4701
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Effect of on-pump versus off-pump coronary bypass surgery on cardiac function assessed by intraoperative transesophageal echocardiography. Adv Med Sci 2013; 58:58-66. [PMID: 23333896 DOI: 10.2478/v10039-012-0046-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE To compare cardiac function assessed by intraoperative transesophageal echocardiography in patients undergoing cardiac revascularization with or without cardiopulmonary bypass. MATERIAL AND METHODS Forty-one patients scheduled for elective, isolated cardiac revascularization (21 on-pump and 20 off-pump) were prospectively analyzed. Patients were matched for demographic (age and gender), anthropometric (BMI), clinical (co-morbidities, EuroScore) and laboratory variables (blood counts, renal function, left ventricular function). Transesophageal echocardiography was performed after induction of anesthesia, protamine sulfate administration, and chest closure. Left ventricular wall motion score index, end-diastolic area, fractional area change, right ventricular area change and end-diastolic area were assessed. Troponin I and C-reactive protein concentrations were measured. RESULTS Regarding echocardiographic parameters of left and right ventricular function no significant differences between on-pump and off-pump groups at any point-of-time measurements were found. Troponin I and C-reactive protein were higher in on-pump as compared to off-pump group (p=0.001 and p=0.002; p=0.003 and p=0.001, respectively). CONCLUSIONS In elective patients scheduled for cardiac revascularization there were no difference in cardiac performance assessed by intraoperative echocardiography regardless of surgical method used.
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4702
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Cohen S, Gaddam S, Gemignani A, Wu WC, Sharma S, Choudhary G. Right Ventricular Function Relates to Functional Capacity in Men with Atrial Fibrillation and Preserved Left Ventricular Ejection Fraction. Echocardiography 2013; 30:542-50. [DOI: 10.1111/echo.12099] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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4703
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Chapman CB, Allana S, Sweitzer NK, Kohmoto T, Murray M, Murray D, Johnson M, Rahko PS. Effects of the HeartMate II left ventricular assist device as observed by serial echocardiography. Echocardiography 2013; 30:513-20. [PMID: 23311405 DOI: 10.1111/echo.12100] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The HeartMate II is the most frequently used left ventricular assist device (LVAD) in patients with end-stage heart failure. There is a paucity of data regarding its longitudinal cardiac effects, particularly that on diastole. METHODS This retrospective study was an evaluation of echocardiograms preoperatively and at 3, 6, and 12 months postoperatively in patients with a HeartMate II. Measurements included left ventricle (LV) dimensions, ejection fraction (EF), right ventricle (RV) size and function, parameters of diastolic function, and an analysis of mitral regurgitation (MR), tricuspid regurgitation (TR), aortic insufficiency (AI), and aortic valve thickening. RESULTS Forty-seven patients were evaluated. LV dimensions decreased but EF, RV size, and RV function were unchanged. Right ventricular systolic pressure (RVSP) and diastolic parameters including mitral inflow E/A, deceleration time (DT), pulmonary vein inflow, left atrial size, and overall diastolic grade improved. LV relaxation measured by tissue Doppler (e') was unchanged and the E/e' ratio was also unchanged. Regarding valve function, MR decreased, TR was unchanged, and the aortic valve became increasingly thickened with increased AI severity. CONCLUSIONS The HeartMate II unloads the LV as shown by decreased LV size, decreased MR, reduced RVSP, and improved patterns of mitral inflow. However, neither systolic function nor diastolic relaxation improves in this cohort. RV size and function also remain unchanged. The aortic valve shows increased thickening and AI likely from valve leaflet fusion. These results provide detailed functional and hemodynamic information regarding the longitudinal effects of the HeartMate II.
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Affiliation(s)
- Carrie B Chapman
- Cardiovascular Medicine Division, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA
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4704
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Demir M, Demir C. Effect of hepatitis B virus infection on right and left ventricular functions. Med Sci Monit 2013; 18:CR587-91. [PMID: 22936196 PMCID: PMC3560655 DOI: 10.12659/msm.883356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND In this study we examined right and left ventricular systolic functions in hepatitis B virus (HBV) patients. MATERIAL/METHODS The study included 50 HBsAg-positive patients (mean age; 33±13 years) and 50 other persons (mean age; 28±11 years) as a control group. Transthoracic echocardiography was performed in all the participants. Right and left ventricle systolic parameters were compared between these 2 groups. RESULTS In the group of the patients with HBsAg positivity, the right ventricular fractional area change (RV FAC), tricuspid annular plane excursion (TAPSE) and RV myocardial systolic velocity (St) values were lower than in the control group (33±11 vs. 52±13%, p=0.001; 14.6±1.1 vs. 22.2±2.4 mm, p<0.001; 8.6±1.2 vs. 15.8±2.3 cm/s, p<0,001, respectively); the right atrium (RA) and RV diameters were higher than in controls (5.1±1.2 vs. 3.7±0.5 cm, p<0.001; 4.9±0.8 vs. 3.4±0.5 cm p<0.001, respectively); and systolic pulmonary artery pressure was higher than in control (39.3±9.5 vs. 22±8.4 mmHg, p<0.001). CONCLUSIONS The findings showed that HBV infection may be associated with right ventricular systolic dysfunction and pulmonary hypertension.
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Affiliation(s)
- Mehmet Demir
- Department of Cardiology, Bursa Yuksek Ihtisas Education and Research Hospital, Bursa, Turkey.
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4705
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Argulian E, Halpern DG, Agarwal V, Agarwal SK, Chaudhry FA. Predictors of Ischemia in Patients Referred for Evaluation of Exertional Dyspnea: A Stress Echocardiography Study. J Am Soc Echocardiogr 2013; 26:72-6. [DOI: 10.1016/j.echo.2012.09.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Indexed: 11/26/2022]
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4706
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Ozcelik N, Shell R, Holtzlander M, Cua C. Decreased right ventricular function in healthy pediatric cystic fibrosis patients versus non-cystic fibrosis patients. Pediatr Cardiol 2013; 34:159-64. [PMID: 22684194 DOI: 10.1007/s00246-012-0407-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Accepted: 05/23/2012] [Indexed: 12/01/2022]
Abstract
Right ventricular (RV) dysfunction may occur in patients with cystic fibrosis (CF). Tissue Doppler imaging (TDI) and strain and strain rate analysis are new echocardiographic tools that can quantitate RV function. This study aimed to compare the RV function between healthy CF patients and non-CF patients to determine whether differences exist. Healthy CF children and age-matched non-CF children were enrolled in the study. In this study, TDI analysis of the RV free wall was performed at the level of the tricuspid valve annulus. Two-dimensional speckle echocardiography was used to measure global strain and strain rates in a six-segment model of the RV. Independent t tests were used to compare the groups. The study enrolled 18 CF patients (age, 7.7 ± 2.0 years) and 15 non-CF patients (age, 6.4 ± 2.5 years). The age difference was not significant. The forced expiratory volume in the first second (FEV(1)) for the CF patients was 91 ± 15 %. The systolic annular velocity by TDI was significantly lower in the CF group. The RV strain values in the CF group were significantly lower in four of the six segments (RV free-wall base, RV free-wall mid, RV septal apex, and RV septal mid). The global strain value, the systolic strain rate, and the early diastolic strain rate were significantly lower in the CF group. Decreased systolic and diastolic RV properties were present in young healthy CF patients. Further studies with longitudinal follow-up evaluation are needed to determine the significance of these findings for the pediatric CF population.
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Affiliation(s)
- Nazire Ozcelik
- Heart Center, Nationwide Children's Hospital, Columbus, OH, USA.
