brompton Hospital, London, United Kingdom.,Cardiovascular Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.,National Heart and Lung Institute (NHLI), Imperial College, London, United Kingdom
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210
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Essandoh M, Crestanello J, Bhatt A, Iyer M, Awad H, Daoud EG. Incidental Intraoperative Diagnosis of Subvalvular Mitral Stenosis With a Dobutamine Stress Echocardiogram. J Cardiothorac Vasc Anesth 2016; 31:1717-1719. [PMID: 28320571 DOI: 10.1053/j.jvca.2016.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Indexed: 11/11/2022]
Affiliation(s)
- Michael Essandoh
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH.
| | - Juan Crestanello
- Department of Surgery, Division of Cardiothoracic Surgery, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Amar Bhatt
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Manoj Iyer
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Hamdy Awad
- Department of Anesthesiology, Wexner Medical Center, The Ohio State University, Columbus, OH
| | - Emile G Daoud
- Department of Internal Medicine, Division of Cardiovascular Medicine, Wexner Medical Center, The Ohio State University, Columbus, OH
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211
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Barletta G, Del Bene MR. Myocardial perfusion echocardiography and coronary microvascular dysfunction. World J Cardiol 2015; 7:861-874. [PMID: 26730291 PMCID: PMC4691812 DOI: 10.4330/wjc.v7.i12.861] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 09/04/2015] [Accepted: 10/19/2015] [Indexed: 02/07/2023] Open
Abstract
Our understanding of coronary syndromes has evolved in the last two decades out of the obstructive atherosclerosis of epicardial coronary arteries paradigm to include anatomo-functional abnormalities of coronary microcirculation. No current diagnostic technique allows direct visualization of coronary microcirculation, but functional assessments of this circulation are possible. This represents a challenge in cardiology. Myocardial contrast echocardiography (MCE) was a breakthrough in echocardiography several years ago that claimed the capability to detect myocardial perfusion abnormalities and quantify coronary blood flow. Research demonstrated that the integration of quantitative MCE and fractional flow reserve improved the definition of ischemic burden and the relative contribution of collaterals in non-critical coronary stenosis. MCE identified no-reflow and low-flow within and around myocardial infarction, respectively, and predicted the potential functional recovery of stunned myocardium using appropriate interventions. MCE exhibited diagnostic performances that were comparable to positron emission tomography in microvascular reserve and microvascular dysfunction in angina patients. Overall, MCE improved echocardiographic evaluations of ischemic heart disease in daily clinical practice, but the approval of regulatory authorities is lacking.
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212
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Coronary calcification with no flow limiting lesions: A potential cause for ischaemic dysfunction in syndrome X patients. IJC HEART & VASCULATURE 2015; 9:109-114. [PMID: 28785718 PMCID: PMC5497281 DOI: 10.1016/j.ijchv.2014.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 07/24/2014] [Accepted: 07/29/2014] [Indexed: 11/22/2022]
Abstract
Aim Exertional angina in patients with no coronary flow limiting lesions remains a clinical puzzle. We aimed to assess the extent of coronary artery calcification (CAC) and its relationship to ventricular wall motion function using stress echocardiography in a group of patients limited by exertional angina, but no obstructive lesions. Methods We compared CT coronary calcium score (CACS) and dobutamine stress echocardiography in 55 patients (age 64.7 ± 7.7 years), divided into Group 1 (CACS ≤ 100) and Group 2 (CACS > 100). No patient had LV ejection fraction-EF < 55%, pulmonary hypertension, arrhythmia, renal failure or parathyroid disease. Multiple linear regression analysis was used to test the association between gender-standardized continuous echocardiographic parameters and patient groups adjusted for age, body surface area, osteoporosis and CV risk factors and CACS. Results At rest, LV long axis ‘subendocardial’ function was reduced (amplitude: β − 1.11 SD, p < 0.05, R2 0.6 and systolic velocity: β − 1.08 SD, p < 0.05, R2 0.44), left atrial (LA) indexed volume was raised (β 1.06 SD, p < 0.05, R2 0.37) and its systolic velocity decreased (β − 1.05 SD, p < 0.05, R2 0.35) in Group 2. With stress, wall motion score index increased (p < 0.05) and long axis disturbances worsened only in the same group. Multivariate analysis demonstrated clear relationship between ischaemic LV disturbances, reduced long axis amplitude, global longitudinal systolic strain and early diastolic strain rate. Resting and stress RV lengthening velocity also correlated with CAC score. Conclusion In symptomatic patients with no obstructive coronary lesions and with more than mild CAC, long axis disturbances and wall motion score index rise occur with stress, at the time of symptom development and correlate with severity of arterial calcification. These findings suggest CAC as a potential mechanism for coronary wall stiffness and consequently exertional ischaemic changes as a result of limited flow reserve.
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213
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Stress echocardiography in paediatrics: implications for the evaluation of anomalous aortic origin of the coronary arteries. Cardiol Young 2015; 25:1524-30. [PMID: 26675599 DOI: 10.1017/s1047951115002012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Stress echocardiography in paediatrics is used to evaluate pre- and post-operative coronary artery conditions, as well as to gain haemodynamic information for a variety of diagnoses, although evidence regarding sensitivity, specificity, and predictive value is lacking. This review will consider the available literature with a focus on anomalous aortic origin of the coronary arteries and discuss a practical approach to test selection and use.
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214
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Bigvava T, Zamani SM, Pieske-Kraigher E, Gebker R, Pieske B, Kelle S. Prognostic value of non-invasive stress testing for coronary artery disease in obese patients. Expert Rev Cardiovasc Ther 2015; 13:1325-32. [PMID: 26536394 DOI: 10.1586/14779072.2015.1102054] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Detecting coronary artery disease (CAD) in obese patients remains a challenge but can have substantial prognostic implications for this patient group. Until now, sufficient data was not available on which to base the selection of the imaging modality in obese patients. The decision on which imaging modality to use should therefore follow the general guidelines. In this article, the authors discuss the prognostic value of the different non-invasive stress testing methods for CAD in obese patients.
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Affiliation(s)
- Tamar Bigvava
- a Tbilisi Heart and Vascular Clinic , Tbilisi , Georgia
| | - Seyedeh Mahsa Zamani
- b Department of Cardiology , Charité, University Medicine Berlin , Berlin , Germany
| | | | - Rolf Gebker
- c Department of Internal Medicine/Cardiology , Deutsches Herzzentrum Berlin , Berlin , Germany
| | - Burkert Pieske
- b Department of Cardiology , Charité, University Medicine Berlin , Berlin , Germany.,c Department of Internal Medicine/Cardiology , Deutsches Herzzentrum Berlin , Berlin , Germany
| | - Sebastian Kelle
- c Department of Internal Medicine/Cardiology , Deutsches Herzzentrum Berlin , Berlin , Germany
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215
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Bouzas-Mosquera A, Peteiro J, Broullón FJ, Álvarez-García N, Rodríguez-Garrido JL, Mosquera VX, Martínez D, Yáñez JC, Vázquez-Rodríguez JM. Incremental value of exercise echocardiography over exercise electrocardiography in a chest pain unit. Eur J Intern Med 2015; 26:720-5. [PMID: 26321649 DOI: 10.1016/j.ejim.2015.08.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 07/29/2015] [Accepted: 08/05/2015] [Indexed: 12/27/2022]
Abstract
BACKGROUND Limited data are available on the added value of exercise echocardiography (ExEcho) over exercise electrocardiography (ExECG) in patients with suspected acute coronary syndromes (ACS) referred to a chest pain unit. We aimed to assess the incremental value of ExEcho over ExECG in this setting. METHODS ExECG and ExEcho were performed in parallel in 1052 patients with suspected ACS, nondiagnostic but interpretable electrocardiograms, and negative serial troponin results. The primary outcome was a composite of coronary death, nonfatal myocardial infarction or unstable angina with angiographic documentation of significant coronary artery disease within 6 months. RESULTS The primary outcome occurred in 2/614 patients (0.3%) with both negative ExECG and ExEcho, 3/60 (5%) with positive ExECG and negative ExEcho, 73/135 (54.1%) with negative ExECG and positive ExEcho, 106/136 (77.9%) with both positive ExECG and ExEcho, and 8/107 (7.5%) with inconclusive results. The addition of ExEcho data to a model based on clinical and ExECG data significantly increased the c statistic from 0.898 to 0.968 (change +0.070, 95% confidence interval 0.052-0.092), with a continuous net reclassification improvement of 1.56 and an integrated discrimination improvement of 22% (p<0.001). Decision curve analysis showed that a strategy of referral to coronary angiography based on ExEcho was associated with the highest net benefit and with the largest reduction in unnecessary coronary angiographies. CONCLUSION ExEcho provides significant incremental prognostic information and higher net clinical benefit than a strategy based on ExECG in patients referred to a chest pain unit for suspected ACS and negative troponin levels.
