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Nuzzi V, Manca P, Mulè M, Leone S, Fazzini L, Cipriani MG, Faletra FF. Contemporary clinical role of echocardiography in patients with advanced heart failure. Heart Fail Rev 2024; 29:1247-1260. [PMID: 39298044 DOI: 10.1007/s10741-024-10434-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/26/2024] [Indexed: 09/21/2024]
Abstract
Echocardiography represents an essential tool for imagers and clinical cardiologists in the management of patients with heart failure. Advanced heart failure (AdHF) is a more severe and, typically, later stage of HF that exposes patients to a high risk of adverse outcomes, with a 1-year mortality rate of around 50%. Currently, several therapies are available to improve the outcomes of these patients, reduce their mortality rate, and, possibly, delay the need for advanced therapies such as heart transplant and long-term mechanical circulatory support. When accurately performed and interpreted, echocardiography provides crucial information to properly tailor medical and device therapy of patients with AdHF and to identify those at even higher risk. In this review, we present the state of the art of echocardiography applications in the clinical management of patients with AdHF. We will discuss the role of echocardiography chronologically, beginning with the prediction of AdHF, proceeding through diagnosis, and detailing how echocardiography informs clinical decision-making, before concluding with indications for advanced therapies.
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Affiliation(s)
- Vincenzo Nuzzi
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy.
| | - Paolo Manca
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Massimiliano Mulè
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Simona Leone
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Luca Fazzini
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Manlio G Cipriani
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
| | - Francesco F Faletra
- Clinical Cardiology and Heart Failure Unit, Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT), Via Tricomi 5, 90127, Palermo, Italy
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Duca ȘT, Tudorancea I, Haba MȘC, Costache AD, Șerban IL, Pavăl DR, Loghin C, Costache-Enache II. Enhancing Comprehensive Assessments in Chronic Heart Failure Caused by Ischemic Heart Disease: The Diagnostic Utility of Holter ECG Parameters. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1315. [PMID: 39202596 PMCID: PMC11356511 DOI: 10.3390/medicina60081315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2024] [Revised: 07/31/2024] [Accepted: 08/13/2024] [Indexed: 09/03/2024]
Abstract
Background and Objectives: Chronic heart failure (CHF) caused by ischemic heart disease (IHD) is the leading cause of death worldwide and presents significant health challenges. Effective management of IHD requires prevention, early detection, and treatment to improve patient outcomes. This study aims to expand the diagnostic utility of various 24 h Holter ECG parameters, such as T-wave alternans (TWA), late ventricular potentials (LVPs), and heart rate variability (HRV) in patients with CHF caused by IHD. Additionally, we seek to explore the association between these parameters and other comorbid conditions affecting the prognosis of CHF patients. Materials and Methods: We conducted a prospective case-control study with 150 patients divided into two subgroups: 100 patients with CHF caused by IHD, and 50 patients in the control group. Data included medical history, physical examination, laboratory tests, echocardiography, and 24 h Holter monitoring. Results: Our comparative analysis demonstrated that both TWA and LVPs were significantly higher in patients with CHF compared to the control group (p < 0.01), indicating increased myocardial electrical vulnerability in CHF patients. Both time and frequency-domain HRV parameters were significantly lower in the CHF group. However, the ratio of NN50 to the total count of NN intervals (PNN50) showed a borderline significance (p = 0.06). While the low-frequency (LF) domain was significantly lower in CHF patients, the high-frequency (HF) domain did not differ significantly between groups. Acceleration and deceleration capacities were also significantly altered in CHF patients. Categorizing CHF patients by left ventricular ejection fraction (LVEF) revealed that the mean of the 5-min normal-to-normal intervals over the complete recording (SDNN Index) was significantly higher in patients with LVEF ≥ 50% compared to those with CHF with reduced EF and CHF with mildly reduced EF (p < 0.001), whereas the other HRV parameters showed no significant differences among the groups. Conclusions: Holter ECG parameters can become a reliable tool in the assessment of patients with CHF. The integration of multiple Holter ECG parameters, such as TWA, LVPs, and HRV, can significantly enhance the diagnostic assessment of CHF caused by IHD. This comprehensive approach allows for a more nuanced understanding of the patient's condition and potential outcomes.
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Affiliation(s)
- Ștefania-Teodora Duca
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.Ș.C.H.); (A.-D.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Ionuț Tudorancea
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - Mihai Ștefan Cristian Haba
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.Ș.C.H.); (A.-D.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
| | - Alexandru-Dan Costache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.Ș.C.H.); (A.-D.C.); (I.-I.C.-E.)
- Department of Cardiovascular Rehabilitation, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ionela-Lăcrămioara Șerban
- Department of Morpho-Functional Science II-Physiology, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania;
| | - D. Robert Pavăl
- Faculty of Health Sciences and Sport, University of Stirling, Stirling FK9 4LA, UK;
| | - Cătălin Loghin
- Department of Internal Medicine, Cardiology Division, University of Texas Health Science Center, Houston, TX 77030, USA;
| | - Irina-Iuliana Costache-Enache
- Department of Internal Medicine I, Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa”, 700115 Iasi, Romania; (M.Ș.C.H.); (A.-D.C.); (I.-I.C.-E.)