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4707
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Role of serial quantitative assessment of right ventricular function by strain in pulmonary arterial hypertension. Am J Cardiol 2013; 111:143-8. [PMID: 23102474 DOI: 10.1016/j.amjcard.2012.08.061] [Citation(s) in RCA: 117] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 08/20/2012] [Accepted: 08/20/2012] [Indexed: 11/23/2022]
Abstract
The aim of this study was to assess whether serial quantitative assessment of right ventricular (RV) function by speckle-based strain imaging is affected by pulmonary hypertension-specific therapies and whether there is a correlation between serial changes in RV strain and clinical status. RV longitudinal systolic function was assessed using speckle-tracking echocardiography in 50 patients with pulmonary arterial hypertension (PAH) before and after the initiation of therapy. The mean interval to follow-up was 6 ± 2 months. Subsequent survival was assessed over 4 years. Patients demonstrated a mean increase in RV systolic strain from -15 ± 5 before to -20 ± 7% (p = 0.0001) after PAH treatment. Persistence of or progression to a severe reduction in free wall systolic strain (<-12.5%) at 6 months was associated with greater disease severity (100% were in functional class III or IV vs 42%, p = 0.005), greater diuretic use (86% vs 40%, p = 0.02), higher mean pulmonary artery pressure (67 ± 20 vs 46 ± 17 mm Hg, p = 0.006), and poorer survival (4-year mortality 43% vs 23%, p = 0.002). After adjusting for age, functional class, and RV strain at baseline, patients with ≥ 5% improvement in RV free wall systolic strain had a greater than sevenfold lower mortality risk at 4 years (hazard ratio 0.13, 95% confidence interval 0.03 to 0.50, p = 0.003). In conclusion, serial echocardiographic assessment of RV longitudinal systolic function by quantitative strain imaging independently predicts clinical deterioration and mortality in patients with PAH after the institution of medical therapy.
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4708
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Kim MH, Kang HJ, Jung BC, Lee BR, Jung HJ, Lee JY, Bae SH, Shin DW. Asymptomatic Isolate Tricuspid Regurgitation with Chordae Tendineae Rupture Caused by Blunt Chest Injury. Yeungnam Univ J Med 2013. [DOI: 10.12701/yujm.2013.30.2.112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Min Hee Kim
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
| | - Hyun Jae Kang
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
| | - Byung Chun Jung
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
| | - Bong Ryeol Lee
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
| | - Ho Jin Jung
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
| | - Jun Young Lee
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
| | - Soo Hyun Bae
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
| | - Dong Woo Shin
- Division of Cardiology, Department of Internal Medicine, Fatima Hospital, Daegu, Korea
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4709
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Grünig E, Henn P, D’Andrea A, Claussen M, Ehlken N, Maier F, Naeije R, Nagel C, Prange F, Weidenhammer J, Fischer C, Bossone E. Reference Values for and Determinants of Right Atrial Area in Healthy Adults by 2-Dimensional Echocardiography. Circ Cardiovasc Imaging 2013. [DOI: 10.1161/circimaging.112.978031] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ekkehard Grünig
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Philipp Henn
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Antonello D’Andrea
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Martin Claussen
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Nicola Ehlken
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Felicitas Maier
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Robert Naeije
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Christian Nagel
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Felix Prange
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Johannes Weidenhammer
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Christine Fischer
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
| | - Eduardo Bossone
- From the Centre for Pulmonary Hypertension at Thoraxclinic Heidelberg, Heidelberg, Germany (E.G., P.H., N.E., F.M., C.N., F.P., J.W.); Second University of Naples, Monaldi Hospital, Naples, Italy (A.D.); Department of Pneumology, Clinic Grosshansdorf, Grosshansdorf, Germany (M.C.); Erasme University Hospital Free University of Brussels, Brussels, Belgium (R.N.); Department of Human Genetics, University of Heidelberg, Heidelberg, Germany (C.F.); and Cardiology Division, “Cava de’ Tirreni and Amalfi
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4710
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Spethmann S, Dreger H, Baldenhofer G, Stüer K, Saghabalyan D, Müller E, Hättasch R, Stangl V, Laule M, Baumann G, Stangl K, Knebel F. Short-Term Effects of Transcatheter Aortic Valve Implantation on Left Atrial Mechanics and Left Ventricular Diastolic Function. J Am Soc Echocardiogr 2013; 26:64-71.e2. [DOI: 10.1016/j.echo.2012.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2012] [Indexed: 11/30/2022]
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4711
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Isasti G, Pérez I, Moreno T, Cabrera F, Palacios R, Santos J. Echocardiographic abnormalities and associated factors in a cohort of asymptomatic HIV-infected patients. AIDS Res Hum Retroviruses 2013; 29:20-4. [PMID: 22891715 DOI: 10.1089/aid.2012.0096] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
HIV patients have been reported to have a greater prevalence of echocardiographic abnormalities. We aimed to determine the prevalence of these abnormalities and their associated factors. This was an observational study of a cohort of asymptomatic HIV patients. Data were recorded on factors of cardiovascular interest and those related to HIV infection. All the subjects underwent a transthoracic echocardiogram. The study included 196 patients, 85.2% men, mean age 46.4 years, with a mean duration of HIV infection of 123.8 months and 27.6% with AIDS. Of the patients, 94.4% were on antiretroviral therapy and 92.5% of these had an undetectable viral load. The mean CD4 cell count was 544/mm(3). The following echocardiographic abnormalities were found: left ventricular (LV) hypertrophy 28.6%, LV diastolic dysfunction 19.9%, left atrial (LA) dilatation 7.7%, right ventricular (RV) systolic dysfunction 6.1%, pulmonary hypertension 2.6%, RV dilatation 2%, and (LV) systolic dysfunction 1%. LV hypertrophy was associated with diabetes mellitus (OR 5.3, 95% CI 1.8-15.3; p=0.001), LV diastolic dysfunction with age (OR for each extra 5 years 4.4, 95% CI 4.2-4.6; p=0.0001), obesity (OR 4.07, 95% CI 1.6-10.0; p=0.02), alcohol consumption (OR 2.5, 95% CI 1.07-6.2; p=0.03) and lower CD4 cell count (OR for each 10 CD4 cells less 10.02, 95% CI 10.00-10.04; p=0.008), and RV systolic dysfunction with hypertension (OR 5.4, 95% CI 1.6-18.2; p=0.005). Echocardiographic abnormalities in HIV patients were common, especially LV hypertrophy and diastolic dysfunction. Prospective comparative studies involving the general population are needed to determine the prevalence of HIV infection and its treatment in these abnormalities.
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Affiliation(s)
- Guillermo Isasti
- UGC del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Isabel Pérez
- UGC de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Tamara Moreno
- UGC de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Fernando Cabrera
- UGC del Corazón, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Rosario Palacios
- UGC de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - Jesús Santos
- UGC de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
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4712
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Atichartakarn V, Chuncharunee S, Yamwong S, Yingchoncharoen T, Jongjirasiri S, Archararit N, Udomsubpayakul U. Pulmonary artery pressure correlates directly with spleen volume in non-splenectomized hemoglobin E/β-thalassemia patients. Acta Haematol 2013; 130:172-5. [PMID: 23735784 DOI: 10.1159/000350644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Accepted: 03/04/2013] [Indexed: 11/19/2022]
Affiliation(s)
- Vichai Atichartakarn
- Division of Hematology, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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4713
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Klouche K, Pommet S, Amigues L, Bargnoux AS, Dupuy AM, Machado S, Serveaux-Delous M, Morena M, Jonquet O, Cristol JP. Plasma Brain Natriuretic Peptide and Troponin Levels in Severe Sepsis and Septic Shock. J Intensive Care Med 2013; 29:229-37. [DOI: 10.1177/0885066612471621] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2012] [Accepted: 09/28/2012] [Indexed: 12/18/2022]
Abstract
The aim of this study was to evaluate and compare brain natriuretic peptide (BNP) and cardiac troponin I (cTnI) levels as mortality prognosticator and predictor for myocardial dysfunction in severe sepsis and septic shock. Baseline clinical and biological variables were collected from 47 patients with severe sepsis or septic shock. Ventricular systolic function assessed by echocardiography was measured over a 5-day period. Both cTnI and BNP plasmatic levels were determined at intensive care unit (ICU) admission and during the following 15 days. At admission, cTnI and BNP levels were compared to those of 12 control critically ill nonseptic patients. The plasma levels of BNP and cTnI in patients with sepsis were elevated at admission and significantly higher than in the controls. Among patients with sepsis, BNP levels were significantly more elevated in nonsurvivors compared to survivors at admission and 1 day later. The cTnI levels were also significantly more elevated in nonsurvivors compared to survivors, but only at admission. From admission to day 5, patients with sepsis with left ventricular systolic dysfunction had higher BNP plasmatic concentrations than those without; differences were significant at days 3 and 4. In contrast, plasma cTnI levels were similar between the 2 groups. In critically ill patients, sepsis induces significant increase in BNP and cTnI levels. High BNP and cTnI plasma levels during ICU admission appear to be associated with poor outcome of sepsis. Time course of BNP levels seems helpful to discriminate between surviving and nonsurviving patients with sepsis and to detect myocardial dysfunction where troponin levels fail to do so.