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Affiliation(s)
| | - Jesús Peteiro
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
| | - Francisco J Broullón
- Department of Health Information Technology, Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | - Víctor X Mosquera
- Department of Cardiac Surgery, Hospital Universitario A Coruña, A Coruña, Spain
| | - Dolores Martínez
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
| | - Juan C Yáñez
- Department of Cardiology, Hospital Universitario A Coruña, A Coruña, Spain
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Longitudinal Strain by Automated Function Imaging Detects Single-Vessel Coronary Artery Disease in Patients Undergoing Dipyridamole Stress Echocardiography. J Am Soc Echocardiogr 2015; 28:1214-21. [DOI: 10.1016/j.echo.2015.06.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Indexed: 11/24/2022]
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217
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Maranta F, Tondi L, Agricola E, Margonato A, Rimoldi O, Camici PG. Ivabradine reduces myocardial stunning in patients with exercise-inducible ischaemia. Basic Res Cardiol 2015; 110:55. [PMID: 26419678 DOI: 10.1007/s00395-015-0511-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 09/18/2015] [Accepted: 09/21/2015] [Indexed: 10/23/2022]
Abstract
Ivabradine is an effective treatment for angina in patients with stable coronary artery disease (CAD) and for heart failure. Experiments in a canine model have shown that ivabradine reduces both acute left ventricular (LV) dysfunction and post-ischaemic stunning. Aim of this study was to investigate the effect of ivabradine on LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. Fifteen patients with ejection fraction >40 % and heart rate >70 bpm were enrolled. After pharmacologic washout, echocardiography was performed at rest, at peak treadmill exercise and during recovery until return to baseline. After 2 weeks of ivabradine (7.5 mg bid) stress echocardiography was repeated at the same workload achieved during washout. Peak global and segmental (ischaemic vs. remote normal segments) LV longitudinal strain (LS) was assessed by 2D speckle tracking analysis. At washout, LS was significantly impaired in ischaemic compared to remote segments at peak stress and for several minutes during recovery. After ivabradine a smaller, albeit still significant, impairment of LS in ischaemic segments was observed at peak whilst no difference with remote segments was present during recovery. Furthermore, the average global LS value improved significantly after treatment. In conclusion, ivabradine reduces both acute LV dysfunction and stunning in patients with CAD and exercise-inducible ischaemia. We hypothesise that this mechanism might contribute to reduce chronic LV dysfunction in patients with CAD. In this setting the drug might limit the development of hibernating myocardium which is believed to result from repeated episodes of ischaemia and stunning.
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Affiliation(s)
- F Maranta
- Università Vita Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy
| | - L Tondi
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - E Agricola
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - A Margonato
- Università Vita Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy.,San Raffaele Hospital of Milan (IRCCS), Milan, Italy
| | - O Rimoldi
- San Raffaele Hospital of Milan (IRCCS), Milan, Italy.,CNR IBFM, Segrate, Italy
| | - Paolo G Camici
- Università Vita Salute San Raffaele, Via Olgettina 58, 20132, Milan, Italy. .,San Raffaele Hospital of Milan (IRCCS), Milan, Italy.
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Ciampi Q, Cortigiani L, Pratali L, Rigo F, Villari B, Picano E, Sicari R. Left Bundle Branch Block Negatively Affects Coronary Flow Velocity Reserve and Myocardial Contractile Reserve in Nonischemic Dilated Cardiomyopathy. J Am Soc Echocardiogr 2015; 29:112-8. [PMID: 26365426 DOI: 10.1016/j.echo.2015.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Coronary flow velocity reserve (CFVR) of the left anterior descending coronary artery (LAD) and myocardial contractile reserve are often impaired in nonischemic dilated cardiomyopathy (DCM). Whether they are affected by the presence of left bundle branch block (LBBB) remains unaddressed. The aim of the study was to investigate how LBBB influences CFVR of the LAD and myocardial contractile reserve in patients with DCM. METHODS One hundred eighty-one patients with DCM (116 men; mean age, 63 ± 12 years) underwent high-dose dipyridamole (0.84 mg/kg over 6 min) stress echocardiography with CFVR evaluation of the LAD by Doppler. All patients had ejection fractions < 40% (mean, 31 ± 8%) and angiographically normal or near normal coronary arteries. CFVR was defined as the ratio between hyperemic peak and basal peak diastolic coronary flow velocities. CFVR > 2.0 was considered normal. Inotropic reserve was defined as rest-stress variation in wall motion score index ≥ 0.20. This was a prospective analysis of an unselected sample consecutively enrolled and retrospectively selected. RESULTS The study group was separated on the basis of presence (n = 122) or absence (n = 59) of LBBB. Patients with LBBB were older (64 ± 11 vs 59 ± 12 years, P = .004) and had reduced resting ejection fractions (30 ± 9% vs 33 ± 7%, P = .02), CFVR of the LAD (1.96 ± 0.41 vs 2.23 ± 0.73, P = .001), and myocardial contractile reserve (variation in wall motion score index, -0.18 ± 0.17 vs -0.33 ± 0.28; P < .001). On multivariate logistic regression analysis, resting ejection fraction (hazard ratio [HR], 1.15; 95% CI, 1.03-1.29; P = .01), smoking habit (HR, 2.63; 95% CI, 1.23-5.62; P = .01), and LBBB (HR, 2.29; 95% CI, 1.05-5.04; P = .04) were independently associated with reduced CFVR, while restrictive transmitral pattern (HR, 2.56; 95% CI, 1.18-5.55; P = .02), end-diastolic volume (HR, 0.98; 95% CI, 0.67-0.99; P = .02), and LBBB (HR, 2.20; 95% CI, 1.11-4.34; P = .02) independently predicted reduced myocardial contractile reserve. CONCLUSIONS CFVR during vasodilator stress echocardiography is a suitable tool for assessing microvascular dysfunction in routine clinical practice. Patients with DCM and LBBB show more severe forms of microvascular dysfunction, which is related to worse left ventricular function and lack of contractile reserve. Therapeutic interventions to restore microvascular function may improve left ventricular function parameters in patients with DCM.
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Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy.
| | | | | | - Fausto Rigo
- Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy
| | - Bruno Villari
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
| | | | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Pisa, Italy
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Coronary vasospasm after dobutamine stress echocardiogram triggered by esmolol. Int J Cardiol 2015; 193:17-9. [PMID: 26005167 DOI: 10.1016/j.ijcard.2015.04.272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 04/30/2015] [Indexed: 11/20/2022]
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Ivabradine and Bisoprolol on Doppler-derived Coronary Flow Velocity Reserve in Patients with Stable Coronary Artery Disease: Beyond the Heart Rate. Adv Ther 2015; 32:757-67. [PMID: 26293212 PMCID: PMC4569671 DOI: 10.1007/s12325-015-0237-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Indexed: 11/12/2022]
Abstract
Introduction Coronary flow velocity reserve (CFVR) is an important prognostic marker in patients with stable coronary artery disease (CAD). Beta-blockers and ivabradine have been shown to improve CFVR in patients with stable CAD, but their effects were never compared. The aim of the current study was to compare the effects of bisoprolol and ivabradine on CFVR in patients with stable CAD. Methods Patients in sinus rhythm with stable CAD were enrolled in this prospective, randomized, double-blind trial. Patients had to be in a stable condition for at least 15 days before enrollment, on their usual therapy. Patients who were receiving beta-blockers or ivabradine entered a 2-week washout period from these drugs before randomization. Transthoracic Doppler-derived CFVR was assessed in left anterior descending coronary artery, and was calculated as the ratio of hyperemic to baseline diastolic coronary flow velocity (CFV). Hyperemic CFV was obtained using dipyridamole administration using standard protocols. After CFVR assessment, patients were randomized to ivabradine or bisoprolol and entered an up-titration phase, and CFVR was assessed again 1 month after the end of the up-titration phase. Results Fifty-nine patients (38 male, 21 female; mean age 69 ± 9 years) were enrolled. Transthoracic Doppler-derived assessment of CFV and CFVR was successfully performed in all patients. Baseline characteristics were similar between the bisoprolol and ivabradine groups. No patient dropped out during the study. At baseline, rest and hyperemic peak CFV as well as CFVR was not significantly different in the ivabradine and bisoprolol groups. After the therapy, resting peak CFV significantly decreased in both the ivabradine and bisoprolol groups, but there was no significant difference between the groups (ivabradine group 20.7 ± 4.6 vs. 22.8 ± 5.2, P < 0.001; bisoprolol group 20.1 ± 4.1 vs. 22.1 ± 4.3, P < 0.001). However, hyperemic peak CFV significantly increased in both groups, but to a greater extent in patients treated with ivabradine (ivabradine: 70.7 ± 9.4 vs. 58.8 ± 9.2, P < 0.001; bisoprolol: 65 ± 8.3 vs. 58.7 ± 8.2, P < 0.001). Accordingly, CFVR significantly increased in both groups (ivabradine 3.52 ± 0.64 vs. 2.67 ± 0.55, P < 0.001; bisoprolol 3.35 ± 0.70 vs. 2.72 ± 0.55, P < 0.001), but it was significantly higher in ivabradine group, despite a similar decrease in heart rate (63 ± 7 vs. 61 ± 6; P not significant). Conclusion Ivabradine improves hyperemic peak CFV and CFVR to a greater extent than bisoprolol in patients with stable CAD, despite a similar decrease in heart rate. These data demonstrate that the benefits from ivabradine therapy go beyond the heart rate. This could be due to a different mechanism such as diastolic perfusion time, isovolumic ventricular relaxation, end-diastolic pressure, and collaterals. Funding Servier. Electronic supplementary material The online version of this article (doi:10.1007/s12325-015-0237-x) contains supplementary material, which is available to authorized users.