- Department of Cardiology, “St. Spiridon” Emergency County Hospital, 700111 Iasi, Romania;
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K G, N UM, R V, B GP. Fine grained automatic left ventricle segmentation via ROI based Tri-Convolutional neural networks. Technol Health Care 2024:THC240062. [PMID: 39058464 DOI: 10.3233/thc-240062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND The left ventricle segmentation (LVS) is crucial to the assessment of cardiac function. Globally, cardiovascular disease accounts for the majority of deaths, posing a significant health threat. In recent years, LVS has gained important attention due to its ability to measure vital parameters such as myocardial mass, end-diastolic volume, and ejection fraction. Medical professionals realize that manually segmenting data to evaluate these processes takes a lot of time, effort when diagnosing heart diseases. Yet, manually segmenting these images is labour-intensive and may reduce diagnostic accuracy. OBJECTIVE/METHODS This paper, propose a combination of different deep neural networks for semantic segmentation of the left ventricle based on Tri-Convolutional Networks (Tri-ConvNets) to obtain highly accurate segmentation. CMRI images are initially pre-processed to remove noise artefacts and enhance image quality, then ROI-based extraction is done in three stages to accurately identify the LV. The extracted features are given as input to three different deep learning structures for segmenting the LV in an efficient way. The contour edges are processed in the standard ConvNet, the contour points are processed using Fully ConvNet and finally the noise free images are converted into patches to perform pixel-wise operations in ConvNets. RESULTS/CONCLUSIONS The proposed Tri-ConvNets model achieves the Jaccard indices of 0.9491 ± 0.0188 for the sunny brook dataset and 0.9497 ± 0.0237 for the York dataset, and the dice index of 0.9419 ± 0.0178 for the ACDC dataset and 0.9414 ± 0.0247 for LVSC dataset respectively. The experimental results also reveal that the proposed Tri-ConvNets model is faster and requires minimal resources compared to state-of-the-art models.
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Affiliation(s)
- Gayathri K
- Department of Computer Science and Engineering, PSNA College of Engineering and Technology, Dindigul, Tamil Nadu, India
| | - Uma Maheswari N
- Department of Computer Science and Engineering, PSNA College of Engineering and Technology, Dindigul, Tamil Nadu, India
| | - Venkatesh R
- Department of Information Technology, PSNA College of Engineering and Technology, Dindigul, Tamil Nadu, India
| | - Ganesh Prabu B
- Department of Electrical and Electronics Engineering, University College of Engineering Dindigul, Tamil Nadu, India
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Wu D, Ono R, Wang S, Kobayashi Y, Sughimoto K, Liu H. Pulse wave signal-driven machine learning for identifying left ventricular enlargement in heart failure patients. Biomed Eng Online 2024; 23:60. [PMID: 38909231 PMCID: PMC11193305 DOI: 10.1186/s12938-024-01257-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 06/12/2024] [Indexed: 06/24/2024] Open
Abstract
BACKGROUND Left ventricular enlargement (LVE) is a common manifestation of cardiac remodeling that is closely associated with cardiac dysfunction, heart failure (HF), and arrhythmias. This study aimed to propose a machine learning (ML)-based strategy to identify LVE in HF patients by means of pulse wave signals. METHOD We constructed two high-quality pulse wave datasets comprising a non-LVE group and an LVE group based on the 264 HF patients. Fourier series calculations were employed to determine if significant frequency differences existed between the two datasets, thereby ensuring their validity. Then, the ML-based identification was undertaken by means of classification and regression models: a weighted random forest model was employed for binary classification of the datasets, and a densely connected convolutional network was utilized to directly estimate the left ventricular diastolic diameter index (LVDdI) through regression. Finally, the accuracy of the two models was validated by comparing their results with clinical measurements, using accuracy and the area under the receiver operating characteristic curve (AUC-ROC) to assess their capability for identifying LVE patients. RESULTS The classification model exhibited superior performance with an accuracy of 0.91 and an AUC-ROC of 0.93. The regression model achieved an accuracy of 0.88 and an AUC-ROC of 0.89, indicating that both models can quickly and accurately identify LVE in HF patients. CONCLUSION The proposed ML methods are verified to achieve effective classification and regression with good performance for identifying LVE in HF patients based on pulse wave signals. This study thus demonstrates the feasibility and potential of the ML-based strategy for clinical practice while offering an effective and robust tool for diagnosing and intervening ventricular remodeling.
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Affiliation(s)
- Dandan Wu
- Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - Ryohei Ono
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Sirui Wang
- Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - Yoshio Kobayashi
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Koichi Sughimoto
- Graduate School of Science and Engineering, Chiba University, Chiba, Japan
| | - Hao Liu
- Graduate School of Science and Engineering, Chiba University, Chiba, Japan.
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Mandoli GE, Landra F, Chiantini B, Bonadiman L, Pastore MC, Focardi M, D’Ascenzi F, Lisi M, Diviggiano EE, Martini L, Bernazzali S, Valente S, Maccherini M, Cameli M, Henein MY. Myocardial Work Indices Predict Hospitalization in Patients with Advanced Heart Failure. Diagnostics (Basel) 2024; 14:1196. [PMID: 38893722 PMCID: PMC11172362 DOI: 10.3390/diagnostics14111196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND An increasing proportion of heart failure (HF) patients progress to the advanced stage (AdHF) with high event rates and limited treatment options. Echocardiography, particularly Speckle Tracking-derived myocardial work (MW), is useful for HF diagnosis and prognosis. We aimed to assess MW's feasibility in the prognostic stratification of AdHF. METHODS We retrospectively screened patients with AdHF who accessed our hospital in 2018-2022. We excluded subjects with inadequate acoustic windows; unavailable brachial artery cuff pressure at the time of the echocardiography; atrial fibrillation; and mitral or aortic regurgitation. We measured standard parameters and left ventricular (LV) strain (LS) and MW. The population was followed up to determine the composite outcomes of all-cause mortality, left ventricular assist device implantation and heart transplantation (primary endpoint), as well as unplanned HF hospitalization (secondary endpoint). RESULTS We enrolled 138 patients, prevalently males (79.7%), with a median age of 58 years (IQR 50-62). AdHF etiology was predominantly non-ischemic (65.9%). Thirty-five patients developed a composite event during a median follow-up of 636 days (IQR 323-868). Diastolic function, pulmonary pressures, and LV GLS and LV MW indices were not associated with major events. Contrarily, for the secondary endpoint, the hazard ratio for each increase in global work index (GWI) by 50 mmHg% was 0.90 (p = 0.025) and for each increase in global constructive work (GCW) by 50 mmHg% was 0.90 (p = 0.022). Kaplan-Meier demonstrated better endpoint-free survival, with an LV GWI ≥ 369 mmHg%. CONCLUSIONS GWI and GCW, with good feasibility, can help in the better characterization of patients with AdHF at higher risk of HF hospitalization and adverse events, identifying the need for closer follow-up or additional HF therapy.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
- Institute of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
| | - Federico Landra
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Benedetta Chiantini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Lorenzo Bonadiman
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Matteo Lisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, 48121 Ravenna, Italy;
| | - Enrico Emilio Diviggiano
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Luca Martini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, 53100 Siena, Italy; (S.B.); (M.M.)
