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Rodríguez-González E, Martínez-Legazpi P, González-Mansilla A, Espinosa MÁ, Mombiela T, Guzmán De-Villoria JA, Borja MG, Díaz-Otero F, Gómez de Antonio R, Fernández-García P, Fernández-Ávila AI, Pascual-Izquierdo C, Del Álamo JC, Bermejo J. Cardiac stasis imaging, stroke, and silent brain infarcts in patients with nonischemic dilated cardiomyopathy. Am J Physiol Heart Circ Physiol 2024; 327:H446-H453. [PMID: 38847759 DOI: 10.1152/ajpheart.00245.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Revised: 05/23/2024] [Accepted: 05/31/2024] [Indexed: 07/17/2024]
Abstract
Cardioembolic stroke is one of the most devastating complications of nonischemic dilated cardiomyopathy (NIDCM). However, in clinical trials of primary prevention, the benefits of anticoagulation are hampered by the risk of bleeding. Indices of cardiac blood stasis may account for the risk of stroke and be useful to individualize primary prevention treatments. We performed a cross-sectional study in patients with NIDCM and no history of atrial fibrillation (AF) from two sources: 1) a prospective enrollment of unselected patients with left ventricular (LV) ejection fraction <45% and 2) a retrospective identification of patients with a history of previous cardioembolic neurological event. The primary end point integrated a history of ischemic stroke or the presence intraventricular thrombus, or a silent brain infarction (SBI) by imaging. From echocardiography, we calculated blood flow inside the LV, its residence time (TR) maps, and its derived stasis indices. Of the 89 recruited patients, 18 showed a positive end point, 9 had a history of stroke or transient ischemic attack (TIA) and 9 were diagnosed with SBIs in the brain imaging. Averaged TR, [Formula: see text] performed well to identify the primary end point [AUC (95% CI) = 0.75 (0.61-0.89), P = 0.001]. When accounting only for identifying a history of stroke or TIA, AUC for [Formula: see text] was 0.92 (0.85-1.00) with odds ratio = 7.2 (2.3-22.3) per cycle, P < 0.001. These results suggest that in patients with NIDCM in sinus rhythm, stasis imaging derived from echocardiography may account for the burden of stroke.NEW & NOTEWORTHY Patients with nonischemic dilated cardiomyopathy (NIDCM) are at higher risk of stroke than their age-matched population. However, the risk of bleeding neutralizes the benefit of preventive oral anticoagulation. In this work, we show that in patients in sinus rhythm, the burden of stroke is related to intraventricular stasis metrics derived from echocardiography. Therefore, stasis metrics may be useful to personalize primary prevention anticoagulation in these patients.
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Affiliation(s)
- Elena Rodríguez-González
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Pablo Martínez-Legazpi
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
- Department of Mathematical Physics and Fluids, Facultad de Ciencias, Universidad Nacional de Educación a Distancia, Madrid, Spain
| | - Ana González-Mansilla
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - M Ángeles Espinosa
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Teresa Mombiela
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Juan A Guzmán De-Villoria
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Radiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Maria Guadalupe Borja
- Department of Mechanical and Aerospace Engineering, University of California San Diego, La Jolla, California, United States
| | - Fernando Díaz-Otero
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Neurology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Rubén Gómez de Antonio
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pilar Fernández-García
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, Madrid, Spain
| | - Ana I Fernández-Ávila
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
| | - Cristina Pascual-Izquierdo
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Department of Hematology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Juan C Del Álamo
- Division of Cardiology, Department of Mechanical Engineering, Center for Cardiovascular Biology, University of Washington, Seattle, Washington, United States
| | - Javier Bermejo
- Department of Cardiology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Department of Medicine, Facultad de Medicina, Universidad Complutense, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Madrid, Spain
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Meyers BA, Zhang J, Nyce J, Loke YH, Vlachos PP. Enhanced echocardiographic assessment of intracardiac flow in congenital heart disease. PLoS One 2024; 19:e0300709. [PMID: 38498562 PMCID: PMC10947680 DOI: 10.1371/journal.pone.0300709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 03/04/2024] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND 4D flow magnetic resonance imaging (4D flow MRI) can assess and measure the complex flow patterns of the right ventricle (RV) in congenital heart diseases, but its limited availability makes the broad application of intracardiac flow assessment challenging. Color Doppler imaging velocity reconstruction from conventional echocardiography is an emerging alternative, but its validity against 4D flow MRI needs to be established. OBJECTIVE To compare intracardiac flow parameters measured by color Doppler velocity reconstruction (DoVeR) against parameters measured from 4D flow MRI. METHODS We analyzed 20 subjects, including 7 normal RVs and 13 abnormal RVs (10 with repaired Tetralogy of Fallot, and 3 with atrial-level shunts). Intracardiac flow parameters such as relative pressure difference, vortex strength, total kinetic energy, and viscous energy loss were quantified using DoVeR and 4D flow MRI. The agreement between the two methods was determined by comparing the spatial fields and quantifying the cross-correlation and normalized difference between time-series measurements. RESULTS The hemodynamic parameters obtained from DoVeR and 4D flow MRI showed similar flow characteristics and spatial distributions. The time evolutions of the parameters were also in good agreement between the two methods. The median correlation coefficient between the time-series of any parameter was between 0.87 and 0.92, and the median L2-norm deviation was between 10% to 14%. CONCLUSIONS Our study shows that DoVeR is a reliable alternative to 4D flow MRI for quantifying intracardiac hemodynamic parameters in the RV.