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Baroncini LAV, Borsoi R, Vidal MEB, Valente NJ, Veloso J, Pecoits Filho R. Assessment of dipyridamole stress echocardiography for risk stratification of diabetic patients. Cardiovasc Ultrasound 2015. [PMID: 26209102 PMCID: PMC4515011 DOI: 10.1186/s12947-015-0030-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Despite advances in medical therapy, cardiovascular disease, mainly coronary artery disease (CAD), remains the leading cause of mortality among patients with diabetes mellitus (DM). The objective of the present study was to assess the effectiveness of dipyridamole stress echocardiography in identify diabetic patients at high risk for cardiovascular events. METHODS Dipyridamole stress echocardiography was administered to 483 diabetic patients (294 women; mean age 63.41 ± 11.28 years) between July 2006 and December 2012. RESULTS Follow-up data were available for 264 patients (163 women; mean age 64.3 ± 10.5 years): 250 with a negative stress echocardiography and 14 with a positive stress echo. During a mean follow-up time of 18 ± 14 months, a cardiovascular event occurred in 18 (6.8%) patients, 12 (4.8%) in patients with a negative stress echo (n = 250) during a mean follow-up period of 20 ± 16 months and 6 (42%) in patients with positive stress echo (n = 14) during a mean follow-up of 13 ± 13 months. The positive and negative predictive values of stress echocardiography were 42% and 96% respectively. The accuracy value was 92%. A Cox regression model showed that CAD (hazard ratio [HR] 5.4, 95% confidence interval [CI] 1.9-15.4; p = 0.002) and positive stress echocardiography (HR 7.1, 95% CI 2.5-20.5; p < 0.001) were significant predictors of cardiovascular events. CONCLUSIONS For patients with diabetes, a negative dipyridamole stress echocardiogram predicts favorable outcome during the first year of follow-up. A new stress imaging test should be done after 12 months in diabetic patients.
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Affiliation(s)
- Liz Andréa Villela Baroncini
- Center of Health and Biological Sciences, Pontificia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Prado Velho, CEP: 80215-901, Curitiba, Paraná, Brazil.
| | - Rafael Borsoi
- Department of Internal Medicine, Medical School, Universidade Federal do Paraná, Rua XV de Novembro, 1299, Centro, CEP: 80060-000, Curitiba, Paraná, Brazil
| | - Maria Eugênia Bégué Vidal
- Medical School, Faculdade Evangélica, Rua Padre Anchieta, 2770, CEP: 80730-000, Curitiba, Paraná, Brazil
| | - Nathália Julim Valente
- Medical School, Faculdade Evangélica, Rua Padre Anchieta, 2770, CEP: 80730-000, Curitiba, Paraná, Brazil
| | - Juliana Veloso
- Pontificia Universidade Católica do Paraná, Curitiba, Brazil
| | - Roberto Pecoits Filho
- Center of Health and Biological Sciences, Pontificia Universidade Católica do Paraná, Rua Imaculada Conceição, 1155, Prado Velho, CEP: 80215-901, Curitiba, Paraná, Brazil
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Abram S, Arruda-Olson AM, Scott CG, Pellikka PA, Nkomo VT, Oh JK, Milan A, McCully RB. Typical blood pressure response during dobutamine stress echocardiography of patients without known cardiovascular disease who have normal stress echocardiograms. Eur Heart J Cardiovasc Imaging 2015. [PMID: 26206464 DOI: 10.1093/ehjci/jev165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Blood pressure (BP) responses during dobutamine stress echocardiography (DSE) have not been systematically studied. Consequently, it is not known what constitutes a normal or an abnormal BP response to dobutamine stress. We sought to define the typical BP response during DSE of patients not known to have cardiovascular disease. METHODS AND RESULTS Of 24 134 patients who underwent DSE from November 2003 to December 2012 at Mayo Clinic, Rochester, MN, 2968 were selected for inclusion in this retrospective study. Excluded were patients with a history of hypertension, diabetes, or coronary artery disease, and those taking vasoactive medications. Patients who had baseline and/or stress-induced wall motion abnormalities were also excluded. The distribution of the study population's BP responses during DSE was Gaussian; we defined cut-point values for normative BP responses at 2 SD for each decade of age and for the whole study population. During DSE, systolic BP (SBP) increased from baseline to peak stress (Δ +2.9 ± 24 mmHg, P < 0.0001) and diastolic BP (DBP) decreased (Δ -7.4 ± 14 mmHg). BP changes were age and sex dependent; men and younger patients had greater ΔSBP and lesser ΔDBP, compared with women and older patients. Patients who received atropine had higher peak BP values than patients who did not receive atropine, due to greater ΔSBP (+7.4 ± 26 vs. -0.5 ± 22 mmHg, P < 0.0001) and lesser ΔDBP (-4 ± 14 vs. -9.7 ± 12 mmHg, P < 0.0001). This atropine effect was present in men and women, and was more pronounced in younger patients. The normative peak SBP values ranged from 82 to 182 mmHg. CONCLUSION BP responses during DSE vary and depend on patients' age, gender, and the use of atropine. We describe the typical BP responses seen during DSE and report normative reference values, which can be used for defining normal and abnormal BP responses to dobutamine stress.
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Affiliation(s)
- Sara Abram
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA Department of Medical Sciences, University Hospital S. Giovanni Battista, University of Torino, Turin, Italy
| | - Adelaide M Arruda-Olson
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Patricia A Pellikka
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Vuyisile T Nkomo
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Jae K Oh
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Alberto Milan
- Department of Medical Sciences, University Hospital S. Giovanni Battista, University of Torino, Turin, Italy
| | - Robert B McCully
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Abstract
OBJECTIVES Takotsubo stress cardiomyopathy (TSC) is an increasingly recognised and diagnosed disease, although the underlying pathophysiology is still unknown. Our aim was to investigate the effect of the catecholamine dobutamine on coronary flow reserve (CFR) measured non-invasively in patients with TSC and controls. Our hypothesis was that dobutamine stress can induce microvascular dysfunction in patients with a previous episode of TSC. SETTING This is a case-control study and a substudy of the Stockholm Myocardial Infarction with Normal Coronaries (SMINC) study. Elective dobutamine investigations were performed focusing on non-invasive measurements of CFR. The investigations were performed more than 6 months after the acute event. PARTICIPANTS 22 patients with a previous episode of TSC and 22 sex-matched and age-matched controls were recruited from the SMINC study. All patients with TSC had a previous normal cardiovascular MR investigation. RESULTS CFR at low-dose dobutamine was significantly lower in the TSC group compared with controls, 1.51 and 1.72, respectively (p=0.017). At high-dose dobutamine, CFR was 1.95 and 2.21 in the TSC group and controls, respectively (p=0.098). CONCLUSIONS We could not confirm that the catecholamine dobutamine induced microvascular dysfunction in patients with TSC. However, we found a small but significant difference in CFR at low-dose dobutamine, which implies that the role of microvascular function in TSC needs to be further explored.