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Massimo Maccherini
- Department of Cardiac Surgery, University of Siena, 53100 Siena, Italy; (S.B.); (M.M.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, 53100 Siena, Italy (B.C.); (L.B.); (M.C.P.); (M.F.); (F.D.); (E.E.D.); (L.M.); (S.V.); (M.C.)
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 901 87 Umeå, Sweden;
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Mandoli GE, Cameli M, Pastore MC, Loiacono F, Righini FM, D'Ascenzi F, Focardi M, Cavigli L, Lisi M, Bisleri G, Dokollari A, Bernazzali S, Maccherini M, Valente S, Henein MY. Left ventricular fibrosis as a main determinant of filling pressures and left atrial function in advanced heart failure. Eur Heart J Cardiovasc Imaging 2024; 25:446-453. [PMID: 38109280 DOI: 10.1093/ehjci/jead340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 12/20/2023] Open
Abstract
AIMS Advanced heart failure (AdHF) is characterized by variable degrees of left ventricular (LV) dysfunction, myocardial fibrosis, and raised filling pressures which lead to left atrial (LA) dilatation and cavity dysfunction. This study investigated the relationship between LA peak atrial longitudinal strain (PALS), assessed by speckle-tracking echocardiography (STE), and invasive measures of LV filling pressures and fibrosis in a group of AdHF patients undergoing heart transplantation (HTX). METHODS AND RESULTS We consecutively enrolled patients with AdHF who underwent HTX at our Department. Demographic and basic echocardiographic data were registered, then invasive intracardiac pressures were obtained from right heart catheterization, and STE was also performed. After HTX, biopsy specimens from explanted hearts were collected to quantify the degree of LV myocardial fibrosis. Sixty-four patients were included in the study (mean age 62.5 ± 11 years, 42% female). The mean LV ejection fraction (LVEF) was 26.7 ± 6.1%, global PALS was 9.65 ± 4.5%, and mean pulmonary capillary wedge pressure (PCWP) was 18.8 ± 4.8 mmHg. Seventy-three % of patients proved to have severe LV fibrosis. Global PALS was inversely correlated with PCWP (R = -0.83; P < 0.0001) and with LV fibrosis severity (R = -0.78; P < 0.0001) but did not correlate with LVEF (R = 0.15; P = 0.2). Among echocardiographic indices of LV filling pressures, global PALS proved the strongest [area under the curve 0.955 (95% confidence interval 0.87-0.99)] predictor of raised (>18 mmHg) PCWP. CONCLUSION In patients with AdHF, reduced global PALS strongly correlated with the invasively assessed LV filling pressure and degree of LV fibrosis. Such relationship could be used as non-invasive indicator for optimum patient stratification for therapeutic strategies.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Ferdinando Loiacono
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
- Division of Cardiology, Department of Cardiovascular Diseases-AUSL Romagna, 'Santa Maria delle Croci' Hospital, Ravenna, Italy
| | | | | | - Sonia Bernazzali
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Massimo Maccherini
- Department of Cardiac Surgery, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Mario Bracci, 1, 53100 Siena, Italy
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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7
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Mancusi C, Basile C, Spaccarotella C, Gargiulo G, Fucile I, Paolillo S, Gargiulo P, Santoro C, Manzi L, Marzano F, Ambrosino P, De Luca N, Esposito G. Novel Strategies in Diagnosing Heart Failure with Preserved Ejection Fraction: A Comprehensive Literature Review. High Blood Press Cardiovasc Prev 2024; 31:127-140. [PMID: 38489152 PMCID: PMC11043114 DOI: 10.1007/s40292-024-00629-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 01/26/2024] [Indexed: 03/17/2024] Open
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) is a prevalent global condition affecting approximately 50% of the HF population. With the aging of the worldwide population, its incidence and prevalence are expected to rise even further. Unfortunately, until recently, no effective medications were available to reduce the high mortality and hospitalization rates associated with HFpEF, making it a significant unmet need in cardiovascular medicine. Although HFpEF is commonly defined as HF with normal ejection fraction and elevated left ventricular filling pressure, performing invasive hemodynamic assessments on every individual suspected of having HFpEF is neither feasible nor practical. Consequently, several clinical criteria and diagnostic tools have been proposed to aid in diagnosing HFpEF. Overall, these criteria and tools are designed to assist healthcare professionals in identifying and evaluating patients who may have HFpEF based on a combination of signs, symptoms, biomarkers, and non-invasive imaging findings. By employing these non-invasive diagnostic approaches, clinicians can make informed decisions regarding the best pharmacological and rehabilitation strategies for individuals with suspected HFpEF. This literature review aims to provide an overview of all currently available methods for diagnosing and monitoring this disabling condition.
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Affiliation(s)
- Costantino Mancusi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
| | - Christian Basile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Carmen Spaccarotella
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ilaria Fucile
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Stefania Paolillo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Paola Gargiulo
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Lina Manzi
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Federica Marzano
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Pasquale Ambrosino
- Istituti Clinici Scientifici Maugeri IRCCS, Scientific Directorate of Telese Terme Institute, Telese, Italy
| | - Nicola De Luca
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University of Naples "Federico II", Naples, Italy.
