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Bautista-Rodriguez C, Sanchez-de-Toledo J, Da Cruz EM. The Role of Echocardiography in Neonates and Pediatric Patients on Extracorporeal Membrane Oxygenation. Front Pediatr 2018; 6:297. [PMID: 30416991 PMCID: PMC6212474 DOI: 10.3389/fped.2018.00297] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 09/21/2018] [Indexed: 11/13/2022] Open
Abstract
Indications for extracorporeal membrane oxygenation (ECMO) and extracorporeal cardiopulmonary resuscitation (ECPR) are expanding, and echocardiography is a tool of utmost importance to assess safety, effectiveness and readiness for circuit initiation and separation. Echocardiography is key to anticipating complications and improving outcomes. Understanding the patient's as well as the ECMO circuit's anatomy and physiology is crucial prior to any ECMO echocardiographic evaluation. It is also vital to acknowledge that the utility of echocardiography in ECMO patients is not limited to the evaluation of cardiac function, and that clinical decisions should not be made exclusively upon echocardiographic findings. Though echocardiography has specific indications and applications, it also has limitations, characterized as: prior to and during cannulation, throughout the ECMO run, upon separation and after separation from the circuit. The use of specific and consistent echocardiographic protocols for patients on ECMO is recommended.
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Affiliation(s)
- Carles Bautista-Rodriguez
- Pediatric Cardiology Department, Hospital Sant Joan de Deu Barcelona, Universitat de Barcelona, Barcelona, Spain
- Department of Paediatric Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Joan Sanchez-de-Toledo
- Pediatric Cardiology Department, Hospital Sant Joan de Deu Barcelona, Universitat de Barcelona, Barcelona, Spain
- Division of Cardiac Intensive Care, Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Eduardo M. Da Cruz
- Department of Pediatrics, Heart Institute, Children's Hospital Colorado, School of Medicine, University of Colorado Denver, Aurora, CO, United States
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Hernandez-Suarez DF, Lopez Menendez FR, Palm D, Lopez-Candales A. Left Ventricular Diastolic Function Assessment of a Heterogeneous Cohort of Pulmonary Arterial Hypertension Patients. J Clin Med Res 2017; 9:353-359. [PMID: 28270896 PMCID: PMC5330779 DOI: 10.14740/jocmr2925w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Pulmonary arterial hypertension (PAH) is known to trigger right ventricular (RV) remodeling that might compromise left ventricular (LV) filling due to inter-ventricular interdependence. In this study, we aimed to examine standard echocardiographic measurements of LV diastolic function in PAH patients. METHODS In this retrospective study, we identified clinical as well as complete echocardiographic data from 128 chronic PAH patients to fully assess LV diastolic dysfunction (LVDD) using standard recommended Doppler guidelines. Accordingly, patients were divided into three groups: LVDD 0, LVDD 1 and LVDD 2. RESULTS The mean age of the studied population was 57 ± 14 years with a mean pulmonary artery systolic pressure (PASP) of 55 ± 21 mm Hg. A total of 36% of the study patients had normal LV diastolic function. However, 64% had LVDD with LVDD stage 1 being the most common (48%). In terms of echocardiographic data, significant differences were found among the three LVDD groups in regards to PASP, LV end systolic and diastolic volumes, tricuspid annular plane systolic excursion, right ventricular fractional area change as well as many other tissue Doppler imaging parameters. Finally, just age and PASP were predictors of abnormal LV diastolic function (P < 0.05). CONCLUSIONS Impaired relaxation is a common abnormality in PAH patients. Additional studies are warranted to determine whether LVDD alters prognosis or is related to changes in the symptomatic profile of this group of patients.