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Affiliation(s)
- Olov Collste
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Per Tornvall
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Mahbubul Alam
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Mats Frick
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Simova I. Coronary Flow Velocity Reserve Assessment with Transthoracic Doppler Echocardiography. Eur Cardiol 2015; 10:12-18. [PMID: 30310417 PMCID: PMC6159450 DOI: 10.15420/ecr.2015.10.01.12] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 06/23/2015] [Indexed: 11/04/2022] Open
Abstract
Coronary flow velocity reserve (CFVR) reflects global coronary atherosclerotic burden, endothelial function and state of the microvasculature. It could be measured using transthoracic Doppler echocardiography in a non-invasive, feasible, reliable and reproducible fashion, following a standardised protocol with different vasodilatory stimuli. CFVR measurement is a recommended complement to vasodilator stress echocardiography. It could serve as a diagnostic tool for coronary microvascular dysfunction and in the setting of epicardial coronary artery stenoses could help in identification and assessment of functional significance of coronary lesions and follow-up of patients after coronary interventions. CFVR has also a prognostic significance in different clinical situations.
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Affiliation(s)
- Iana Simova
- National Cardiology Hospital, Sofia, Bulgaria
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225
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Cortigiani L, Borelli L, Raciti M, Bovenzi F, Picano E, Molinaro S, Sicari R. Prediction of mortality by stress echocardiography in 2835 diabetic and 11 305 nondiabetic patients. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002757. [PMID: 25904573 DOI: 10.1161/circimaging.114.002757] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND To compare the capability by stress echocardiography results to predict overall mortality in a large unselected cohort of diabetic and nondiabetic patients. METHODS AND RESULTS The study group comprised 14 140 patients (2835 diabetics and 11 305 nondiabetics) who underwent stress echocardiography for evaluation of known (n=5671) or suspected (n=8469) coronary artery disease. Ischemia at stress echocardiography was observed in 768 (27%) diabetics and 2644 (23%) nondiabetics. During a median follow-up of 30 months (first quartile, 9; third quartile, 63), 1213 patients died. In diabetics, multivariable indicators of mortality were age (hazard ratio [HR], 1.07, 95% confidence interval [CI], 1.06-1.09), rest wall motion abnormality (HR, 2.43; 95% CI, 1.83-3.22), and ischemia at stress echocardiography (HR, 1.71; 95% CI, 1.34-2.18). In nondiabetics, multivariable indicators of mortality were age (HR, 1.07; 95% CI, 1.06-1.08), rest wall motion abnormality (HR, 2.19; 95% CI, 1.86-2.57), male sex (HR, 1.65; 95% CI, 1.41-1.93), ischemia at stress echocardiography (HR, 1.54; 95% CI, 1.32-1.80), and antischemic therapy at the time of test (HR, 1.15; 95% CI, 1.00-1.32). In stress echo negative subjects for ischemia, antischemic therapy showed increased annual mortality in nondiabetic patients with (3.8% versus 3.1%; P=0.04) or without rest wall motion abnormality (1.6% versus 0.9%; P<0.0001); it failed to do so in diabetic patients with (5.7% versus 5.8%; P=0.89) or without rest wall motion abnormality (2.6% versus 1.9%; P=0.10). CONCLUSIONS Ischemia at stress echocardiography is a strong and independent predictor of total mortality in diabetic as well as nondiabetic patients. Antischemic therapy markedly affects the negative predictive value of stress echocardiography in nondiabetic patients, whereas it is prognostically neutral in the diabetic population.
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Affiliation(s)
- Lauro Cortigiani
- From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Lucia Borelli
- From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Mauro Raciti
- From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Francesco Bovenzi
- From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Eugenio Picano
- From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Sabrina Molinaro
- From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy
| | - Rosa Sicari
- From the Division of Cardiology, San Luca Hospital, Lucca, Italy (L.C., L.B., F.B.); and Departments of Echocardiography (M.R., E.P, R.S.) and Epidemiology (S.M.), Institute of Clinical Physiology, CNR, Pisa, Italy.
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Abstract
Transthoracic echocardiography is the most widely used imaging test in cardiology. Although completely noninvasive, transthoracic echocardiography has a well-established role in the diagnosis of numerous cardiovascular diseases, and also provides critical qualitative and quantitative information on their prognosis and pathophysiological processes. The aim of this Review is to outline the broad principles of transthoracic echocardiography, including the traditional techniques of two-dimensional, colour, and spectral Doppler echocardiography, and newly developed advances including tissue Doppler, myocardial deformation imaging, torsion, stress echocardiography, contrast and three-dimensional echocardiography. The advantages and disadvantages, clinical application, prognostic value, and salient research findings of each modality are described. Advances in complex imaging techniques are expected to continue unabated, and this Review highlights technical improvements that will influence the diagnosis and improve our understanding of cardiovascular function and disease.
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Affiliation(s)
- Anita C Boyd
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
| | - Nelson B Schiller
- University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
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Ciampi Q, Rigo F, Grolla E, Picano E, Cortigiani L. Dual imaging stress echocardiography versus computed tomography coronary angiography for risk stratification of patients with chest pain of unknown origin. Cardiovasc Ultrasound 2015; 13:21. [PMID: 25896850 PMCID: PMC4409769 DOI: 10.1186/s12947-015-0013-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 04/01/2015] [Indexed: 01/07/2023] Open
Abstract
Background Dual imaging stress echocardiography, combining the evaluation of wall motion and coronary flow reserve (CFR) on the left anterior descending artery (LAD), and computed tomography coronary angiography (CTCA) are established techniques for assessing prognosis in chest pain patients. In this study we compared the prognostic value of the two methods in a cohort of patients with chest pain having suspected coronary artery disease (CAD). Methods A total of 131 patients (76 men; age 68 ± 9 years) with chest pain of unknown origin underwent dipyridamole (up to 0.84 mg/kg over 6 min) stress echo with CFR assessment of LAD by Doppler and CTCA. A CFR ≤ 1.9 was considered abnormal, while > 50% lumen diameter reduction was the criterion for significant CAD at CTCA. Results Of 131 patients, 34 (26%) had ischemia at stress echo (new wall motion abnormalities), and 56 (43%) had reduced CFR on LAD. Significant coronary stenosis at CTCA was found in 69 (53%) patients. Forty-six patients (84%) with abnormal CFR on LAD showed significant CAD at CTCA (p < 0.001). Calcium score was higher in patients with reduced than in those with normal CFR (265 ± 404 vs 131 ± 336, p = 0.04). During a median follow-up of 7 months (1st to 3rd quartile: 5–13 months), there were 45 major cardiac events (4 deaths, 11 nonfatal myocardial infarctions, and 30 late [≥6 months] coronary revascularizations). At Cox analysis, independent prognostic indicators were calcium score > 100 (HR 2.84, 95% CI 1.33-6.07, p = 0.007), significant CAD at CTCA (HR 2.68, 95% CI 1.23-5.82, p = 0.013), and inducible ischemia or CFR <1.9R on LAD on dual imaging stress echo (HR 2.25, 95% CI 1.05-4.84, p = 0.038). Conclusions Functional and anatomical evaluation using, respectively, dual imaging stress echocardiography and CTCA are both effective modalities to risk stratify patients with chest pain of unknown origin, yielding independent and comparable prognostic value. Compared to CTCA, however, stress echocardiography has the advantage of lower cost and of being free of radiations.
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Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, 12 I-82100, Benevento, Italy. .,CNR Institute of Clinical Physiology, Pisa, Italy.
| | - Fausto Rigo
- Department of Cardiology, dell'Angelo Hospital, Mestre-Venice, Italy.
| | - Elisabetta Grolla
- Department of Cardiology, dell'Angelo Hospital, Mestre-Venice, Italy.