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8
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Pergola V, Cameli M, Mattesi G, Mushtaq S, D’Andrea A, Guaricci AI, Pastore MC, Amato F, Dellino CM, Motta R, Perazzolo Marra M, Dellegrottaglie S, Pedrinelli R, Iliceto S, Nodari S, Perrone Filardi P, Pontone G. Multimodality Imaging in Advanced Heart Failure for Diagnosis, Management and Follow-Up: A Comprehensive Review. J Clin Med 2023; 12:7641. [PMID: 38137711 PMCID: PMC10743799 DOI: 10.3390/jcm12247641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/02/2023] [Accepted: 12/07/2023] [Indexed: 12/24/2023] Open
Abstract
Advanced heart failure (AHF) presents a complex landscape with challenges spanning diagnosis, management, and patient outcomes. In response, the integration of multimodality imaging techniques has emerged as a pivotal approach. This comprehensive review delves into the profound significance of these imaging strategies within AHF scenarios. Multimodality imaging, encompassing echocardiography, cardiac magnetic resonance imaging (CMR), nuclear imaging and cardiac computed tomography (CCT), stands as a cornerstone in the care of patients with both short- and long-term mechanical support devices. These techniques facilitate precise device selection, placement, and vigilant monitoring, ensuring patient safety and optimal device functionality. In the context of orthotopic cardiac transplant (OTC), the role of multimodality imaging remains indispensable. Echocardiography offers invaluable insights into allograft function and potential complications. Advanced methods, like speckle tracking echocardiography (STE), empower the detection of acute cell rejection. Nuclear imaging, CMR and CCT further enhance diagnostic precision, especially concerning allograft rejection and cardiac allograft vasculopathy. This comprehensive imaging approach goes beyond diagnosis, shaping treatment strategies and risk assessment. By harmonizing diverse imaging modalities, clinicians gain a panoramic understanding of each patient's unique condition, facilitating well-informed decisions. The aim is to highlight the novelty and unique aspects of recently published papers in the field. Thus, this review underscores the irreplaceable role of multimodality imaging in elevating patient outcomes, refining treatment precision, and propelling advancements in the evolving landscape of advanced heart failure management.
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Affiliation(s)
- Valeria Pergola
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Giulia Mattesi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | | | - Andrea Igoren Guaricci
- University Cardiology Unit, Interdisciplinary Department of Medicine, Policlinic University Hospital, 70121 Bari, Italy;
| | - Maria Concetta Pastore
- Department of Cardiovascular Diseases, University of Sienna, 53100 Siena, Italy; (M.C.); (M.C.P.)
| | - Filippo Amato
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Carlo Maria Dellino
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
| | - Raffaella Motta
- Unit of Radiology, Department of Medicine, Medical School, University of Padua, 35122 Padua, Italy;
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, 80011 Acerra, Italy;
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, 56126 Pisa, Italy;
| | - Sabino Iliceto
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padua, Via Giustiniani 2, 35128 Padova, Italy; (G.M.); (F.A.); (M.P.M.); (S.I.)
| | - Savina Nodari
- Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, Institute of Cardiology, University of Brescia, 25123 Brescia, Italy;
| | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, 80138 Naples, Italy;
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino IRCCS, 20138 Milan, Italy; (S.M.); (C.M.D.); (G.P.)
- Department of Biomedical, Surgical and Sciences, University of Milan, 20122 Milan, Italy
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9
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Shahnazaryan S, Pepoyan S, Sisakian H. Heart Failure with Reduced Ejection Fraction: The Role of Cardiovascular and Lung Ultrasound beyond Ejection Fraction. Diagnostics (Basel) 2023; 13:2553. [PMID: 37568916 PMCID: PMC10416843 DOI: 10.3390/diagnostics13152553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 08/13/2023] Open
Abstract
Heart failure with reduced ejection fraction (HFrEF) is considered a major health care problem with frequent decompensations, high hospitalization and mortality rates. In severe heart failure (HF), the symptoms are refractory to medical treatment and require advanced therapeutic strategies. Early recognition of HF sub- and decompensation is the cornerstone of the timely treatment intensification and, therefore, improvement in the prognosis. Echocardiography is the gold standard for the assessment of systolic and diastolic functions. It allows one to obtain accurate and non-invasive measurements of the ventricular function in HF. In severely compromised HF patients, advanced cardiovascular ultrasound modalities may provide a better assessment of intracardiac hemodynamic changes and subclinical congestion. Particularly, cardiovascular and lung ultrasound allow us to make a more accurate diagnosis of subclinical congestion in HFrEF. The aim of this review was to summarize the advantages and limitations of the currently available ultrasound modalities in the ambulatory monitoring of patients with HFrEF.
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Affiliation(s)
| | | | - Hamayak Sisakian
- Clinic of General and Invasive Cardiology, “Heratsi” Hospital Complex #1, Yerevan State Medical University, 2 Koryun Street, Yerevan 375025, Armenia; (S.S.); (S.P.)
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10
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Mandoli GE, Pastore MC, Giannoni A, Benfari G, Dini FL, Rosa G, Pugliese NR, Taddei C, Correale M, Brunetti ND, Mazzeo P, Carluccio E, Mengoni A, Guaricci AI, Piscitelli L, Citro R, Ciccarelli M, Novo G, Corrado E, Pasquini A, Loria V, De Carli G, Degiovanni A, Patti G, Santoro C, Moderato L, Cicoira M, Canepa M, Malagoli A, Emdin M, Cameli M. Deformation Imaging by Strain in Chronic Heart Failure Over Sacubitril-Valsartan: A Multicenter Echocardiographic Registry. ESC Heart Fail 2023; 10:846-857. [PMID: 36448244 PMCID: PMC10053272 DOI: 10.1002/ehf2.14155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 12/03/2022] Open
Abstract
AIMS Sacubitril/valsartan has changed the treatment of heart failure with reduced ejection fraction (HFrEF), due to the positive effects on morbidity and mortality, partly mediated by left ventricular (LV) reverse remodelling (LVRR). The aim of this multicenter study was to identify echocardiographic predictors of LVRR after sacubitril/valsartan administration. METHODS AND RESULTS Patients with HFrEF requiring therapy with sacubitril/valsartan from 13 Italian centres were included. Echocardiographic parameters including LV global longitudinal strain (GLS) and global peak atrial longitudinal strain by speckle tracking echocardiography were measured to find the predictors of LVRR [= LV end-systolic volume reduction ≥10% and ejection fraction (LVEF) improvement ≥10% at follow-up] at 6 month follow-up as the primary endpoint. Changes in symptoms [New York Heart Association (NYHA) class] and neurohormonal activations [N-terminal pro-brain natriuretic peptide (NT-proBNP)] were also evaluated as secondary endpoints; 341 patients (excluding patients with poor acoustic windows and missing data) were analysed (mean age: 65 ± 10 years; 18% female, median LVEF 30% [inter-quartile range: 25-34]). At 6 month follow-up, 82 (24%) patients showed early complete response (LVRR and LVEF ≥ 35%), 55 (16%) early incomplete response (LVRR and LVEF < 35%), and 204 (60%) no response (no LVRR and LVEF < 35%). Non-ischaemic aetiology, a lower left atrial volume index, and a higher GLS were all independent predictors of LVRR at multivariable logistic analysis (all P < 0.01). A baseline GLS < -9.3% was significantly associated with early response (area under the curve 0.75, P < 0.0001). Left atrial strain was the best predictor of positive changes in NYHA class and NT-proBNP (all P < 0.05). CONCLUSIONS Speckle tracking echocardiography parameters at baseline could be useful to predict LVRR and clinical response to sacubitril-valsartan and could be used as a guide for treatment in patients with HFrEF.