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Affiliation(s)
| | - Francisco R Lopez Menendez
- Division of Cardiovascular Health and Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Denada Palm
- Division of Cardiovascular Health and Diseases, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Angel Lopez-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, San Juan, Puerto Rico
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3
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Cardiac dysfunction during exacerbations of chronic obstructive pulmonary disease. THE LANCET RESPIRATORY MEDICINE 2016; 4:138-48. [DOI: 10.1016/s2213-2600(15)00509-3] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 11/26/2015] [Accepted: 11/26/2015] [Indexed: 11/17/2022]
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Portillo K, Abad-Capa J, Ruiz-Manzano J. Enfermedad pulmonar obstructiva crónica y ventrículo izquierdo. Arch Bronconeumol 2015; 51:227-34. [DOI: 10.1016/j.arbres.2014.03.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Revised: 03/06/2014] [Accepted: 03/17/2014] [Indexed: 01/19/2023]
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Eweda I, Hamada G. Concordance between Doppler and pulsed-wave Doppler tissue imaging in estimation of the degree of left ventricular dysfunction and correlating it to the degree of chronic obstructive pulmonary disease. J Saudi Heart Assoc 2015; 28:15-21. [PMID: 26778901 PMCID: PMC4685242 DOI: 10.1016/j.jsha.2015.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Revised: 04/12/2015] [Accepted: 04/17/2015] [Indexed: 12/03/2022] Open
Abstract
Objective As a consequence of leftward shift of the interventricular septum and of pericardial restraint, related to the degree of right ventricular dilation, alveolar hypoxia and related pulmonary vascular changes, left ventricular function is influenced by chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the prevalence of echocardiographic abnormalities by conventional echocardiography and Doppler tissue imaging (DTI) in COPD patients according to the degree of disease severity. Methods We enrolled forty consecutive patients with COPD and twenty matched control. Twenty of the patients were suffering from mild form of COPD, twenty were suffering from severe form of COPD as decided by pulmonary function test and arterial blood gases and twenty apparently healthy non COPD control persons were subjected to echocardiographic assessment to left ventricular diastolic and systolic functions by conventional echocardiography and DTI at the mitral annulus. Results There were no significant statistical difference between the three groups as regards the age and the gender. There were significant statistical differences between the patients and the control as regards the diastolic functions of the left ventricle. E and A waves obtained by conventional Doppler and by DTI showed significant statistical difference between mild, severe forms of COPD and control subjects. The degree of diastolic dysfunction increased significantly with increase of the severity of COPD. Conclusion Left ventricular diastolic function is significantly affected in patients with COPD and the degree of affection is related to the severity of COPD.
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Affiliation(s)
- Inas Eweda
- Cardiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ghada Hamada
- Chest Department, Faculty of Medicine, Cairo University, Cairo, Egypt
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Wells JM, Dransfield MT. Pathophysiology and clinical implications of pulmonary arterial enlargement in COPD. Int J Chron Obstruct Pulmon Dis 2013; 8:509-21. [PMID: 24235822 PMCID: PMC3826513 DOI: 10.2147/copd.s52204] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a complex condition defined by progressive airflow limitation in response to noxious stimuli, inflammation, and vascular changes. COPD exacerbations are critical events in the natural history of the disease, accounting for the majority of disease burden, cost, and mortality. Pulmonary vascular disease is an important risk factor for disease progression and exacerbation risk. Relative pulmonary artery enlargement on computed tomography scan, defined by a pulmonary artery to aortic (PA:A) ratio >1, has been evaluated as a marker of pulmonary vascular disease. The PA:A ratio can be measured reliably independent of electrocardiographic gating or the use of contrast, and in healthy patients a PA:A ratio >0.9 is considered to be abnormal. The PA:A ratio has been compared with invasive hemodynamic parameters, primarily mean pulmonary artery pressure in various disease conditions and is more strongly correlated with mean pulmonary artery pressure in obstructive as compared with interstitial lung disease. In patients without known cardiac or pulmonary disease, the PA:A ratio is predictive of mortality, while in COPD, an elevated PA:A ratio is correlated with increased exacerbation risk, outperforming other well established predictors of these events. Future studies should be aimed at determining the stability of the metric over time and evaluating the utility of the PA:A ratio in guiding specific therapies.