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Affiliation(s)
- Kada Klouche
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Stephane Pommet
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Laurent Amigues
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | | | - Anne Marie Dupuy
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| | - Sonia Machado
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | | | - Marion Morena
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
| | - Olivier Jonquet
- Department of Intensive Care Medicine, Lapeyronie University Hospital, Montpellier, France
| | - Jean Paul Cristol
- Department of Biochemistry, Lapeyronie University Hospital, Montpellier, France
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4714
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Affiliation(s)
- Gerard P. Aurigemma
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
| | - Giovanni de Simone
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
| | - Timothy P. Fitzgibbons
- From the Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA (G.P.A., T.P.F.); and Translational Medical Sciences, Federico II University, Naples, Italy (G.d.S.)
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4715
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Senthilnathan S, Dragulescu A, Mertens L. Pulmonary Regurgitation after Tetralogy of Fallot Repair: A Diagnostic and Therapeutic Challenge. J Cardiovasc Echogr 2013; 23:1-9. [PMID: 28465877 PMCID: PMC5353440 DOI: 10.4103/2211-4122.117975] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pulmonary regurgitation is the key hemodynamically significant lesion in repaired tetralogy of Fallot contributing to progressive right ventricular (RV) dilatation and biventricular dysfunction. The timing for pulmonary valve replacement remains a controversial topic, and the decision to intervene depends on assessment of RV size and RV function. OBJECTIVES This review aims to discuss the echocardiographic techniques that can be used to assess patients with pulmonary regurgitation after the repair of tetralogy of Fallot defect. While cardiac magnetic resonance (CMR) imaging is the clinical reference method, there is an important role of echocardiography in identifying patients with significant pulmonary regurgitation and assessing the RV size and function. The different echocardiographic techniques that can be used in this context are discussed. Newer techniques for assessing RV size and function include three-dimensional (3D) echocardiography, tissue Doppler and strain imaging. 3D RV volumetric reconstruction based on two-dimensional imaging is a promising new technique that could potentially replace CMR for RV volumetric assessment. CONCLUSIONS Developments in echocardiographic techniques provide new insights into the impact of pulmonary regurgitation on RV structure and function. Echocardiography and CMR are complementary modalities and further research is required to define the optimal use of both techniques for this indication.
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Affiliation(s)
- Selvi Senthilnathan
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
| | - Andreea Dragulescu
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
| | - Luc Mertens
- The Labatt Family Heart Center, the Hospital for Sick Children, University of Toronto. Toronto, ON, Canada
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4716
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Cho JS, Youn HJ, Cho EJ, Her SH, Park MW, Lee JB, Choi MS, Park CS. Feasibility of Real-Time Three-Dimensional Echocardiography for the Assessment of Distorted Biventricular Systolic Function in Patients with Cor Pulmonale. J Cardiovasc Ultrasound 2013; 21:64-71. [PMID: 23837116 PMCID: PMC3701781 DOI: 10.4250/jcu.2013.21.2.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2012] [Revised: 04/29/2013] [Accepted: 05/22/2013] [Indexed: 11/22/2022] Open
Abstract
Background This study was to investigate the feasibility of real-time 3-dimensional echocardiography (RT3DE) for the analysis of biventricular ejection fractions and volume measurements in patients with cor pulmonale and the correlations of RT3DE results with 64-slice multi-detector cardiac computed tomography (64-MDCT) results. Methods This study included a total of 22 patients (59.3 ± 16.6 years of age; 10 males and 12 females) who showed flattening or reverse curvature of the interventricular septum and severe pulmonary hypertension [mean right ventricular (RV) systolic pressure = 66.8 ± 19.7 mmHg] on 2-dimensional transthoracic echocardiography due to cor pulmonale. Biventricular end-diastolic and end-systolic volumes were measured by RT3DE and 64-MDCT. The severity of D-shaped deformation was evaluated by using left ventricular (LV) eccentricity index (ratio of diameters parallel/perpendicular to the interventricular septum on parasternal short axis images of the papillary muscle level). Results There were moderate correlations between biventricular volumes measured by RT3DE and 64-MDCT except for LV end-systolic volume (59.8 ± 17.1 vs. 73.2 ± 20.2 mL, r = 0.652, p = 0.001 for LV end-diastolic volume; 30.6 ± 9.1 vs. 30.8 ± 12.5 mL, r = 0.361, p = 0.099 for LV end-systolic volume; 110.1 ± 42.9 vs. 171.1 ± 55.3 mL, r = 0.545, p = 0.009 for RV end-diastolic volume; and 80.9 ± 35.0 vs. 128.7 ± 45.1 mL, r = 0.549, p = 0.005 for RV end-systolic volume respectively). Conclusion This study suggests that RT3DE may be a modest method for measuring distorted biventricular end-systolic and end-diastolic volumes in patients with cor pulmonale.
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Affiliation(s)
- Jung Sun Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Ho-Joong Youn
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Eun-Joo Cho
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Sung-Ho Her
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Mahn-Won Park
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Jae Beum Lee
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Min Seok Choi
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chan Seok Park
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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4717
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Park JH, Kim JH, Lee JH, Choi SW, Jeong JO, Seong IW. Evaluation of right ventricular systolic function by the analysis of tricuspid annular motion in patients with acute pulmonary embolism. J Cardiovasc Ultrasound 2012; 20:181-8. [PMID: 23346287 PMCID: PMC3542511 DOI: 10.4250/jcu.2012.20.4.181] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 11/09/2012] [Accepted: 11/21/2012] [Indexed: 01/29/2023] Open
Abstract
Background Measurement of right ventricular (RV) systolic function is important for patients with acute pulmonary embolism (PE). However, assessment of RV function is a challenge due to its complex anatomy. We measured RV systolic function with analysis of tricuspid annular motion in acute PE patients. Methods From August 2007 to May 2011, all consecutive PE patients were prospectively included. Tricuspid annular motion was analyzed with tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV). Results We analyzed total 50 patients (38 females, 68 ± 14 years). Mean RV fractional area change (RVFAC) was 26.2 ± 10.8%; RV Tei index 0.78 ± 0.35; TR Vmax 3.8 ± 0.5 m/sec; pulmonary vascular resistance (PVR) 3.5 ± 1.2 WU. TAPSE was 16 ± 4 mm and TASV was 11.7 ± 4.0 cm/sec. TAPSE showed significant correlations with RVFAC (r = 0.841, p < 0.001), RV Tei index (r = -0.347, p = 0.018), Log B-type natriuretic peptide (BNP) (r = -0.634, p < 0.001) and PVR (r = -0.635, p < 0.001). TASV also revealed significant correlations with RVFAC (r = 0.605, p < 0.001), RV Tei index (r = -0.380, p = 0.009), LogBNP (r = -0.477, p = 0.001) and PVR (r = -0.483, p = 0.001). The best cutoff of TAPSE for detection of RV systolic dysfunction (defined as RVFAC < 35%) was 1.75 cm [Areas under the curve (AUC) = 0.96, p < 0.001] with a sensitivity of 87% and specificity 91%. The best cutoff for TASV was 13.8 cm/sec (AUC = 0.90, p < 0.001), sensitivity 86% and specificity 78%. However, there was no statistical significance in the detection of RV dysfunction (difference = 0.07, 95% CI = -0.21-0.17, p = 0.130) between TAPSE and TASV. Conclusion TAPSE and TASV showed significant correlations with conventional echocardiographic parameters of RV function and LogBNP value. These values can be used to detect RV systolic dysfunction more easily in patients with acute PE.