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Sharma R, O'Driscoll JM, Saha A, Sritharan M, Sutton R, Rosen SD. Differing autonomic responses to dobutamine stress in the presence and absence of myocardial ischaemia. J Physiol 2015; 593:2171-84. [PMID: 25689169 DOI: 10.1113/jp270063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 02/11/2015] [Indexed: 11/08/2022] Open
Abstract
KEY POINTS Dobutamine stress echocardiography is a validated tool for the non-invasive evaluation of myocardial ischaemia and enables the recording of heart rate variability in non-resting conditions. In this study we determined whether individuals with transient myocardial ischaemia had different autonomic responses to the stress of dobutamine infusion compared to non-ischaemic (normal) responders. Non-ischaemic responders had a residual predominance of parasympathetic over sympathetic activity. However, under conditions of myocardial ischaemia, there was a directionally opposite cardiac autonomic response with a residual increase of sympathetic over parasympathetic modulation. The sympathetic response to dobutamine stress is augmented as the burden of myocardial ischaemia is increased. ABSTRACT Cardiac autonomic dysfunction has prognostic significance in patients with coronary artery disease. This investigation aimed to assess changes in autonomic modulation induced by dobutamine stress in the presence and absence of myocardial ischaemia. In total, 314 individuals underwent dobutamine stress echocardiography to detect or exclude myocardial ischaemia. Simultaneous autonomic and haemodynamic data were obtained using a plethysmographic device. Total power spectral density and associated low-frequency (LF) and high-frequency (HF) power spectral components in absolute (ms(2) ) and normalised units (nu) were determined. Participants were categorised as non-ischaemic (NI) or ischaemic (IS) responders. There were no significant differences in LFnu or HFnu between groups at baseline. At peak stress, LFnu decreased from baseline in NI (43 ± 1.8 to 40 ± 1.8%), but increased from baseline in IS responders (39.5 ± 2 to 56 ± 2%, P < 0.05). In contrast, HFnu increased in NI patients (57 ± 1.8 to 60 ± 1.8%) but decreased in IS responders (60.5 ± 2 to 44 ± 2%, P < 0.05). Those with a high ischaemic burden [more than three ischaemic left ventricular (LV) segments] had a greater increase in LFnu (41 ± 4.8 to 65 ± 3.2% vs. 44.8 ± 3.8 to 57.7 ± 3.1%, P < 0.05) and greater decrease in HFnu (59 ± 4.8 to 35 ± 3.2% vs. 55.2 ± 3.8 to 42.3 ± 3.1%, P < 0.05) compared to patients with a low ischaemic burden (1-3 ischaemic LV segments) respectively, at peak stress. In the absence of myocardial ischaemia, dobutamine stress is associated with a residual predominance of parasympathetic over sympathetic activity. Under conditions of ischaemia, there is a directionally opposite autonomic response with a significant residual increase of sympathetic over parasympathetic modulation. This response is augmented as the burden of ischaemia is increased.
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Affiliation(s)
- Rajan Sharma
- Department of Cardiology, St George's Healthcare NHS Trust, Blackshaw Road, Tooting, London, SW17 0QT, UK
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229
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Januszko-Giergielewicz B, Dębska-Ślizień A, Górny J, Kozak J, Oniszczuk K, Gromadziński L, Dorniak K, Dudziak M, Malinowski P, Rutkowski B. Dobutamine stress echocardiography in the diagnosis of asymptomatic ischemic heart disease in patients with chronic kidney disease--review of literature and single-center experience. Transplant Proc 2015; 47:295-303. [PMID: 25769563 DOI: 10.1016/j.transproceed.2014.11.034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Coronary artery disease (CAD) may be present in kidney transplant (KT) candidates without the presence of CAD clinical symptoms. This study joins an ongoing discussion about appropriate noninvasive diagnostic approaches for ischemic heart disease (IHD) assessment and patient selection for revascularization procedures. The aim of this study was to evaluate the role of dobutamine stress echocardiography (DSE) in IHD diagnosis in initially asymptomatic maintenance hemodialysis (HD) patients. METHODS Forty HD patients aged 52.4 ± 2.0 years, were studied for 2.5 years. At inclusion, they were free of both symptoms and history of IHD. Standard electrocardiography (ECG), chest X-ray, standard echocardiography, DSE, 24-hour Holter ECG, and Doppler ultrasonography (carotids and lower extremities) were performed. Results were analyzed according to a predefined diagnostic algorithm. RESULTS DSE yielded negative results in all patients. Left ventricular (LV) ejection fraction ≤ 60%, LV hypertrophy, and Holter ECG silent ischemia features were noticed in 15%, 70%, and 10% of patients, respectively. Atherosclerotic lesions in lower extremities and carotid arteries were present in 50% and 37.5% of patients, respectively. During the follow-up, 9/40 patients died, including 6 cardiovascular (CV) deaths: 2 with intermediate and 4 with high CV risk according to the proposed algorithm. CONCLUSIONS In asymptomatic KT candidates, not only DSE, but also other noninvasive tests (eg, echocardiography and Doppler ultrasonography of the carotid and peripheral arteries) along with a detailed profile of the remaining CV risk factors should be performed and analyzed. Defined composition of risk factors and particular changes in noninvasive tests may be an indication for coronary angiography.
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Affiliation(s)
| | - A Dębska-Ślizień
- Clinic of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - J Górny
- Department of Cardiology, Provincial Specialist Hospital, Olsztyn, Poland
| | - J Kozak
- Ultrasonography and Fine Needle Biopsy Laboratory, Provincial Specialist Hospital, Olsztyn, Poland
| | - K Oniszczuk
- Ultrasonography and Fine Needle Biopsy Laboratory, Provincial Specialist Hospital, Olsztyn, Poland
| | - L Gromadziński
- University Clinical Hospital, University of Warmia and Mazury, Olsztyn, Poland
| | - K Dorniak
- Department of Cardiac Diagnostics, 2nd Chair of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - M Dudziak
- Department of Cardiac Diagnostics, 2nd Chair of Cardiology, Medical University of Gdańsk, Gdańsk, Poland
| | - P Malinowski
- Department of Transplantation, Provincial Specialist Hospital, Olsztyn, Poland
| | - B Rutkowski
- Clinic of Nephrology, Transplantology, and Internal Medicine, Medical University of Gdańsk, Gdańsk, Poland
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230
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van Zalen J, Patel NR, J Podd S, Raju P, McIntosh R, Brickley G, Beale L, Sturridge LP, Lloyd GWL. Prognostic importance of tissue velocity imaging during exercise echocardiography in patients with systolic heart failure. Echo Res Pract 2015; 2:19-27. [PMID: 26693312 PMCID: PMC4676458 DOI: 10.1530/erp-14-0074] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/03/2015] [Indexed: 11/08/2022] Open
Abstract
Resting echocardiography measurements are poor predictors of exercise capacity and symptoms in patients with heart failure (HF). Stress echocardiography may provide additional information and can be expressed using left ventricular ejection fraction (LVEF), or diastolic parameters (E/E'), but LVEF has some major limitations. Systolic annular velocity (S') provides a measure of longitudinal systolic function, which is relatively easy to obtain and shows a good relationship with exercise capacity. The objective of this study was to investigate the relationship among S', E/E' and LVEF obtained during stress echocardiography and both mortality and hospitalisation. A secondary objective was to compare S' measured using a simplified two-wall model. A total of 80 patients with stable HF underwent exercise stress echocardiography and simultaneous cardiopulmonary exercise testing. Volumetric and tissue velocity imaging (TVI) measurements were obtained, as was peak oxygen uptake (VO2 peak). Of the total number of patients, 11 died and 22 required cardiac hospitalisation. S' at peak exertion was a powerful predictor for death and hospitalisation. Cut-off points of 5.3 cm/s for death and 5.7 cm/s for hospitalisation provided optimum sensitivity and specificity. This study suggests that, in patients with systolic HF, S' at peak exertion calculated from the averaged spectral TVI systolic velocity of six myocardial segments, or using a simplified measure of two myocardial segments, is a powerful predictor of future events and stronger than LVEF, diastolic velocities at rest or exercise and VO2 peak. Results indicate that measuring S' during exercise echocardiography might play an important role in understanding the likelihood of adverse clinical outcomes in patients with HF.