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Affiliation(s)
- J Michael Wells
- Division of Pulmonary, Allergy, and Critical Care, Department of Medicine, University of Alabama Birmingham and the Birmingham Veterans Affairs Medical Center, Birmingham, AL, USA
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Schoos MM, Dalsgaard M, Kjærgaard J, Moesby D, Jensen SG, Steffensen I, Iversen KK. Echocardiographic predictors of exercise capacity and mortality in chronic obstructive pulmonary disease. BMC Cardiovasc Disord 2013; 13:84. [PMID: 24118827 PMCID: PMC3852306 DOI: 10.1186/1471-2261-13-84] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 10/10/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) reduces exercise capacity, but lung function parameters do not fully explain functional class and lung-heart interaction could be the explanation. We evaluated echocardiographic predictors of mortality and six minutes walking distance (6MWD), a marker for quality of life and mortality in COPD. METHODS Ninety COPD patients (GOLD criteria) were evaluated by body plethysmography, 6MWD and advanced echocardiography parameters (pulsed wave tissue Doppler and speckle tracking). RESULTS Mean 6MWD was 403 (± 113) meters. All 90 subjects had preserved left ventricular (LV) ejection fraction 64.3% ± 8.6%. Stroke volume decreased while heart rate increased with COPD severity and hyperinflation. In 66% of patients, some degree of diastolic dysfunction was present. Mitral tissue Doppler data in COPD could be interpreted as a sign of low LV preload and not necessarily an intrinsic impairment in LV relaxation/compliance. Tricuspid regurgitation (TR) increased with COPD severity and hyperinflation. Age (p < 0.001), BMI (p < 0.001), DLCO SB (p < 0.001) and TR (p 0.005) were independent predictors of 6MWD and a multivariable model incorporating heart function parameters (adjusted r2 = .511) compared well to a model with lung function parameters alone (adjusted r2 = .475). LV global longitudinal strain (p = 0.034) was the only independent predictor of mortality among all baseline, body plethysmographic and echocardiographic variables. CONCLUSIONS Among subjects with moderate to severe COPD and normal LVEF, GLS independently predicted all-cause mortality. Exercise tolerance correlated with standard lung function parameters only in univariate models; in subsequent models including echocardiographic parameters, longer 6MWD correlated independently with milder TR, better DLCO SB, younger age and lower BMI. We extended the evidence on COPD affecting cardiac chamber volumes, LV preload, heart rate, as well as systolic and diastolic function. Our results highlight lung-heart interaction and the necessity of cardiac evaluation in COPD.
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Affiliation(s)
- Mikkel Malby Schoos
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark
| | - Morten Dalsgaard
- Department of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark
| | - Jesper Kjærgaard
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Dorte Moesby
- Department of Pulmonary and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Sidse Graff Jensen
- Department of Pulmonary and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Ida Steffensen
- Department of Pulmonary and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Rigshospitalet, University Hospital Copenhagen, Blegdamsvej 9, 2100 Copenhagen, Denmark
- Department of Cardiology and Endocrinology, Hillerød Hospital, Hillerød, Denmark
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Isiguzo GC, Okeahialam BN, Danbauchi SS, Odili AN, Iroezindu MO, Placid U. Contributions of pulmonary hypertension to HIV-related cardiac dysfunction. Indian Heart J 2013; 65:644-9. [PMID: 24206894 PMCID: PMC3860612 DOI: 10.1016/j.ihj.2013.08.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 04/25/2013] [Accepted: 08/10/2013] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND/AIM To evaluate the prevalence of pulmonary hypertension among patients living with HIV/AIDS and to determine its contribution to cardiac dysfunction. METHOD A hospital based cross sectional study was carried out over a 6-month period at the Jos University Teaching Hospital. The subjects were 200 confirmed HIV positive patients, ≥18 years of age who consented to the study. Physical examination, laboratory investigations, 2 dimensional and Doppler echocardiography were conducted on the subjects. RESULTS The mean age of the patients was 38 ± 9 years, and there were 142 females (71%). Females were younger, mean age 36 ± 8 years versus 41 ± 10 years for males (p-value <0.01). The median CD4 cell count was 312 cells/μl, there were no homosexual or intravenous drug user among the subjects. Eight of the subjects had pulmonary hypertension, with a case prevalence of 4%, and this had no relationship to CD4 cell count. Both systolic and diastolic functions were worse in subjects with pulmonary hypertension, with a negative correlation between mean pulmonary arterial systolic pressure (mPASP) and parameters like ejection fraction (r = -0.28, p-value 0.0003), fractional shortening (r = -0.21, p-value 0.003), deceleration time (r = -0.13. p-value 0.09). CONCLUSION Immune-suppression affects the cardiac function adversely and coexisting pulmonary hypertension contributes to poor systolic and diastolic function in affected patients. The subtle nature of presentation of pulmonary hypertension and other cardiac dysfunctions in HIV/AIDS patients demand a high-index of suspicion and early intervention if detected, to ensure better care for these emerging threats to our patients.