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Affiliation(s)
- Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, School of Medicine, Chungnam National University, Chungnam National University Hospital, Daejeon, Korea
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4718
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Cevik A, Kula S, Olgunturk R, Saylan B, Pektas A, Oguz D, Tunaoglu S. Doppler tissue imaging provides an estimate of pulmonary arterial pressure in children with pulmonary hypertension due to congenital intracardiac shunts. CONGENIT HEART DIS 2012; 8:527-34. [PMID: 23280192 DOI: 10.1111/chd.12030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2012] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this study is to determine the relationship between the cardiac catheterization findings and pulsed-wave (PW) Doppler and Doppler tissue imaging (DTI) in pulmonary arterial hypertension patients with congenital heart disease with intracardiac shunts. DESIGN AND PATIENTS The present study aims to determine the relationship between the cardiac catheterization findings and PW Doppler and Doppler tissue imaging (DTI) in patients who have pulmonary arterial hypertension patients due to congenital heart disease with intracardiac shunts. Echocardiographic measurements were performed at the catheter angiography laboratory with concurrent catheterization. Left and right ventricle inflow velocities were recorded with PW Doppler and DTI studies. Maximum tricuspid regurgitation velocity (TS) was recorded in cases with measurable levels by continuous-wave Doppler. Moreover, the correlations among the echocardiographic values and invasive hemodynamic measures such as systolic pulmonary arterial pressure (PAPsystolic), mean pulmonary arterial pressure (PAPmean), diastolic pulmonary arterial pressure (PAPdiastolic) and pulmonary vascular resistance index (PVRI) were evaluated. RESULTS A negative correlation was found between TE'/TA' and PAPsystolic, PAPdiastolic and PAPmean (P = 0.008, r = -0.480; P = 0.001, r = -0.584; P = 0.001, r = -0.567, respectively). ME/ME' was also found to be negatively correlated with PAPdiastolic, PAPmean and PVRI (P = 0.002, r = -0.556; P = 0.005, r = -0.502; P = 0.027, r = -0.411, respectively). The concurrent use of TE'/TA' (cut-off value <2.6) and TS had a sensitivity of 79% and a specificity of 93% for distinguishing between patients with healthy controls. CONCLUSION When used in conjunction with conventional methods, TE'/TA' has the highest sensitivity and specificity in distinguishing between patients and healthy controls.
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Affiliation(s)
- Ayhan Cevik
- Department of Pediatric Cardiology, Gazi University Medical Faculty Hospital, Ankara, Turkey
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4719
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Ernande L, Cottin V, Leroux PY, Girerd N, Huez S, Mulliez A, Bergerot C, Ovize M, Mornex JF, Cordier JF, Naeije R, Derumeaux G. Right isovolumic contraction velocity predicts survival in pulmonary hypertension. J Am Soc Echocardiogr 2012; 26:297-306. [PMID: 23265440 DOI: 10.1016/j.echo.2012.11.011] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Indexed: 11/16/2022]
Abstract
BACKGROUND Right ventricular function is a strong determinant of prognosis in severe pulmonary hypertension. METHODS The aim of this study was to evaluate the prognostic value of estimates of right ventricular function obtained by echocardiography and Doppler tissue imaging and of functional class and 6-min walk distance (6MWD) in 142 patients with either pulmonary arterial hypertension (n = 104) or chronic thromboembolic pulmonary hypertension (n = 38). Echocardiography was prospectively performed, and demographics, medications, associated medical conditions, New York Heart Association class, and 6MWD at inclusion in addition to vital status, transplantation, and hospital admission related to pulmonary hypertension at follow-up were then collected by review of the medical records. RESULTS Variables associated with overall survival by univariate analysis were 6MWD (P = .009), functional class (P = .024), tricuspid annular plane systolic excursion (P = .03) and isovolumic peak velocity at the tricuspid annulus (IVCv) (P = .003). On multivariate analysis, IVCv (P = .015) and 6MWD (P = .016) were the only independent predictors of survival. Kaplan-Meier estimates of survival at 1 year were 95% in patients with IVCv > 9 cm/sec and 80% in those with IVCv ≤ 9 cm/sec (P = .002). Intraobserver and interobserver variability of IVCv measurement were 5% and 9%, respectively. CONCLUSIONS Measurement of right ventricular function by Doppler tissue imaging, an easy, noninvasive, and reproducible method, is an independent predictor of clinical outcomes in patients with severe pulmonary hypertension.
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Affiliation(s)
- Laura Ernande
- Explorations Fonctionnelles Cardiovasculaires, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France
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4720
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Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Am Coll Cardiol 2012; 60:1438-54. [PMID: 23036636 DOI: 10.1016/j.jacc.2012.09.001] [Citation(s) in RCA: 1414] [Impact Index Per Article: 117.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. BACKGROUND A recent study confirmed that VARC definitions have already been incorporated into clinical and research practice and represent a new standard for consistency in reporting clinical outcomes of patients with symptomatic severe aortic stenosis (AS) undergoing TAVI. However, as the clinical experience with this technology has matured and expanded, certain definitions have become unsuitable or ambiguous. METHODS AND RESULTS Two in-person meetings (held in September 2011 in Washington, DC, USA, and in February 2012 in Rotterdam, the Netherlands) involving VARC study group members, independent experts (including surgeons, interventional and non-interventional cardiologists, imaging specialists, neurologists, geriatric specialists, and clinical trialists), the US Food and Drug Administration (FDA), and industry representatives, provided much of the substantive discussion from which this VARC-2 consensus manuscript was derived. This document provides an overview of risk assessment and patient stratification that need to be considered for accurate patient inclusion in studies. Working groups were assigned to define the following clinical endpoints: mortality, stroke, myocardial infarction, bleeding complications, acute kidney injury, vascular complications, conduction disturbances and arrhythmias, and a miscellaneous category including relevant complications not previously categorized. Furthermore, comprehensive echocardiography recommendations are provided for the evaluation of prosthetic valve (dys)function. Definitions for the quality of life assessments are also reported. These endpoints formed the basis for several recommended composite endpoints. CONCLUSIONS This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVI and/or surgical aortic valve replacement. This initiative and document can furthermore be used as a model during current endeavors of applying definitions to other transcatheter valve therapies (for example, mitral valve repair).
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4721
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Harinstein ME, Iyer S, Mathier MA, Flaherty JD, Fontes P, Planinsic RM, Edelman K, Katz WE, Lopez-Candales A. Role of baseline echocardiography in the preoperative management of liver transplant candidates. Am J Cardiol 2012; 110:1852-5. [PMID: 23021513 DOI: 10.1016/j.amjcard.2012.08.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Revised: 08/01/2012] [Accepted: 08/01/2012] [Indexed: 12/22/2022]
Abstract
Liver transplantation (LT) has not traditionally been offered to patients with intracardiac shunts (ICSs) or pulmonary hypertension (PH). There is a paucity of data regarding cardiac structural characteristics in LT candidates. We examined echocardiographic characteristics and their role in managing LT candidates diagnosed with ICS and PH. We identified 502 consecutive patients (318 men, mean age 55 ± 11 years) who underwent LT and had preoperative echocardiogram. Demographics, cardiovascular risk factors, and echocardiographic variables were recorded and data were analyzed for end-stage liver disease diagnosis. ICSs were diagnosed with contrast echocardiography and PH was defined as estimated pulmonary artery systolic pressure >40 mm Hg. Primary end points included short-term (30-day) and long-term (mean 41-month) mortalities and the correlation between pre- and perioperative stroke. In our studied population >50% had >2 cardiovascular risk factors and with increasing frequency ICSs were diagnosed in 16%, PH in 25%, and intrapulmonary shunts in 41% of LT candidates. There was no correlation between short- and long-term mortality and ICS (p = 0.71 and 0.76, respectively) or PH (p = 0.79 and 0.71). Importantly, in those with ICS, no strokes occurred. In conclusion, structural differences exist between various end-stage liver disease diagnoses. ICSs diagnosed by echocardiography are not associated with an increased risk of perioperative stroke or increased mortality. A diagnosis of mild or moderate PH on baseline echocardiogram is not associated with worse outcomes and requires further assessment. Based on these findings, patients should not be excluded from consideration for LT based solely on the presence of an ICS or PH.
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4722
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Abstract
Right ventricular (RV) function is a strong independent predictor of outcome in a number of distinct cardiopulmonary diseases. The RV has a remarkable ability to sustain damage and recover function which may be related to unique anatomic, physiologic, and genetic factors that differentiate it from the left ventricle. This capacity has been described in patients with RV myocardial infarction, pulmonary arterial hypertension, and chronic thromboembolic disease as well as post-lung transplant and post-left ventricular assist device implantation. Various echocardiographic and magnetic resonance imaging parameters of RV function contribute to the clinical assessment and predict outcomes in these patients; however, limitations remain with these techniques. Early diagnosis of RV function and better insight into the mechanisms of RV recovery could improve patient outcomes. Further refinement of established and emerging imaging techniques is necessary to aid subclinical diagnosis and inform treatment decisions.