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Affiliation(s)
- Brett A. Meyers
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jiacheng Zhang
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
| | - Jonathan Nyce
- Division of Cardiology, Children’s National Hospital, Washington, DC, United States of America
| | - Yue-Hin Loke
- Division of Cardiology, Children’s National Hospital, Washington, DC, United States of America
| | - Pavlos P. Vlachos
- School of Mechanical Engineering, Purdue University, West Lafayette, IN, United States of America
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Chalikias GK, Tziakas DN. Echocardiography derived intra-ventricular pressure gradients: a window to the temporal and spatial components of diastolic dysfunction. Int J Cardiovasc Imaging 2021; 37:2675-2678. [PMID: 34286446 DOI: 10.1007/s10554-021-02351-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Georgios K Chalikias
- Cardiology Department, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece.
| | - Dimitrios N Tziakas
- Cardiology Department, Medical School, Democritus University of Thrace, Dragana, 68100, Alexandroupolis, Greece
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Zhong Y, Cai Y, Liu M, Bai W, Wang F, Tang H, Rao L. Left ventricular diastolic pressure gradient and outcome in advanced chronic kidney disease patients with preserved ejection fraction. Int J Cardiovasc Imaging 2021; 37:2663-2673. [PMID: 34286450 DOI: 10.1007/s10554-021-02339-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/02/2021] [Indexed: 02/06/2023]
Abstract
Assessment of left ventricular (LV) diastolic dysfunction is important in patients with chronic kidney disease (CKD). The early diastolic peak intraventricular pressure gradient (IVPG) has a vital role in diastolic function. Relative pressure imaging (RPI) is a new echocardiographic method to quantify IVPG. The purpose of this study was to analyze RPI-derived IVPG in advanced CKD patients with preserved LV ejection fraction. The study population consisted of 51 advanced CKD patients and 39 healthy controls. Patients were stratified by the evidence of heart failure with preserved ejection fraction (HFpEF) into HFpEF group (32 patients) and non-HFpEF group (19 patients). RPI analysis was used to determine the early diastolic LV relative pressure and pressure distribution. The total IVPG and segmental IVPGs corresponding to basal, mid, and apical part of the LV were calculated. Total IVPG, along with apical and mid IVPGs were all significantly reduced in HFpEF Group compared with non-HFpEF Group and controls (all P < 0.05). But no significant difference of total or segmental IVPGs was found between non-HFpEF Group and the controls. Additionally, apical IVPG < 0.02 mmHg/cm (Hazard ratio 9.82, 95 % confidence interval 2.01-48.01, P = 0.005) was the independent risk factor for the composite outcome (mortality and cardiovascular hospitalization) during a median follow-up of 24 months. Advanced CKD patients with HFpEF exhibited decreased apical and mid IVPG of the LV, and the severity of apical IVPG reduction correlated with poor outcome.
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Affiliation(s)
- Yue Zhong
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Yuyan Cai
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Mei Liu
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Wenjuan Bai
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Fang Wang
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Hong Tang
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Li Rao
- Department of Cardiology, West China Hospital of Sichuan University, 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
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Adabifirouzjaei F, Igata S, Strachan M, DeMaria AN. Diastolic Left Ventricular Energy Loss: Relation to Age, Phase of Diastole, and Flow Velocity. J Am Soc Echocardiogr 2021; 34:698-700. [PMID: 33675945 DOI: 10.1016/j.echo.2021.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Fatemeh Adabifirouzjaei
- Division of Cardiology, University of California at San Diego, Sulpizio Cardiovascular Center, San Diego, California
| | - Sachiyo Igata
- Division of Cardiology, University of California at San Diego, Sulpizio Cardiovascular Center, San Diego, California
| | - Monet Strachan
- Division of Cardiology, University of California at San Diego, Sulpizio Cardiovascular Center, San Diego, California
| | - Anthony N DeMaria
- Division of Cardiology, University of California at San Diego, Sulpizio Cardiovascular Center, San Diego, California
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