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Affiliation(s)
- Jet van Zalen
- Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK
| | - Nikhil R Patel
- Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK
| | - Steven J Podd
- Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK
| | - Prashanth Raju
- Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK
| | - Rob McIntosh
- Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK
| | - Gary Brickley
- School of Sport and Service Management, University of Brighton , Hillbrow, Denton Road, Eastbourne, BN20 7SR , UK
| | - Louisa Beale
- School of Sport and Service Management, University of Brighton , Hillbrow, Denton Road, Eastbourne, BN20 7SR , UK
| | - Lydia P Sturridge
- Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK
| | - Guy W L Lloyd
- Cardiology Department, District General Hospital , Kings Drive, Eastbourne, BN21 2UD , UK
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231
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Neglia D, Rovai D, Caselli C, Pietila M, Teresinska A, Aguadé-Bruix S, Pizzi MN, Todiere G, Gimelli A, Schroeder S, Drosch T, Poddighe R, Casolo G, Anagnostopoulos C, Pugliese F, Rouzet F, Le Guludec D, Cappelli F, Valente S, Gensini GF, Zawaideh C, Capitanio S, Sambuceti G, Marsico F, Perrone Filardi P, Fernández-Golfín C, Rincón LM, Graner FP, de Graaf MA, Fiechter M, Stehli J, Gaemperli O, Reyes E, Nkomo S, Mäki M, Lorenzoni V, Turchetti G, Carpeggiani C, Marinelli M, Puzzuoli S, Mangione M, Marcheschi P, Mariani F, Giannessi D, Nekolla S, Lombardi M, Sicari R, Scholte AJ, Zamorano JL, Kaufmann PA, Underwood SR, Knuuti J. Detection of Significant Coronary Artery Disease by Noninvasive Anatomical and Functional Imaging. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002179. [DOI: 10.1161/circimaging.114.002179] [Citation(s) in RCA: 237] [Impact Index Per Article: 26.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Danilo Neglia
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Daniele Rovai
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Chiara Caselli
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Mikko Pietila
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Anna Teresinska
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Santiago Aguadé-Bruix
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Maria Nazarena Pizzi
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Giancarlo Todiere
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Alessia Gimelli
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Stephen Schroeder
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Tanja Drosch
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Rosa Poddighe
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Giancarlo Casolo
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Constantinos Anagnostopoulos
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Francesca Pugliese
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Francois Rouzet
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Dominique Le Guludec
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Francesco Cappelli
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Serafina Valente
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Gian Franco Gensini
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Camilla Zawaideh
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Selene Capitanio
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Gianmario Sambuceti
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Fabio Marsico
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Pasquale Perrone Filardi
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Covadonga Fernández-Golfín
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Luis M Rincón
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Frank P Graner
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Michiel A. de Graaf
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Michael Fiechter
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Julia Stehli
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Oliver Gaemperli
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Eliana Reyes
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Sandy Nkomo
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Maija Mäki
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Valentina Lorenzoni
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Giuseppe Turchetti
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Clara Carpeggiani
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Martina Marinelli
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Stefano Puzzuoli
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Maurizio Mangione
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Paolo Marcheschi
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Fabio Mariani
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Daniela Giannessi
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Stephan Nekolla
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Massimo Lombardi
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Rosa Sicari
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Arthur J.H.A. Scholte
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - José L. Zamorano
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Philipp A. Kaufmann
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - S. Richard Underwood
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
| | - Juhani Knuuti
- From the Institute of Clinical Physiology, CNR, Pisa, Italy (D.N., D.R., C. Caselli, C. Carpeggiani, M. Marinelli, F. Mariani, D.G., R.S.); Cardiothoracic Department (D.N., G. Todiere), Imaging Department (A.G., M.L.) and Technology Department (S.P., M. Mangione, P.M.), Fondazione Toscana G. Monasterio, Pisa, Italy; Heart Center (M.P.) and Turku PET Center (M.Mäki, J.K.), University of Turku and Turku University Hospital, Turku, Finland; Department of Nuclear Medicine, Institute of Cardiology,
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Cardim N, Galderisi M, Edvardsen T, Plein S, Popescu BA, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Freitas A, Habib G, Kitsiou A, Petersen SE, Schroeder S, Lancellotti P, Camici P, Dulgheru R, Hagendorff A, Lombardi M, Muraru D, Sicari R. Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Heart J Cardiovasc Imaging 2015; 16:280. [PMID: 25650407 DOI: 10.1093/ehjci/jeu291] [Citation(s) in RCA: 190] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost.
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MESH Headings
- Cardiac Imaging Techniques/methods
- Cardiac Imaging Techniques/standards
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Consensus
- Echocardiography, Doppler/methods
- Echocardiography, Doppler/standards
- Europe
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine/methods
- Magnetic Resonance Imaging, Cine/standards
- Male
- Multimodal Imaging/methods
- Multimodal Imaging/standards
- Positron-Emission Tomography/methods
- Positron-Emission Tomography/standards
- Practice Guidelines as Topic/standards
- Role
- Saudi Arabia
- Societies, Medical/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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Caselli C, Rovai D, Lorenzoni V, Carpeggiani C, Teresinska A, Aguade S, Todiere G, Gimelli A, Schroeder S, Casolo G, Poddighe R, Pugliese F, Le Guludec D, Valente S, Sambuceti G, Perrone-Filardi P, Del Ry S, Marinelli M, Nekolla S, Pietila M, Lombardi M, Sicari R, Scholte A, Zamorano J, Kaufmann PA, Underwood SR, Knuuti J, Giannessi D, Neglia D. A New Integrated Clinical-Biohumoral Model to Predict Functionally Significant Coronary Artery Disease in Patients With Chronic Chest Pain. Can J Cardiol 2015; 31:709-16. [PMID: 26022987 DOI: 10.1016/j.cjca.2015.01.035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 01/23/2015] [Accepted: 01/29/2015] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND In patients with chronic angina-like chest pain, the probability of coronary artery disease (CAD) is estimated by symptoms, age, and sex according to the Genders clinical model. We investigated the incremental value of circulating biomarkers over the Genders model to predict functionally significant CAD in patients with chronic chest pain. METHODS In 527 patients (60.4 years, standard deviation, 8.9 years; 61.3% male participants) enrolled in the European Evaluation of Integrated Cardiac Imaging (EVINCI) study, clinical and biohumoral data were collected. RESULTS Functionally significant CAD-ie, obstructive coronary disease seen at invasive angiography causing myocardial ischemia at stress imaging or associated with reduced fractional flow reserve (FFR < 0.8), or both-was present in 15.2% of patients. High-density lipoprotein (HDL) cholesterol, aspartate aminotransferase (AST) levels, and high-sensitivity C-reactive protein (hs-CRP) were the only independent predictors of disease among 31 biomarkers analyzed. The model integrating these biohumoral markers with clinical variables outperformed the Genders model by receiver operating characteristic curve (ROC) (area under the curve [AUC], 0.70 [standard error (SE), 0.03] vs 0.58 [SE, 0.03], respectively, P < 0.001) and reclassification analysis (net reclassification improvement, 0.15 [SE, 0.07]; P = 0.04). Cross-validation of the ROC analysis confirmed the discrimination ability of the new model (AUC, 0.66). As many as 56% of patients who were assigned to a higher pretest probability by the Genders model were correctly reassigned to a low probability class (< 15%) by the new integrated model. CONCLUSIONS The Genders model has a low accuracy for predicting functionally significant CAD. A new model integrating HDL cholesterol, AST, and hs-CRP levels with common clinical variables has a higher predictive accuracy for functionally significant CAD and allows the reclassification of patients from an intermediate/high to a low pretest likelihood of CAD.
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Affiliation(s)
- Chiara Caselli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy.
| | - Daniele Rovai
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Clara Carpeggiani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | | | | | | | | | | | | | - Francesca Pugliese
- Centre for Advanced Cardiovascular Imaging, NIHR Cardiovascular Biomedical Research Unit at Barts, William Harvey Research Institute, Barts and The London School of Medicine, Queen Mary University of London, London, United Kingdom
| | - Dominique Le Guludec
- APHP, Groupe Hospitalier Bichat-Claude Bernard, Département Hospitalo-Universitaire FIRE and Université Paris Diderot, Paris, France
| | | | | | | | - Silvia Del Ry
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Martina Marinelli
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Stephan Nekolla
- Klinikum rechts der Isar der Technischen Universitat Munchen, Munchen, Germany
| | - Mikko Pietila
- University of Turku and Turku University Hospital, Turku, Finland
| | | | - Rosa Sicari
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Arthur Scholte
- Leiden University Medical Center, Leiden, The Netherlands
| | - José Zamorano
- University Hospital Clinico San Carlos, Madrid, Spain
| | | | | | - Juhani Knuuti
- University of Turku and Turku University Hospital, Turku, Finland
| | - Daniela Giannessi
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Danilo Neglia
- Institute of Clinical Physiology, National Research Council, Pisa, Italy; Fondazione Toscana G. Monasterio, Pisa, Italy
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Reant P, Reynaud A, Pillois X, Dijos M, Arsac F, Touche C, Landelle M, Rooryck C, Roudaut R, Lafitte S. Comparison of Resting and Exercise Echocardiographic Parameters as Indicators of Outcomes in Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2015; 28:194-203. [DOI: 10.1016/j.echo.2014.10.001] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Indexed: 11/25/2022]
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236
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Cortigiani L, Rigo F, Gherardi S, Bovenzi F, Picano E, Sicari R. Prognostic value of Doppler echocardiographic-derived coronary flow velocity reserve of left anterior descending artery in octogenarians with stress echocardiography negative for wall motion criteria. Eur Heart J Cardiovasc Imaging 2015; 16:653-60. [PMID: 25588801 DOI: 10.1093/ehjci/jeu311] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 12/14/2014] [Indexed: 11/14/2022] Open
Abstract
AIMS Doppler-derived coronary flow velocity reserve (CFVR) of left anterior descending (LAD) artery is an effective tool to predict overall mortality. The aim was to investigate the capability of CFVR to predict outcome in an unselected cohort of patients older than 80 years having stress echo negative by wall motion criteria. METHODS AND RESULTS The study group refers to 369 patients aged > 80 years (156 men; mean age 83 ± 2 years) who had undergone dipyridamole stress echocardiography with CFVR assessment of LAD artery of known (n = 144) or suspected (n = 225) coronary artery disease. Stress echocardiography was negative for wall motion criteria in all cases. Mean CFVR was 2.07 ± 0.53. During a median follow-up of 21 months, there were 62 major adverse cardiac events (MACEs; 45 deaths and 17 non-fatal myocardial infarctions). With a receiver operating characteristic analysis, a CFVR of ≤ 1.93 was the best cut-off for predicting mortality and MACE. At individual patient analysis, 152 (41%) subjects had a CFVR of < 1.93. Annual mortality was 9.8% in patients with CFVR <1.93 and 3.7% in those with CFVR > 1.93 (P = 0.001); an annual MACE rate was 14.8% in the former and 4.5% in the latter (P < 0.0001). Of 15 clinical and echocardiographic parameters analysed, CFVR ≤ 1.93 [hazard ratio (HR) = 2.17, 95% CI 1.14-4.10] and resting wall motion abnormality (RWMA; HR = 2.60; 95% CI 1.35-5.00) were multivariable indicators of mortality. Moreover, CFVR ≤ 1.93 (HR = 2.69, 95% CI 1.56-4.67), and RWMA (HR = 2.38; 95% CI 1.31-4.33) were also strong independent predictors of MACEs. At incremental analysis, CFR ≤ 1.93 added prognostic information over clinical evaluation and RWMA when both mortality and MACE were taken as clinical end points. CONCLUSIONS A reduced CFVR of LAD artery is a strong and independent indicator of both mortality and MACE, adding prognostic information over clinical evaluation and RWMA. Conversely, a preserved CFVR predicts a favourable outcome particularly in subjects with no RWMA.