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Affiliation(s)
- Evan L Brittain
- Division of Cardiovascular Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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4723
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Chang HY, Lo LW, Lin YJ, Chang SL, Hu YF, Li CH, Chao TF, Chung FP, Ha TL, Singhal R, Chong E, Yin WH, Tsao HM, Hsieh MH, Chen SA. Long-term outcome of catheter ablation in patients with atrial fibrillation originating from nonpulmonary vein ectopy. J Cardiovasc Electrophysiol 2012; 24:250-8. [PMID: 23210627 DOI: 10.1111/jce.12036] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Data regarding the long-term outcome of catheter ablation in patients with nonpulmonary vein (NPV) ectopy initiating atrial fibrillation (AF) are limited. We aimed to evaluate the long-term result of patients with AF who had NPV triggers and underwent catheter ablation. METHODS AND RESULTS The study included 660 consecutive patients (age 54 ± 11 years old, 477 males) who had undergone catheter ablation for AF. Group 1 consisted of 132 patients with AF initiating from the NPV, and group 2 consisted of 528 patients with AF initiating from pulmonary vein (PV) triggers only. Patients from Group 1 were younger than those from Group 2 (51 ± 12 years old vs 54 ± 11 years old, P = 0.001) and were more likely to be females (34.4% vs 25.8%, P = 0.049). The incidences of nonparoxysmal AF (36.4% vs 16.3%, P < 0.001) and right atrial (RA) enlargement (31.3% vs 19%, P = 0.004) were higher, and the biatrial substrates were worse in Group 1 than those in Group 2 (left atrial voltage 1.5 ± 0.7 mV vs 1.9 ± 0.7 mV, P < 0.001, RA voltage 1.6 ± 0.5 mV vs 1.8 ± 0.6 mV, P = 0.014). During a follow-up period of 46 ± 23 months, there was a higher AF recurrence rate in Group 1 than in Group 2 (57.6% vs 38.8%, P < 0.001). The independent predictors of AF recurrence were NPV trigger (P < 0.001, HR 2, 95% CI 1.4-2.85), nonparoxysmal AF (P = 0.021, HR 1.55, 95% CI 1.07-2.24), larger left atrial diameter (P = 0.002, HR 1.04, 95% CI 1.02-1.07) and worse left atrial substrate (P = 0.028, HR 1.3, 95% CI 1.03-1.64). CONCLUSION Compared to AF originating from the PV alone, AF originating from the NPV ectopy showed a worse outcome.
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Affiliation(s)
- Hung-Yu Chang
- Division of Cardiology, Taipei Veterans General Hospital, Taipei, Taiwan
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4724
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Kajimoto K, Madeen K, Nakayama T, Tsudo H, Kuroda T, Abe T. Rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating heart failure from pulmonary disease as the cause of acute dyspnea in the emergency setting. Cardiovasc Ultrasound 2012; 10:49. [PMID: 23210515 PMCID: PMC3527194 DOI: 10.1186/1476-7120-10-49] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Accepted: 11/29/2012] [Indexed: 11/25/2022] Open
Abstract
Background Rapid and accurate diagnosis and management can be lifesaving for patients with acute dyspnea. However, making a differential diagnosis and selecting early treatment for patients with acute dyspnea in the emergency setting is a clinical challenge that requires complex decision-making in order to achieve hemodynamic balance, improve functional capacity, and decrease mortality. In the present study, we examined the screening potential of rapid evaluation by lung-cardiac-inferior vena cava (LCI) integrated ultrasound for differentiating acute heart failure syndromes (AHFS) from primary pulmonary disease in patients with acute dyspnea in the emergency setting. Methods Between March 2011 and March 2012, 90 consecutive patients (45 women, 78.1 ± 9.9 years) admitted to the emergency room of our hospital for acute dyspnea were enrolled. Within 30 minutes of admission, all patients underwent conventional physical examination, rapid ultrasound (lung-cardiac-inferior vena cava [LCI] integrated ultrasound) examination with a hand-held device, routine laboratory tests, measurement of brain natriuretic peptide, and chest X-ray in the emergency room. Results The final diagnosis was acute dyspnea due to AHFS in 53 patients, acute dyspnea due to pulmonary disease despite a history of heart failure in 18 patients, and acute dyspnea due to pulmonary disease in 19 patients. Lung ultrasound alone showed a sensitivity, specificity, negative predictive value, and positive predictive value of 96.2, 54.0, 90.9, and 75.0%, respectively, for differentiating AHFS from pulmonary disease. On the other hand, LCI integrated ultrasound had a sensitivity, specificity, negative predictive value, and positive predictive value of 94.3, 91.9, 91.9, and 94.3%, respectively. Conclusions Our study demonstrated that rapid evaluation by LCI integrated ultrasound is extremely accurate for differentiating acute dyspnea due to AHFS from that caused by primary pulmonary disease in the emergency setting.
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4725
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Non-invasive quantification of right ventricular systolic function by echocardiography: a new semi-automated approach. Clin Res Cardiol 2012. [DOI: 10.1007/s00392-012-0528-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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4726
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D'Oronzio U, Senn O, Biaggi P, Gruner C, Jenni R, Tanner FC, Greutmann M. Right Heart Assessment by Echocardiography: Gender and Body Size Matters. J Am Soc Echocardiogr 2012; 25:1251-8. [DOI: 10.1016/j.echo.2012.08.013] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Indexed: 11/24/2022]
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4727
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Willis J, Augustine D, Shah R, Stevens C, Easaw J. Right Ventricular Normal Measurements: Time to Index? J Am Soc Echocardiogr 2012; 25:1259-67. [DOI: 10.1016/j.echo.2012.06.015] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2011] [Indexed: 11/29/2022]
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4728
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D’Andrea A, Riegler L, Morra S, Scarafile R, Salerno G, Cocchia R, Golia E, Martone F, Di Salvo G, Limongelli G, Pacileo G, Bossone E, Calabrò R, Russo MG. Right Ventricular Morphology and Function in Top-Level Athletes: A Three-Dimensional Echocardiographic Study. J Am Soc Echocardiogr 2012; 25:1268-76. [DOI: 10.1016/j.echo.2012.07.020] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Indexed: 11/29/2022]
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4729
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4730
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Frea S, Bovolo V, Bergerone S, D'Ascenzo F, Antolini M, Capriolo M, Canavosio FG, Morello M, Gaita F. Echocardiographic Evaluation of Right Ventricular Stroke Work Index in Advanced Heart Failure: A New Index? J Card Fail 2012. [DOI: 10.1016/j.cardfail.2012.10.018] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4731
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The 2012 Canadian Cardiovascular Society heart failure management guidelines update: focus on acute and chronic heart failure. Can J Cardiol 2012. [PMID: 23201056 DOI: 10.1016/j.cjca.2012.10.007] [Citation(s) in RCA: 156] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The 2012 Canadian Cardiovascular Society Heart Failure (HF) Guidelines Update provides management recommendations for acute and chronic HF. In 2006, the Canadian Cardiovascular Society HF Guidelines committee first published an overview of HF management. Since then, significant additions to and changes in many of these recommendations have become apparent. With this in mind and in response to stakeholder feedback, the Guidelines Committee in 2012 has updated the overview of both acute and chronic heart failure diagnosis and management. The 2012 Update also includes recommendations, values and preferences, and practical tips to assist the medical practitioner manage their patients with HF.