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Affiliation(s)
- Giulia Elena Mandoli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Alberto Giannoni
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
- Institute of Life SciencesScuola Superiore Sant'AnnaPisaItaly
| | - Giovanni Benfari
- Section of Cardiology, Department of MedicineUniversity of VeronaVeronaItaly
| | | | - Gianmarco Rosa
- Department of Internal Medicine and Medical SpecialitiesUniversity of GenoaGenoaItaly
| | | | - Claudia Taddei
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
| | - Michele Correale
- Cardiology DepartmentPoliclinico Riuniti University HospitalFoggiaItaly
| | | | - Pietro Mazzeo
- Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ HospitalUniversity of PerugiaPerugiaItaly
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology—Heart Failure Unit, ‘Santa Maria della Misericordia’ HospitalUniversity of PerugiaPerugiaItaly
| | - Andrea Igoren Guaricci
- University Cardiology Unit, Cardiothoracic DepartmentPolyclinic University HospitalBariItaly
| | - Laura Piscitelli
- University Cardiology Unit, Cardiothoracic DepartmentPolyclinic University HospitalBariItaly
| | - Rodolfo Citro
- Cardio‐Thoracic‐Vascular DepartmentUniversity Hospital San Giovanni di Dio e Ruggi d'AragonaSalernoItaly
| | - Michele Ciccarelli
- Department of Medicine, Surgery and DentistryUniversity of SalernoBaronissiItaly
| | - Giuseppina Novo
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Egle Corrado
- Division of Cardiology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (ProMISE), University Hospital Paolo GiacconeUniversity of PalermoPalermoItaly
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Valentina Loria
- Department of Cardiovascular and Thoracic SciencesFondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro CuoreRomeItaly
| | - Giuseppe De Carli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
| | - Anna Degiovanni
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
| | - Giuseppe Patti
- Department of Thoracic, Heart and Vascular DiseasesMaggiore della Carità HospitalNovaraItaly
- Department of Translational MedicineUniversity of Piemonte OrientaleNovaraItaly
| | - Ciro Santoro
- Department of Advanced Biomedical ScienceFederico II University HospitalNaplesItaly
| | - Luca Moderato
- Cardiology DepartmentOspedale Guglielmo da SalicetoPiacenzaItaly
| | | | - Marco Canepa
- Cardiovascular Disease UnitIRCCS Ospedale Policlinico San Martino, IRCCS Italian Cardiovascular NetworkGenoaItaly
- Department of Internal MedicineUniversity of GenoaGenoaItaly
| | - Alessandro Malagoli
- Division of Cardiology, Nephro‐Cardiovascular Department, Baggiovara HospitalUniversity of Modena and Reggio EmiliaModenaItaly
| | - Michele Emdin
- Cardiology and Cardiovascular Medicine DepartmentFondazione Toscana G. MonasterioPisaItaly
- Institute of Life SciencesScuola Superiore Sant'AnnaPisaItaly
| | - Matteo Cameli
- Division of Cardiology, Department of Medical BiotechnologiesUniversity of SienaViale Bracci 1SienaItaly
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11
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Zhang Y. Diagnostic value of echocardiography combined with serum C-reactive protein level in chronic heart failure. J Cardiothorac Surg 2023; 18:94. [PMID: 36966338 PMCID: PMC10040132 DOI: 10.1186/s13019-023-02176-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 01/29/2023] [Indexed: 03/27/2023] Open
Abstract
BACKGROUND Chronic heart failure (CHF) is regarded as common clinical heart disease. This study aims to investigate the clinical diagnostic value of echocardiography (Echo) and serum C-reactive protein (CRP) levels in patients with CHF. METHODS A total of 75 patients with CHF (42 males, 33 females, age 62.72 ± 1.06 years) were enrolled as study subjects, with 70 non-CHF subjects (38 males, 32 females, age 62.44 ± 1.28 years) as controls. The left ventricular ejection fraction (LVEF), fraction shortening rate of the left ventricle (FS), and early to late diastolic filling (E/A) were determined by Echo, followed by an examination of the expression of serum CRP by ELISA. In addition, the Pearson method was used to analyze the correlation between echocardiographic quantitative parameters (EQPs) (LVEF, FS, and E/A) and serum CRP levels. Receiver operating characteristic (ROC) curve was adopted to evaluate the diagnostic efficacy of EQPs and serum CRP levels for CHF. The independent risk factors for CHF patients were measured by logistics regression analysis. RESULTS The serum CRP level of CHF patients was elevated, the values of LVEF and FS decreased, and the E/A values increased. ROC curve revealed that the EQPs (LVEF, FS, and E/A) combined with serum CRP had high diagnostic values for CHF patients. Logistic regression analysis showed that the EQPs (LVEF, FS, and E/A) and serum CRP levels were independent risk factors for CHF patients. CONCLUSION Echo combined with serum CRP level has high clinical diagnostic values for CHF patients.