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Affiliation(s)
| | - Fausto Rigo
- Divisione di Cardiologia, Ospedale dell'Angelo, Mestre-Venezia, Italy
| | | | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, 56124 Pisa, Italy
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Patrikeev AV, Rudman VI, Maksimkin DA, Baranovich VI, Faĭbushevich AG, Veretnik GI, Mambetov AV, Shugushev ZK. [Immediate and remote results of endovascular treatment of patients with postinfarction cardiosclerosis]. Khirurgiia (Mosk) 2015:17-22. [PMID: 25909546 DOI: 10.17116/hirurgia2015117-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Two approaches in treatment of 131 patients with postinfarction cardiosclerosis are compared in the work. Tactics of "total" myocardial revascularization means restoration of coronary blood flow in all arteries with hemodynamically significant lesion while "selective" revascularization provides restoration of coronary blood flow only in those arteries which have a viable myocardium in their pool. It was concluded that restoration of coronary blood flow in patients after myocardial infarction permits to prevent postinfarction heart remodeling, development of heart failure thereby affecting on the prognosis. Evaluation of myocardial viability in the area of suggested surgery increases efficiency of revascularization, reduces number of implantable stents and decreases frequency of unfounded coronary interventions. Elimination of ischemia in the area of hibernation provides a rapid restoration of myocardial contractility in most of left ventricle segments with initially impaired kinetics. It was revealed that terms of contractility restoration of hibernating myocardium depend on duration of hibernation period up to revascularization.
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Affiliation(s)
- A V Patrikeev
- Rossiĭskiĭ universitet druzhby narodov, Moskva; Tsentral'naia klinicheskaia bol'nitsa #2 im. N.A. Semashko OAO "RZhD", Moskva
| | - V Ia Rudman
- Rossiĭskiĭ universitet druzhby narodov, Moskva; Kraevaia bol'nitsa #2, Khabarovsk
| | - D A Maksimkin
- Rossiĭskiĭ universitet druzhby narodov, Moskva; Tsentral'naia klinicheskaia bol'nitsa #2 im. N.A. Semashko OAO "RZhD", Moskva
| | - V Iu Baranovich
- Rossiĭskiĭ universitet druzhby narodov, Moskva; Tsentral'naia klinicheskaia bol'nitsa #2 im. N.A. Semashko OAO "RZhD", Moskva
| | - A G Faĭbushevich
- Rossiĭskiĭ universitet druzhby narodov, Moskva; Tsentral'naia klinicheskaia bol'nitsa #2 im. N.A. Semashko OAO "RZhD", Moskva
| | | | | | - Z Kh Shugushev
- Rossiĭskiĭ universitet druzhby narodov, Moskva; Tsentral'naia klinicheskaia bol'nitsa #2 im. N.A. Semashko OAO "RZhD", Moskva
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Faccini A, Agricola E, Oppizzi M, Margonato A, Galderisi M, Sabbadini MG, Franchini S, Camici PG. Coronary Microvascular Dysfunction in Asymptomatic Patients Affected by Systemic Sclerosis – Limited vs. Diffuse Form –. Circ J 2015; 79:825-9. [DOI: 10.1253/circj.cj-14-1114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Alessia Faccini
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Eustachio Agricola
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Michele Oppizzi
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Alberto Margonato
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | | | | | - Stefano Franchini
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
| | - Paolo G Camici
- Vita-Salute San Raffaele University and San Raffaele Scientific Institute
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239
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Garbi M, McDonagh T, Cosyns B, Bucciarelli-Ducci C, Edvardsen T, Kitsiou A, Nieman K, Lancellotti P. Appropriateness criteria for cardiovascular imaging use in heart failure: report of literature review. Eur Heart J Cardiovasc Imaging 2014; 16:147-53. [PMID: 25550363 DOI: 10.1093/ehjci/jeu299] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
The Imaging Task Force appointed by the European Society of Cardiology (ESC) and the European Association of Cardiovascular Imaging (EACVI) identified the need to develop appropriateness criteria for the use of cardiovascular imaging in heart failure as a result of continuously increasing demand for imaging in diagnosis, definition of aetiology, follow-up, and treatment planning. This article presents the report of literature review performed in order to inform the process of definition of clinical indications and to aid the decisions of the appropriateness criteria voting panel. The report is structured according to identified common heart failure clinical scenarios.
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Affiliation(s)
- Madalina Garbi
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Theresa McDonagh
- King's Health Partners, King's College Hospital NHS Foundation Trust, London, UK
| | - Bernard Cosyns
- Universitair Ziekenhuis van Brussel, CHVZ and ICMI Laboratory, CHIREC, Brussels, Belgium
| | - Chiara Bucciarelli-Ducci
- Bristol NIHR Cardiovascular Biomedical Research Unit (BRU), Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, University of Bristol, Bristol, UK
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Norway
| | | | - Koen Nieman
- Department of Cardiology and Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Patrizio Lancellotti
- Department of GIGA Cardiovascular Sciences, Heart Valve Clinic, Department of Cardiology, University of Liège Hospital, University Hospital SartTilman, Liège, Belgium Department of GVM Care and Research, Bologna, Italy
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240
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Role of Stress Echocardiography in Operated Fallot: Feasibility and Detection of Right Ventricular Response. J Am Soc Echocardiogr 2014; 27:1319-28. [DOI: 10.1016/j.echo.2014.08.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Indexed: 11/18/2022]
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241
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Clinical and imaging description of the Maron subtypes of hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 2014; 31:47-55. [DOI: 10.1007/s10554-014-0529-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/01/2014] [Indexed: 11/25/2022]
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242
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Why Do Some Recovered Peripartum Cardiomyopathy Mothers Experience Heart Failure With a Subsequent Pregnancy? CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2014; 17:354. [DOI: 10.1007/s11936-014-0354-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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243
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Prognostic role of transthoracic echocardiography in patients affected by heart failure and reduced ejection fraction. Heart Fail Rev 2014; 20:305-16. [DOI: 10.1007/s10741-014-9461-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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244
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Sharma T, Lau EM, Choudhary P, Torzillo PJ, Munoz PA, Simmons LR, Naeije R, Celermajer DS. Dobutamine stress for evaluation of right ventricular reserve in pulmonary arterial hypertension. Eur Respir J 2014; 45:700-8. [DOI: 10.1183/09031936.00089914] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Right ventricular contractile response to pharmacological stress in pulmonary arterial hypertension (PAH) has not been characterised. We evaluated right ventricular contractile reserve in adults with PAH using dobutamine stress echocardiography.16 PAH patients and 18 age-matched controls underwent low-dose dobutamine stress echocardiography. Contractile reserve was assessed by the change (Δ; peak stress minus rest value) in tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (S′). A subgroup of 13 PAH patients underwent treadmill cardiopulmonary exercise testing for peak oxygen uptake (V′O2peak).At rest, TAPSE and S′ were reduced in the PAH group compared with controls (1.7±0.4 versus 2.4±0.2 cm and 9.7±2.6 versus 12.5±1.2 cm·s−1, respectively; p<0.05). Contractile reserve was markedly attenuated in PAH compared to controls (ΔTAPSE 0.1±0.2 versus 0.6±0.3 cm and ΔS′ 4.6±2.8 versus 11.2±3.6 cm·s−1; p<0.0001). In the sub-group of PAH patients with preserved right ventricular systolic function at rest, contractile reserve remained depressed compared to controls. V′O2peak was significantly correlated with ΔS′ (r=0.87, p=0.0003) and change in stroke volume (r=0.59, p=0.03).Dobutamine stress can reveal sub-clinical reduction in right ventricular contractile reserve in patients with PAH. A correlation with exercise capacity suggests potential clinical value beyond resting measurements.