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4732
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Eroglu E, Cakal SD, Cakal B, Dundar C, Alici G, Ozkan B, Yazicioglu MV, Tigen K, Esen AM. Time Course of Right Ventricular Remodeling after Percutaneous Atrial Septal Defect Closure: Assessment of Regional Deformation Properties with Two-Dimensional Strain and Strain Rate Imaging. Echocardiography 2012. [DOI: 10.1111/echo.12053] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Elif Eroglu
- Department of Cardiology; Yeditepe University Hospital; İstanbul; Turkey
| | - Sinem Deniz Cakal
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Beytullah Cakal
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Cihan Dundar
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Gokhan Alici
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Birol Ozkan
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Mehmet Vefik Yazicioglu
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Kursat Tigen
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
| | - Ali Metin Esen
- Department of Cardiology; Kartal Kosuyolu Yuksek Ihtisas Heart and Research Hospital; İstanbul; Turkey
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4733
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Detterich JA, Sangkatumvong S, Kato R, Dongelyan A, Bush A, Khoo M, Meiselman HJ, Coates TD, Wood JC. Patients with sickle cell anemia on simple chronic transfusion protocol show sex differences for hemodynamic and hematologic responses to transfusion. Transfusion 2012; 53:1059-68. [PMID: 23176402 DOI: 10.1111/j.1537-2995.2012.03961.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 06/07/2012] [Accepted: 06/26/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Chronic transfusion therapy (CTT) is a mainstay for stroke prophylaxis in sickle cell anemia, but its effects on hemodynamics are poorly characterized. Transfusion improves oxygen-carrying capacity, reducing demands for high cardiac output, while decreasing hemoglobin (Hb)S%, reticulocyte count, and hemolysis. We hypothesized that transfusion would improve oxygen-carrying capacity, but that would be counteracted by a decrease in cardiac output due to increased hematocrit (Hct) and vascular resistance, leaving oxygen delivery unchanged. STUDY DESIGN AND METHODS To test this hypothesis, we examined patients on CTT immediately before transfusion and again 12 to 120 hours after transfusion, using echocardiography and near infrared spectroscopy. RESULTS Comparable increases in Hb and Hct and decreases in reticulocyte count and HbS with transfusion were observed in all patients, but males had a larger rebound of HbS%, reticulocyte count, and free Hb levels between transfusions. In males, transfusion decreased heart rate by 12%, stroke volume by 15%, and cardiac index by 24% while estimates for pulmonary and systemic vascular resistance increased, culminating in 6% decrease in oxygen delivery. In contrast, stroke volume and cardiac index and systemic and pulmonary vascular resistance did not change in women after transfusion, such that oxygen delivery improved 17%. CONCLUSION In our sample population, males exhibit a paradoxical reduction in oxygen delivery in response to transfusion because the increase in vascular resistance is larger than the increase in oxygen capacity. This may result from an inability to adequately suppress their HbS% between transfusion cycles.
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Affiliation(s)
- Jon A Detterich
- Division of Cardiology, Division of Pediatric Pulmonology, Division of Hematology, Children's Hospital Los Angeles, Los Angeles, California 90027, USA.
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4734
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Bolignano D, Rastelli S, Agarwal R, Fliser D, Massy Z, Ortiz A, Wiecek A, Martinez-Castelao A, Covic A, Goldsmith D, Suleymanlar G, Lindholm B, Parati G, Sicari R, Gargani L, Mallamaci F, London G, Zoccali C. Pulmonary hypertension in CKD. Am J Kidney Dis 2012; 61:612-22. [PMID: 23164943 DOI: 10.1053/j.ajkd.2012.07.029] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2012] [Accepted: 07/27/2012] [Indexed: 12/12/2022]
Abstract
Pulmonary arterial hypertension is a rare disease often associated with positive antinuclear antibody and high mortality. Pulmonary hypertension, which rarely is severe, occurs frequently in patients with chronic kidney disease (CKD). The prevalence of pulmonary hypertension ranges from 9%-39% in individuals with stage 5 CKD, 18.8%-68.8% in hemodialysis patients, and 0%-42% in patients on peritoneal dialysis therapy. No epidemiologic data are available yet for earlier stages of CKD. Pulmonary hypertension in patients with CKD may be induced and/or aggravated by left ventricular disorders and risk factors typical of CKD, including volume overload, an arteriovenous fistula, sleep-disordered breathing, exposure to dialysis membranes, endothelial dysfunction, vascular calcification and stiffening, and severe anemia. No specific intervention trial aimed at reducing pulmonary hypertension in patients with CKD has been performed to date. Correcting volume overload and treating left ventricular disorders are factors of paramount importance for relieving pulmonary hypertension in patients with CKD. Preventing pulmonary hypertension in this population is crucial because even kidney transplantation may not reverse the high mortality associated with established pulmonary hypertension.
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Affiliation(s)
- Davide Bolignano
- Nephrology, Dialysis and Transplantation Unit, Reggio Calabria, Italy
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4735
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Saylan B, Cevik A, Kirsaclioglu CT, Ekici F, Tosun O, Ustundag G. Subclinical cardiac dysfunction in children with coeliac disease: is the gluten-free diet effective? ISRN GASTROENTEROLOGY 2012; 2012:706937. [PMID: 23209919 PMCID: PMC3504373 DOI: 10.5402/2012/706937] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 10/02/2012] [Indexed: 12/17/2022]
Abstract
Objectives. The aim of this study is to investigate the effects of coeliac disease on cardiac function in children using conventional transthoracic echocardiography (TTE) and tissue Doppler echocardiography (TDE). Methods. Coeliac disease patients were evaluated in two different groups based on serum endomysial antibody (EmA) titers (EmA (+) and EmA (−)), and the data obtained by conventional and TDE studies were compared between the patient groups and healthy controls. Results. There was no significant difference between EmA (+) and EmA (−) groups in terms of the conventional TTE parameters, including ejection fraction (EF), fractional shortening (FS), and left ventricle end diastolic diameter (LVEDD), that show the left ventricular systolic function (P = 0.727, P = 0.317, P = 0.118). TDE showed a significant difference in left ventricle (LV) isovolumic relaxation time (LV IVRT) and LV myocardial performance index (LV MPI) parameters between EmA (+) and EmA (−) patient groups (P < 0.0001). Conclusion. The measurement of LV MPI and LV IVRT parameters by TDE would be beneficial in early determination of the cardiac involvement and establishing appropriate treatment and followup of patients with coeliac disease as well as in making distinction between EmA (+) and EmA (−) patients.
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Affiliation(s)
- Berna Saylan
- Department of Pediatric Cardiology, Faculty of Medicine, Zonguldak Karaelmas University, 67600 Zonguldak, Turkey
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4736
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Rydman R, Söderberg M, Larsen F, Alam M, Caidahl K. d-Dimer and simplified pulmonary embolism severity index in relation to right ventricular function. Am J Emerg Med 2012; 31:482-6. [PMID: 23154103 DOI: 10.1016/j.ajem.2012.09.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 09/11/2012] [Accepted: 09/11/2012] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Right ventricular (RV) involvement in pulmonary embolism (PE) is an ominous sign. The aim of this study was to investigate the extent to which the d-dimer level or simplified PE severity index (sPESI) indicates RV dysfunction in patients with preserved systemic arterial pressure. METHODS Right ventricular function was studied in 34 consecutive patients with acute nonmassive PE by echocardiography including Doppler tissue imaging within 24 hours after arrival to the hospital. d-Dimer and sPESI were assessed upon arrival. RESULTS d-Dimer correlated with RV pressure (Rs, 0.60; P < .001) and pulmonary vascular resistance (PVR; Rs, 0.68; P < .0001) and tended to be related to myocardial performance index (MPI; Rs, 0.31; P = .067). Compared to a level less than 3.0 mg/L, patients with d-dimer 3.0 mg/L or higher had lower systolic tricuspid annular velocity (11.3 ± 2.7 vs 13.5 ± 2.7 cm/s; P < .05), a prolonged MPI (0.8 ± 0.3 vs 0.5 ± 0.2; P < .01), increased RV pressure (58 ± 13 vs 37 ± 12 mm Hg; P < .001), and increased PVR (3.3 ± 1.1 vs 1.8 ± 0.4 Woods units; P < .001). Patients in the high-risk sPESI group had higher filling pressure than those in the low risk sPESI group. CONCLUSIONS In the acute stage of PE, a d-dimer level 3 mg/L or higher may identify nonmassive PE patients with RV dysfunction and thereby help to determine their risk profile. We found no additional value for sPESI in this context.
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Affiliation(s)
- Riikka Rydman
- Section of Clinical Physiology, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden.
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4737
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Bossone E, D'Andrea A, D'Alto M, Citro R, Argiento P, Ferrara F, Cittadini A, Rubenfire M, Naeije R. Echocardiography in pulmonary arterial hypertension: from diagnosis to prognosis. J Am Soc Echocardiogr 2012; 26:1-14. [PMID: 23140849 DOI: 10.1016/j.echo.2012.10.009] [Citation(s) in RCA: 331] [Impact Index Per Article: 27.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Indexed: 12/27/2022]
Abstract
Pulmonary arterial hypertension is most often diagnosed in its advanced stages because of the nonspecific nature of early symptoms and signs. Although clinical assessment is essential when evaluating patients with suspected pulmonary arterial hypertension, echocardiography is a key screening tool in the diagnostic algorithm. It provides an estimate of pulmonary artery pressure, either at rest or during exercise, and is useful in ruling out secondary causes of pulmonary hypertension. In addition, echocardiography is valuable in assessing prognosis and treatment options, monitoring the efficacy of specific therapeutic interventions, and detecting the preclinical stages of disease.