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Affiliation(s)
- Yongxia Zhang
- Cardiovascular Medicine Department, The Third Affiliated Hospital of Guangzhou Medical University, No.63 Duobao Road, Liwan District, Guangzhou, 510150, Guangdong Province, China.
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12
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Du Y, Yuan N, Yan J, Han G, Hu X, Zhang Y, Tian J. Identification of echocardiographic subgroups in patients with coronary heart disease combined with heart failure based on latent variable stratification. Int J Cardiol 2023; 373:90-98. [PMID: 36442673 DOI: 10.1016/j.ijcard.2022.11.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prognosis of chronic heart failure is poor, and it remains a challenge to classify patients for better personalized intervention. This study aimed to explore potential subgroups in patients with coronary heart disease and chronic heart failure using comprehensive echocardiographic indices. METHODS 5126 patients with coronary heart disease with chronic heart failure were included. Latent class analysis was applied to identify the grouping patterns of patients based on echocardiographic indices. Network maps and radar charts of echocardiographic indices were drawn to visualize the distribution of echocardiographic findings. The incidence of adverse outcomes was presented on the Kaplan-Meier curve and compared using the log-rank test. The Cox regression model was used to analyze the relationship between subgroups and mortality. RESULTS Three groups were identified: eccentric hypertrophy, concentric hypertrophy, and decreased diastolic function. Network plots showed a higher correlation between left atrial diameter, left ventricular mass index, and left ventricle ejection fraction in the eccentric hypertrophy group than in the other groups. The Kaplan-Meier curve showed a significant difference in mortality between the three subgroups (P < 0.001). Multivariate Cox analysis indicated that the eccentric hypertrophy group had the highest risk of death (HR = 1.586, 95% CI: 1.310-1.921, P < 0.001) compared with the other groups. CONCLUSION Patients with coronary heart disease and chronic heart failure can be classified into three subgroups based on echocardiographic indices. This grouping has been shown to be an independent risk factor for mortality in these patients. Accurate subgrouping based on echocardiographic indices is important for identifying high-risk patients.
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Affiliation(s)
- Yutao Du
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China
| | - Na Yuan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China
| | - Jingjing Yan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China
| | - Gangfei Han
- Department of Cardiology, the 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001, China
| | - Xiaojuan Hu
- Department of Cardiology, the 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001, China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China; Shanxi University of Chinese Medicine, 121 University Street, Jinzhong, Shanxi Province 030619, China.
| | - Jing Tian
- Department of Cardiology, the 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001, China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China.
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13
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Raco J, Peterson B, Muallem S. Assessment of Volume Status in Hospitalized Patients With Chronic Heart Failure. Cardiol Res 2023; 14:2-11. [PMID: 36896231 PMCID: PMC9990539 DOI: 10.14740/cr1434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/26/2022] [Indexed: 02/27/2023] Open
Abstract
Assessment of volume status in hospitalized patients with heart failure is a critically important diagnostic skill that clinicians utilize frequently. However, accurate assessment is challenging and there is often significant inter-provider disagreement. This review serves as an appraisal of current methods of volume assessment amongst different categories of evaluation including patient history, physical exam, laboratory analysis, imaging, and invasive procedures. Within each category, this review highlights methods that are particularly sensitive or specific, or those that carry impactful positive or negative likelihood ratios. Utilization of the information that this review provides will allow clinicians to determine volume status of hospitalized heart failure patients more accurately and more precisely in order to provide appropriate and effective therapies.
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Affiliation(s)
- Joseph Raco
- Department of Internal Medicine, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Brandon Peterson
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Samer Muallem
- Department of Cardiology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
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14
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Abstract
Abstract
In the last decade, speckle tracking echocardiography (STE) has acquired a fundamental role in the evaluation of the systolic function of the left ventricle, with several advantages over the Doppler method, including angle independence, greater reproducibility, and rapidity of image acquisition. Speckle tracking finds application in various pathologies, ranging from ischaemic heart disease, to cardiomyopathies, to heart failure, both with reduced and preserved ejection fraction (EF), in which the EF is not a reliable prognostic marker and the estimate of left ventricular function by means of ‘strain’ is of crucial utility. In addition, the strain of the left atrium finds application in many clinical contexts as an early index of diastolic dysfunction and left ventricular filling pressures. Finally, the strain of the right ventricle is of particular prognostic importance in the evaluation of heart failure, particularly in its advanced form, becoming an indispensable index in the evaluation of patients who are candidates for advanced therapeutic strategies. This document aims to describe the various fields of clinical application of STE, with particular emphasis on its diagnostic and prognostic role, so much that it is now integrated into the algorithms for managing multiple pathologies in daily clinical practice.
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Affiliation(s)
- Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena , Siena
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15
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Current Concepts and Future Applications of Non-Invasive Functional and Anatomical Evaluation of Coronary Artery Disease. Life (Basel) 2022; 12:life12111803. [PMID: 36362957 PMCID: PMC9696378 DOI: 10.3390/life12111803] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 10/31/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Over the last decades, significant advances have been achieved in the treatment of coronary artery disease (CAD). Proper non-invasive diagnosis and appropriate management based on functional information and the extension of ischemia or viability remain the cornerstone in the fight against adverse CAD events. Stress echocardiography and single photon emission computed tomography are often used for the evaluation of ischemia. Advancements in non-invasive imaging modalities such as computed tomography (CT) coronary angiography and cardiac magnetic resonance imaging (MRI) have not only allowed non-invasive imaging of coronary artery lumen but also provide additional functional information. Other characteristics regarding the plaque morphology can be further evaluated with the latest modalities achieving a morpho-functional evaluation of CAD. Advances in the utilization of positron emission tomography (PET), as well as software advancements especially regarding cardiac CT, may provide additional prognostic information to a more evidence-based treatment decision. Since the armamentarium on non-invasive imaging modalities has evolved, the knowledge of the capabilities and limitations of each imaging modality should be evaluated in a case-by-case basis to achieve the best diagnosis and treatment decision. In this review article, we present the most recent advances in the noninvasive anatomical and functional evaluation of CAD.