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245
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Conti A, Alesi A, Aspesi G, Bigiarini S, Bianchi S, Angeli E, Zanobetti M, Innocenti F, Pini R, Gensini GF. Comparison of exercise electrocardiogram and exercise echocardiography in intermediate-risk chest pain patients. Am J Emerg Med 2014; 33:7-13. [PMID: 25445858 DOI: 10.1016/j.ajem.2014.09.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/23/2014] [Accepted: 09/24/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The novel exercise computer-assisted high-frequency QRS analysis (HF/QRS) has demonstrated improved sensitivity and specificity over the conventional ST/electrocardiogram-segment analysis (ST/ECG) in the detection of myocardial ischemia. The aim of the present study was to compare the diagnostic value of the validated exercise echocardiography (ex-Echo) with the novel exercise ECG (ex-ECG) including HF/QRS and ST/ECG analysis. METHODS A prospective cohort study was conducted in the emergency department of a tertiary care teaching Hospital. Patients with chest pain (CP), normal resting ECGs, troponins, and echocardiography, labeled as "intermediate-risk" for adverse coronary events, underwent the novel ex-ECG and ex-Echo. An ST-segment depression of at least 2 mV or at least 1 mV when associated with CP was considered as an index of ischemia, as well as a decrease of at least 50% in HF/QRS intensity, or new wall motion abnormalities on ex-Echo. Exclusion criteria were QRS duration of at least 120 milliseconds, poor echo-acoustic window, and inability to exercise. Patients were followed up to 3 months. The end point was the composite of coronary stenoses of 50% or greater at angiography or acute coronary syndrome, revascularization, and cardiovascular death on the 3-month follow-up. RESULTS Of 188 patients enrolled, 18 achieved the end point. The novel ex-ECG and ex-Echo showed comparable negative predictive value (97% vs 96%; P = .930); however, sensitivity was 83% vs 61%, respectively (P = .612), and specificity was 64% vs 92%, respectively,(P = .026). The areas on receiver operating characteristic analysis were comparable (ex-ECG: 0.734 [95% confidence interval, or CI, 0.62-0.85] vs ex-Echo: 0.767 [CI, 0.63-0.91]; C statistic, P = .167). On multivariate analysis, both ex-ECG (hazard ratio, 5; CI, 1-20; P = .017) and ex-Echo (HR, 12; CI, 4-40; P < .001) were predictors of the end point. CONCLUSIONS In intermediate-risk CP patients, the novel ex-ECG including HF/QRS added to ST/ECG analysis was a valuable diagnostic tool and might be proposed to avoid additional imaging. However, the novel test needs additional study before it can be recommended as a replacement for current techniques.
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Affiliation(s)
- Alberto Conti
- Emergency Medicine and Chest Pain Clinic, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy.
| | - Andrea Alesi
- Emergency Medicine and Chest Pain Clinic, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
| | - Giovanna Aspesi
- Emergency Medicine and Chest Pain Clinic, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
| | - Sofia Bigiarini
- Emergency Medicine and Chest Pain Clinic, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
| | - Simone Bianchi
- Emergency Medicine and Chest Pain Clinic, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
| | - Elena Angeli
- Emergency Medicine and Chest Pain Clinic, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
| | - Maurizio Zanobetti
- Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
| | - Francesca Innocenti
- Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
| | - Riccardo Pini
- Emergency Medicine, Department of Critical Care Medicine and Surgery, Careggi University Hospital, Florence, Italy
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246
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The medium term prognostic value of dobutamine stress echocardiogram in patients with high risk scores of coronary artery disease according to NICE Clinical Guideline 95. Int J Cardiol 2014; 176:1190-1. [DOI: 10.1016/j.ijcard.2014.07.235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Accepted: 07/27/2014] [Indexed: 11/22/2022]
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247
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Coronary Flow Velocity Reserve during Pharmacologic Stress Echocardiography with Normal Contractility Adds Important Prognostic Value in Diabetic and Nondiabetic Patients. J Am Soc Echocardiogr 2014; 27:1113-9. [DOI: 10.1016/j.echo.2014.05.009] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Indexed: 11/17/2022]
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248
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Hwang HJ, Lee HM, Yang IH, Lee JL, Pak HY, Park CB, Jin ES, Cho JM, Kim CJ, Sohn IS. The value of assessing myocardial deformation at recovery after dobutamine stress echocardiography. J Cardiovasc Ultrasound 2014; 22:127-33. [PMID: 25309689 PMCID: PMC4192410 DOI: 10.4250/jcu.2014.22.3.127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/08/2023] Open
Abstract
Background The purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort. Methods DSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 µg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a ≥ 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group]. Results There were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 ± 3.4% vs. -21.0 ± 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%). Conclusion Assessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD.
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Affiliation(s)
- Hui-Jeong Hwang
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyae-Min Lee
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - In-Ho Yang
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jung Lok Lee
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyun Young Pak
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chang-Bum Park
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eun-Sun Jin
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin-Man Cho
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chong-Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
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249
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Vulnerability to sympathetic stress does not persist in takotsubo stress cardiomyopathy. J Card Fail 2014; 20:968-72. [PMID: 25267077 DOI: 10.1016/j.cardfail.2014.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 09/22/2014] [Accepted: 09/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Our objective was to investigate whether dobutamine stress echocardiography (DSE) could induce abnormal cardiac function in takotsubo stress cardiomyopathy (TSC) patients in a stable condition after the acute attack. METHODS AND RESULTS This was a case-control study and a substudy of the Stockholm Myocardial Infarction With Normal Coronaries (SMINC) study. Twenty-two patients with a previous episode of TSC and 22 sex- and age-matched control subjects were recruited from the SMINC study and investigated with the use of DSE. All TSC patients had a previous normal cardiovascular magnetic resonance investigation. Tissue Doppler imaging-derived time phases of the cardiac cycle were recorded to calculate myocardial performance index (MPI) to assess ventricular function. Compared with control subjects at rest, TSC patients had a slightly but significantly higher left ventricular MPI (LV-MPI; 0.53 vs 0.59; P = .01) and as a trend higher right ventricular MPI (0.38 vs 0.47; P = .08), although during DSE these variables did not differ significantly. CONCLUSION We found no difference in standard diastolic parameters between TSC and control subjects, but a significant higher value in LV-MPI in the TSC group at rest. However, no such difference could be demonstrated during DSE between the groups, indicating that vulnerability to sympathetic stimulation does not persist in TSC patients.
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250
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Chenzbraun A. Non-ischaemic cardiac conditions: role of stress echocardiography. Echo Res Pract 2014; 1:R1-7. [PMID: 26693299 PMCID: PMC4676472 DOI: 10.1530/erp-14-0030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Accepted: 07/09/2014] [Indexed: 01/06/2023] Open
Abstract
Stress echocardiography (SE) has a unique ability for simultaneous assessment of both functional class and exercise-related haemodynamic changes and as such is increasingly recognised for the evaluation of non-coronary artery disease pathologies. Some indications such as valvular heart disease or hypertrophic cardiomyopathy have been well established already, while others such as diastolic exercise testing are emerging of late. This paper addresses the main and best established indications for SE in non-ischaemic conditions, providing a practical perspective correlated with updated guidelines.
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Affiliation(s)
- Adrian Chenzbraun
- The Royal Liverpool University Hospital , Prescott Street, Liverpool, L7 8XP , UK
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