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Affiliation(s)
- Eduardo Bossone
- Department of Cardiac Surgery, IRCCS Policlinico San Donato, Milan, Italy.
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4738
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Weiner RB, Baggish AL, Chen-Tournoux A, Marshall JE, Gaggin HK, Bhardwaj A, Mohammed AA, Rehman SU, Barajas L, Barajas J, Gregory SA, Moore SA, Semigran MJ, Januzzi JL. Improvement in structural and functional echocardiographic parameters during chronic heart failure therapy guided by natriuretic peptides: mechanistic insights from the ProBNP Outpatient Tailored Chronic Heart Failure (PROTECT) study. Eur J Heart Fail 2012; 15:342-51. [PMID: 23132825 DOI: 10.1093/eurjhf/hfs180] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
AIMS We sought to determine if heart failure (HF) care with a goal to lower N-terminal pro B-type natriuretic peptide (NT-proBNP) concentrations, compared with standard of care (SOC) management, is associated with improvement in echocardiographic parameters of cardiac structure and function. METHODS AND RESULTS Of 151 subjects with HF due to left ventricular systolic dysfunction (LVSD) prospectively randomized to NT-proBNP-guided vs. SOC HF care, 116 had serial echocardiographic data. Endpoints in this echocardiographic study included the relationship between change in NT-proBNP and LV reverse remodelling, as well as associations between biomarker-guided therapy and measures of diastolic function, right ventricular (RV) size and function, estimates of LV filling pressure and RV systolic pressure (RVSP), and the degree of mitral regurgitation (MR). After a mean of 10 months of study procedures, in adjusted analyses, final NT-proBNP concentrations predicted risk of remodelling [hazard ratio (HR) ↑LV end-diastolic volume index = 1.43, 95% confidence interval (CI) 1.10-1.86, P = 0.007; HR ↑LV end-systolic volume index = 1.54, 95% CI 1.10-1.91, P = 0.01; HR ↓LV ejection fraction (LVEF) = 1.53, 905% CI 1.12-1.89, P = 0.02]. In addition to greater improvement in LVEF and reductions in LV volume, compared with SOC, NT-proBNP-guided patients showed significant decreases in the ratio of early transmitral peak velocity to early diastolic peak annular velocity (E/E'), pulmonary vein peak S velocity, RV fractional area change, RVSP, and MR severity. CONCLUSION NT-proBNP concentrations may serve as a non-invasive indicator of the state of cardiac structure and function in HF due to LVSD. Multiple, prognostically meaningful echocardiographic variables improved more significantly in patients treated with NT-proBNP-guided care vs. SOC.
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Affiliation(s)
- Rory B Weiner
- Division of Cardiology, Massachusetts General Hospital, Boston, MA, USA
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4739
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Rosenkranz S, Bonderman D, Buerke M, Felgendreher R, ten Freyhaus H, Grünig E, de Haan F, Hammerstingl C, Harreuter A, Hohenforst-Schmidt W, Kindermann I, Kindermann M, Kleber FX, Kuckeland M, Kuebler WM, Mertens D, Mitrovic V, Opitz C, Schmeisser A, Schulz U, Speich R, Zeh W, Weil J. Pulmonary hypertension due to left heart disease: updated Recommendations of the Cologne Consensus Conference 2011. Int J Cardiol 2012; 154 Suppl 1:S34-44. [PMID: 22221972 DOI: 10.1016/s0167-5273(11)70491-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension (PH) have been adopted for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more frequent forms of PH including PH owing to left heart disease. The guidelines point out that the drugs currently used to treat patients with PAH (prostanoids, endothelin receptor antagonists and phosphodiesterase type 5 inhibitors) have not been sufficiently investigated in other forms of PH. However, despite the lack of respective efficacy data an uncritical use of targeted PAH drugs in patients with PH associated with left heart disease is currently observed at an increasing rate. This development is a matter of concern. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease. It that sense, the practical implementation of the European Guidelines in Germany requires the consideration of several specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2010, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH due to left heart disease. This commentary describes in detail the results and recommendations of the working group which were last updated in October 2011.
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Affiliation(s)
- Stephan Rosenkranz
- Clinic III for Internal Medicine, Heart Center at University of Cologne, Cologne, Germany.
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4740
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Naderi N, Ojaghi Haghighi Z, Amin A, Naghashzadeh F, Bakhshandeh H, Taghavi S, Maleki M. Utility of Right Ventricular Strain Imaging in Predicting Pulmonary Vascular Resistance in Patients With Pulmonary Hypertension. ACTA ACUST UNITED AC 2012; 19:116-22. [DOI: 10.1111/chf.12009] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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4741
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Barrera CE. Determinación de valores normalizados del desplazamiento sistólico del plano del anillo tricúspide (tapse) en pacientes colombianos sin comorbilidades. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70148-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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4742
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Función longitudinal del ventrículo derecho estimada por el desplazamiento sistólico del anillo tricúspide (TAPSE) en 557 pacientes sanos. REVISTA COLOMBIANA DE CARDIOLOGÍA 2012. [DOI: 10.1016/s0120-5633(12)70147-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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4743
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Right ventricular morphology on catheter angiography: Variations and its implications for the diagnosis of arrhythmogenic right ventricular cardiomyopathy. Heart Lung Circ 2012; 21:700-5. [DOI: 10.1016/j.hlc.2012.06.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 06/03/2012] [Accepted: 06/14/2012] [Indexed: 11/22/2022]
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4744
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Seif D, Perera P, Mailhot T, Riley D, Mandavia D. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract 2012; 2012:503254. [PMID: 23133747 PMCID: PMC3485910 DOI: 10.1155/2012/503254] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/22/2012] [Indexed: 12/14/2022] Open
Abstract
Assessment of hemodynamic status in a shock state remains a challenging issue in Emergency Medicine and Critical Care. As the use of invasive hemodynamic monitoring declines, bedside-focused ultrasound has become a valuable tool in the evaluation and management of patients in shock. No longer a means to simply evaluate organ anatomy, ultrasound has expanded to become a rapid and noninvasive method for the assessment of patient physiology. Clinicians caring for critical patients should strongly consider integrating ultrasound into their resuscitation pathways.
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Affiliation(s)
- Dina Seif
- Department of Emergency Medicine, Los Angeles County+USC Medical Center, General Hospital, 1200 State Street, Room 1011, Los Angeles, CA 90033, USA
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4745
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Jainandunsing JS, Matyal R, Shahul SS, Wang A, Woltersom B, Mahmood F. 3-dimensional right ventricular volume assessment. J Cardiothorac Vasc Anesth 2012; 27:367-75. [PMID: 23089261 DOI: 10.1053/j.jvca.2012.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this review was to evaluate new computer software available for 3-dimensional right ventricular (RV) volume estimation. DESCRIPTION Based on 2-dimensional echocardiography, various algorithms have been used for RV volume estimation. These are complex, time-consuming techniques and are prone to significant error. The current clinical paradigm of RV volume assessment is based on the visual quantitative assessment of chamber size and the use of tricuspid annular and RV internal diameters as a surrogate measure of RV volume. Hence, there is a need for a practical method for the intraoperative assessment of RV volume. EVALUATION The evaluation consists of an objective review of the capabilities of this software and its potential application in the operating room. The authors also performed a detailed review of the potential limitations and possible improvements. CONCLUSIONS This new software has the potential to be incorporated into the existing workflow environment of the ultrasound systems in the future, making it clinically feasible to perform perioperative RV volume analysis.