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16
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Katapadi A, Umland M, Khandheria BK. Update on the Practical Role of Echocardiography in Selection, Implantation, and Management of Patients Requiring Left Ventricular Assist Device Therapy. Curr Cardiol Rep 2022; 24:1587-1597. [PMID: 35984555 DOI: 10.1007/s11886-022-01771-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2022] [Indexed: 01/11/2023]
Abstract
PURPOSE OF REVIEW Echocardiography is a valuable tool for management of patients with a left ventricular assist device (LVAD). We present an updated review on the practical applications of the role of echocardiography for pre- and postoperative evaluation of patients selected. RECENT FINDINGS The LVAD is a temporary or permanent option for patients with advanced heart failure who are unresponsive to other therapy. Use of the device has its own risks, and implantation remains a complex procedure. Transthoracic and transesophageal echocardiography are useful tools for patient evaluation and monitoring both peri- and postoperatively, as we previously presented. Assessment of left and right ventricular function, complications such as thrombus formation or intracardiac shunting, and valvular disease are all important in this assessment. This also aids in predicting postoperative complications. Placement of the device is confirmed intraoperatively, and subsequent ramp studies are used to determine optimal device settings. Right ventricular (RV) failure is the most common postoperative complication and preoperative evaluation of its function is crucial. Studies suggest that tricuspid annular plane systolic excursion, RV fractional area change, and RV global longitudinal strain are strong predictors of RV failure; LV ejection fraction, size, and end-diastolic diameter are also important markers. Aortic regurgitation and mitral stenosis must always be corrected prior to LVAD placement. However, direct visualization before and after implantation, especially to rule out potential contraindications such as thrombi, cannot be overemphasized. Ramp studies remain an integral part of device optimization and may result in greater myocardial recovery than previously realized.
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Affiliation(s)
- Aashish Katapadi
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Matt Umland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, 2801 W. Kinnickinnic River Parkway, Ste. 880, Milwaukee, WI, 53215, USA.
- School of Medicine and Public Health, University of Wisconsin, Milwaukee, WI, 53215, USA.
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Gao L, Lin Y, Ji M, Wu W, Li H, Qian M, Zhang L, Xie M, Li Y. Clinical Utility of Three-Dimensional Speckle-Tracking Echocardiography in Heart Failure. J Clin Med 2022; 11:6307. [DOI: 10.3390/jcm11216307] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023] Open
Abstract
Heart failure (HF) is an extremely major health problem with gradually increasing incidence in developed and developing countries. HF may lead to cardiac remodeling; thus, advanced imaging techniques are required to comprehensively evaluate cardiac mechanics. Recently, three-dimensional speckle-tracking echocardiography (3D-STE) has been developed as a novel imaging technology that is based on the three-dimensional speckle-tracking on the full volume three-dimensional datasets. Three-dimensional speckle-tracking echocardiography allows a more accurate evaluation of global and regional myocardial performance, assessment of cardiac mechanics, detection of subclinical cardiac dysfunction, and prediction of adverse clinical events in a variety of cardiovascular diseases. Therefore, this review summarizes the clinical usefulness of 3D-STE in patients with HF.
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18
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Lu S, Hu X, Zhang J, Zhu Y, Zhou W, Liu Y, Deng Y. Post-systolic shortening is superior to global longitudinal strain in predicting adverse events in patients with stable coronary artery disease and preserved systolic function. Insights Imaging 2022; 13:35. [PMID: 35237872 PMCID: PMC8891405 DOI: 10.1186/s13244-022-01174-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 02/03/2022] [Indexed: 11/28/2022] Open
Abstract
Background Post-systolic shortening (PSS) is an important indicator for early identifying myocardial dysfunction. We aimed to investigate the predictive value of PSS assessed with speckle tracking automated functional imaging (AFI) on adverse events in patients with stable coronary artery disease (CAD) and preserved systolic function. Methods A total of 204 consecutive patients clinically diagnosed with stable CAD and left ventricular ejection fraction (LVEF) > 50% were included. Multiple parameters were analyzed with AFI technique. The composite endpoint included all-cause mortality, heart failure, myocardial infarction and stroke. Results During a median follow-up of 24 months (IQR 19–28 months), 30 patients (14.7%) reached the endpoint. Patients experiencing the endpoint had a lower absolute global longitudinal strain (GLS), a higher post-systolic index (PSI), and more left ventricle walls displaying PSS than patients without events. PSI (hazard ratio, 1.15; 95% CI, 1.04–1.27; p = 0.005) and per 1 increase in the number of left ventricle walls with PSS (hazard ratio 1.52, 95% CI 1.21–1.91, p < 0.000) were independent predictors of the endpoint, whereas GLS was not significantly associated with the endpoint after adjustment models. For patients with absolute value of GLS > 15.4%, a significant prognostic superiority was found in PSI compared with GLS (AUC = 0.73 [PSI] vs. 0.58 [GLS], p = 0.024). Conclusions PSS is an independent predictor for adverse events in stable CAD patients with preserved systolic function, and the prognostic value may be superior to GLS in patients with normal or mildly reduced GLS. Supplementary Information The online version contains supplementary material available at 10.1186/s13244-022-01174-y.