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MESH Headings
- Adult
- Age Distribution
- Comorbidity
- Cross-Sectional Studies
- Disease Progression
- Echocardiography, Doppler
- Female
- Follow-Up Studies
- HIV Infections/diagnosis
- HIV Infections/drug therapy
- HIV Infections/epidemiology
- Heart Failure, Diastolic/diagnosis
- Heart Failure, Diastolic/epidemiology
- Heart Failure, Systolic/diagnosis
- Heart Failure, Systolic/epidemiology
- Humans
- Hypertension, Pulmonary/diagnosis
- Hypertension, Pulmonary/epidemiology
- Hypertension, Pulmonary/therapy
- Male
- Middle Aged
- Prevalence
- Reference Values
- Risk Assessment
- Severity of Illness Index
- Sex Distribution
- Stroke Volume/physiology
- Survival Analysis
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/epidemiology
- Ventricular Dysfunction, Left/physiopathology
- Young Adult
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Affiliation(s)
- Godsent C Isiguzo
- Internal Medicine Department, Federal Teaching Hospital Abakaliki, Ebonyi State, Nigeria.
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Surie S, Reesink HJ, Marcus JT, van der Plas MN, Kloek JJ, Vonk-Noordegraaf A, Bresser P. Bosentan treatment is associated with improvement of right ventricular function and remodeling in chronic thromboembolic pulmonary hypertension. Clin Cardiol 2013; 36:698-703. [PMID: 24037998 DOI: 10.1002/clc.22197] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2013] [Accepted: 07/15/2013] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Medical pretreatment before pulmonary endarterectomy (PEA) can optimize right ventricular (RV) function and may improve postoperative outcome in high-risk patients. Using cardiac magnetic resonance imaging (cMRI), we determined whether the dual endothelin-1 antagonist bosentan improves RV function and remodeling in patients with chronic thromboembolic pulmonary hypertension (CTEPH) who waited for PEA. HYPOTHESIS We hypothesized that medical therapy prior to PEA will be associated with improvements in RV remodeling and function. METHODS In this pilot study, 15 operable CTEPH patients were randomly assigned to either bosentan (n = 8) or no bosentan (n = 7, control) for 16 weeks, next to "best standard of care." Both before and after treatment, RV stroke volume index (RVSVI), RV ejection fraction (RVEF), RV mass, RV isovolumic relaxation time (rIVRT), leftward ventricular septal bowing (LVSB), and left ventricular ejection fraction (LVEF) were determined using cMRI. RESULTS After 16 weeks, the change (Δ) from baseline (median [range]) in the studied cMRI parameters differed significantly between the bosentan group and the controls: Δ RVSVI: 6 [-4-11] vs 1 [-6-3] mL/m(-2) ; Δ RVEF: 8 [-10-15] vs -4 [-7-5]%; Δ RV mass: -3 [-6--2] vs 2 [-1-3] g/m(-2) ; Δ rIVRT: -30 [-130-20] vs 10 [-30-30] msec; Δ LVSB: 0.03 [-0.03-0.13] vs -0.03[-0.08-0.04] cm(-1) ; and Δ LVEF: 8 [-5-17] vs -2 [-14-2]% (all P < 0.05). The change from baseline in mean pulmonary artery pressure (-11 [-17-11] vs 5 [-6-21] mm Hg, P < 0.05) and 6-minute walk distance (20 [3-88] vs -4 [-40-40] m, P < 0.05) also differed significantly. CONCLUSIONS In CTEPH, compared with control, treatment with bosentan for 16 weeks was associated with a significant improvement in cMRI parameters of RV function and remodelling.
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Affiliation(s)
- Sulaiman Surie
- Departments of Pulmonology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
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Wrobel JP, Thompson BR, Williams TJ. Mechanisms of pulmonary hypertension in chronic obstructive pulmonary disease: A pathophysiologic review. J Heart Lung Transplant 2012; 31:557-64. [DOI: 10.1016/j.healun.2012.02.029] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2011] [Revised: 02/17/2012] [Accepted: 02/27/2012] [Indexed: 10/28/2022] Open
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