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Affiliation(s)
- Jayant S Jainandunsing
- Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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4746
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Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, Brott TG, Cohen DJ, Cutlip DE, van Es GA, Hahn RT, Kirtane AJ, Krucoff MW, Kodali S, Mack MJ, Mehran R, Rodés-Cabau J, Vranckx P, Webb JG, Windecker S, Serruys PW, Leon MB. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg 2012; 145:6-23. [PMID: 23084102 DOI: 10.1016/j.jtcvs.2012.09.002] [Citation(s) in RCA: 704] [Impact Index Per Article: 58.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 07/24/2012] [Accepted: 07/26/2012] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of the current Valve Academic Research Consortium (VARC)-2 initiative was to revisit the selection and definitions of transcatheter aortic valve implantation (TAVI) clinical endpoints to make them more suitable to the present and future needs of clinical trials. In addition, this document is intended to expand the understanding of patient risk stratification and case selection. BACKGROUND A recent study confirmed that VARC definitions have already been incorporated into clinical and research practice and represent a new standard for consistency in reporting clinical outcomes of patients with symptomatic severe aortic stenosis (AS) undergoing TAVI. However, as the clinical experience with this technology has matured and expanded, certain definitions have become unsuitable or ambiguous. METHODS AND RESULTS Two in-person meetings (held in September 2011 in Washington, DC, and in February 2012 in Rotterdam, The Netherlands) involving VARC study group members, independent experts (including surgeons, interventional and noninterventional cardiologists, imaging specialists, neurologists, geriatric specialists, and clinical trialists), the US Food and Drug Administration (FDA), and industry representatives, provided much of the substantive discussion from which this VARC-2 consensus manuscript was derived. This document provides an overview of risk assessment and patient stratification that need to be considered for accurate patient inclusion in studies. Working groups were assigned to define the following clinical endpoints: mortality, stroke, myocardial infarction, bleeding complications, acute kidney injury, vascular complications, conduction disturbances and arrhythmias, and a miscellaneous category including relevant complications not previously categorized. Furthermore, comprehensive echocardiographic recommendations are provided for the evaluation of prosthetic valve (dys)function. Definitions for the quality of life assessments are also reported. These endpoints formed the basis for several recommended composite endpoints. CONCLUSIONS This VARC-2 document has provided further standardization of endpoint definitions for studies evaluating the use of TAVI, which will lead to improved comparability and interpretability of the study results, supplying an increasingly growing body of evidence with respect to TAVI and/or surgical aortic valve replacement. This initiative and document can furthermore be used as a model during current endeavors of applying definitions to other transcatheter valve therapies (for example, mitral valve repair).
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Affiliation(s)
- A Pieter Kappetein
- Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
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4747
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Jian XH, Huang J, Ding Y, Xiao XJ, Wu M, Chen JM, Zhuang J. Surgical outcome of isolated total anomalous pulmonary venous connection in adults: a 14-year experience. J Card Surg 2012; 27:736-9. [PMID: 23046109 DOI: 10.1111/jocs.12006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM OF THE STUDY To investigate the surgical result of adult total anomalous pulmonary venous connection (TAPVC). METHODS From March 1997 to March 2011, 12 adult cases of isolated TAPVC, with an average age of 24.9 ± 6.7 years (from 18 to 41 years), underwent surgical repair in our department. All patients suffered from right-sided volume overload with clinical manifestations varying from mild cyanosis to severe heart failure. RESULTS According to Darling's classification, eight cases were classified as supracardiac type, four as cardiac type. Unobstructed connections were established between the left atrium and the pulmonary common vein in all patients with external cardiac approach in four supracardiac cases, and internal cardiac approach in four cardiac and three supracardiac cases, and Warden technique in one supracardiac patient. Concomitant operations included De Vega's tricuspid annuloplasty in six patients, patent arteriosus ductus closure in two. All patients survived the operation, and postoperative follow-up was 100% complete with a period ranging from 10 months to 14 years. NYHA grade decreased from 2.33 ± 0.49 to 1.08 ± 0.29 (p < 0.01). Three patients had postoperative tricuspid insufficiency. Five patients had cardiac arrhythmia, among two symptomatic cases; one controlled with medication, another received a successful radiofrequency ablation for incision-related atrial flutter. CONCLUSIONS Surgical correction of isolated adult TAPVC can be carried out safely with acceptable long-term outcome. Postoperative tricuspid insufficiency and cardiac arrhythmias may have a negative long-term impact, which should be evaluated preoperatively and managed individually during surgery.
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Affiliation(s)
- Xu-hua Jian
- Department of Cardiovascular Surgery, Guangdong Provincial Cardiovascular Institute, Guangdong General Hospital, Guangzhou, PR China.
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4748
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Maharaj N, Peters F, Khandheria BK, Libhaber E, Essop MR. Left ventricular twist in a normal African adult population. Eur Heart J Cardiovasc Imaging 2012; 14:526-33. [PMID: 23053853 DOI: 10.1093/ehjci/jes208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Speckle tracking has emerged as a quantitative technique for assessing left ventricular (LV) function. However, no normative data for LV twist using speckle tracking echocardiography (STE) are available in the black population. This study assessed myocardial mechanics by determining LV twist parameters in different age groups using STE, and evaluated the effect of ageing on LV twist in this population. METHODS AND RESULTS The study population consisted of 127 healthy volunteers divided into four age groups: 20-29 (n = 34); 30-39 (n = 33); 40-49 (n = 29); and 50-65 (n = 31) years. Parasternal short-axis images of three consecutive end-expiratory cardiac cycles at LV basal, papillary muscle, and apical levels, and apical four-chamber images were obtained. Apical and (AR) basal (BR) LV peak systolic rotation during ejection and instantaneous LV peak systolic twist (net twist, defined as maximal value of instantaneous AR minus BR) were measured. Mean strain values were -17.28 ± 3.30% for longitudinal, -17.40 ± 3.29% for circumferential, and 57.49 ± 3.32% for radial strain. Mean rotational values were AR (5.56 ± 1.98°), BR (-3.31 ± 0.92°), and net twist (8.87 ± 2.21°). AR, BR, and net twist increased with age, whereas longitudinal, circumferential, and radial strain decreased with age. Multivariate linear regression analysis showed age as the main predictor of net twist (R(2) = 0.82, P < 0.0001). CONCLUSION These data establish values for strain and twist in a normal black adult population. Net twist increases with age, whereas strain parameters decrease. Age is the strongest independent predictor of LV twist.
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Affiliation(s)
- Nirvarthi Maharaj
- Division of Cardiology, Chris Hani Baragwanath Hospital and University of Witwatersrand, Johannesburg, South Africa
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4749
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Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Iung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, McDonagh T, Moulin C, Popescu BA, Reiner Ž, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, Popescu BA, Von Segesser L, Badano LP, Bunc M, Claeys MJ, Drinkovic N, Filippatos G, Habib G, Kappetein AP, Kassab R, Lip GY, Moat N, Nickenig G, Otto CM, Pepper J, Piazza N, Pieper PG, Rosenhek R, Shuka N, Schwammenthal E, Schwitter J, Mas PT, Trindade PT, Walther T. Guidelines on the management of valvular heart disease (version 2012). Eur J Cardiothorac Surg 2012; 42:S1-44. [DOI: 10.1093/ejcts/ezs455] [Citation(s) in RCA: 1024] [Impact Index Per Article: 85.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
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McMurray JJ, Adamopoulos S, Anker SD, Auricchio A, Böhm M, Dickstein K, Falk V, Filippatos G, Fonseca C, Gomez Sanchez MA, Jaarsma T, Køber L, Lip GY, Maggioni AP, Parkhomenko A, Pieske BM, Popescu BA, Rønnevik PK, Rutten FH, Schwitter J, Seferovic P, Stepinska J, Trindade PT, Voors AA, Zannad F, Zeiher A, Bax JJ, Baumgartner H, Ceconi C, Dean V, Deaton C, Fagard R, Funck-Brentano C, Hasdai D, Hoes A, Kirchhof P, Knuuti J, Kolh P, h T, Moulin C, Popescu BA, Reiner Z, Sechtem U, Sirnes PA, Tendera M, Torbicki A, Vahanian A, Windecker S, McDonagh T, Sechtem U, Almenar Bonet L, Avraamides P, Ben Lamin HA, Brignole M, Coca A, Cowburn P, Dargie H, Elliott P, Arnold Flachskampf F, Francesco Guida G, Hardman S, Iung B, Merkely B, Mueller C, Nanas JN, Nielsen OW, Ørn S, Parissis JT, Ponikowski P. Guía de práctica clínica de la ESC sobre diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica 2012. Rev Esp Cardiol 2012. [DOI: 10.1016/j.recesp.2012.08.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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