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Affiliation(s)
- Shirui Lu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Xin Hu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Jun Zhang
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Ying Zhu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Wei Zhou
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
| | - Yani Liu
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China.
| | - Youbin Deng
- Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Road, Wuhan, 430030, China
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Feng XH, Wang Y, Wang LY, Shen JF, You CY, Feng QT. Value of PTEN and Echocardiography in Predicting the Efficacy of Trimetazidine Combined with Metoprolol in the Treatment of Heart Failure. Int J Gen Med 2022; 14:10257-10263. [PMID: 34992440 PMCID: PMC8711637 DOI: 10.2147/ijgm.s346538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
Objective To investigate the predictive value of PTEN and echocardiography in the treatment of heart failure with trimetazidine combined with metoprolol. Methods A total of 100 patients with coronary heart disease and HF who admitted to our hospital from August 2018 to August 2020 were enrolled into research. All patients received routine treatment according to the guidelines and were treated with trimetazidine and metoprolol for a total course of 6 months. Echocardiographic parameters and PTEN levels were measured at baseline and after treatment. The patients were divided into groups according to the quartile of basic PTEN level, and the total effective rates were compared. The echocardiographic parameters of patients with different prognosis were analyzed. Bivariate correlation analysis was used to evaluate the correlation between PTEN, echocardiography and treatment effect. Results Compared with that before treatment, the level of PTEN increased significantly after treatment (P < 0.01). According to the quartile of basic PTEN level, the total effective rate of patients with different levels of basic PTEN was was statistically different (P < 0.01). There was a linear correlation between the level of basic PTEN and the treatment effect, and the total effective rate of patients with high level of basic PTEN was higher than that of patients with low level of PTEN. Compared with before treatment, LVEF, SV, E/A and lvfs increased significantly after treatment (P < 0.01). There was a correlation between the basic echocardiographic parameters and the treatment effect of patients. The basic echocardiographic parameters of patients with poor prognosis were worse than those with good prognosis. PTEN expression in patients’ serum was only positively correlated with E/A, but not with LVFE, SV and LVFS (P < 0.01). Conclusion PTEN and echocardiographic parameters serve as a good method to evaluate the short-term therapeutic effect of trimetazidine combined with metoprolol in patients with heart failure.
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Affiliation(s)
- Xue-Hong Feng
- Department of Echocardiography, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214002, People's Republic of China
| | - Yang Wang
- Department of Echocardiography, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214002, People's Republic of China
| | - Lian-Yu Wang
- Department of Echocardiography, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214002, People's Republic of China
| | - Jun-Fei Shen
- Department of Echocardiography, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214002, People's Republic of China
| | - Chun-Yuan You
- Department of Echocardiography, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214002, People's Republic of China
| | - Qiu-Ting Feng
- Department of Cardiology, The Second Hospital of Wuxi Affiliated to Nanjing Medical University, Wuxi, Jiangsu, 214002, People's Republic of China
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20
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Mandoli GE, Pastore MC, Benfari G, Setti M, Nistor D, D'Ascenzi F, Focardi M, Baccani B, Patti G, Valente S, Mondillo S, Cameli M. New echocardiographic indices of shift to biventricular failure to optimize risk stratification of chronic heart failure. ESC Heart Fail 2021; 9:476-485. [PMID: 34874122 PMCID: PMC8788050 DOI: 10.1002/ehf2.13722] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 11/01/2021] [Accepted: 11/06/2021] [Indexed: 01/15/2023] Open
Abstract
Aims The present study investigated the prognostic impact of either isolated left atrial (LA) impairment, or its association with right ventricular (RV) failure, in heart failure (HF) with reduced ejection fraction (HFrEF), using basic and speckle tracking echocardiography (STE). Methods and results One hundred and six outpatients with HFrEF were enrolled in this prospective observational study. Patients with primary lung diseases, non‐sinus rhythm, previous cardiac surgery, and poor acoustic window were excluded. After clinical examination and basic echocardiography, STE was used to measure peak atrial longitudinal strain (PALS) and a new marker of RV performance and pulmonary circulation relation: free‐wall RV longitudinal strain (fwRVLS)/systolic pulmonary artery pressure (sPAP). Patients were followed for all‐cause/cardiovascular death and HF hospitalization. Of 84 eligible patients (60.1 ± 11.5 years; 82% male patients), 48 reached the combined endpoint (cardiovascular death and/or HF hospitalization). Population was divided into three groups: Group 1 (PALS ≥ 15 and fwRVLS/sPAP ≤ −0.5), Group 2 (PALS ≤ 15 and fwRVLS/sPAP ≤ −0.5), and Group 3 (PALS ≤ 15 and fwRVLS/sPAP > −0.5). Mean follow up was 3.5 ± 0.3 years. The higher severity groups were associated with higher LA volume index (P < 0.0001), New York Heart Association class (P = 0.02), mitral regurgitation (P = 0.0004) and tricuspid regurgitation grades (P < 0.0001), lower left ventricular (LV) ejection fraction (P = 0.0003), LV global longitudinal strain (P < 0.0001), PALS (P < 0.0001), tricuspid annular plane systolic excursion (P < 0.007), sPAP (P < 0.0001), and RV strain (P < 0.0001). Reduced PALS and fwRVLS/sPAP were independent predictors of the combined endpoint with adjusted Cox models (hazard ratio = 9.54; 95% confidence interval = 2.95–30.92; P = 0.0002 for Group 3 vs. Group 1). Kaplan–Meier curves showed early and persistent divergence between the three groups for the prediction of the combined endpoint and of all‐cause death (P < 0.0001). Conclusions The combination of LA and right heart damage entails worse prognosis in patients with HFrEF. The evaluation of PALS and fwRVLS/sPAP could aid risk stratification of HFrEF patients to provide them early treatment.
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Affiliation(s)
- Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy.,Department of Thoracic and Cardiovascular Diseases, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Martina Setti
- Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Dan Nistor
- Department M3, University of Medicine, Pharmacy, Science, and Technology of Târgu Mureș, Târgu Mureș, Romania
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy
| | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy
| | - Bernardo Baccani
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy
| | - Giuseppe Patti
- Department of Thoracic and Cardiovascular Diseases, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci 1, Siena, 53100, Italy
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21
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Soliman-Aboumarie H, Pastore MC, Galiatsou E, Gargani L, Pugliese NR, Mandoli GE, Valente S, Hurtado-Doce A, Lees N, Cameli M. Echocardiography in the intensive care unit: An essential tool for diagnosis, monitoring and guiding clinical decision-making. Physiol Int 2021. [PMID: 34825894 DOI: 10.1556/1647.2021.00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2021] [Accepted: 10/22/2021] [Indexed: 11/19/2022]
Abstract
In the last years, new trends on patient diagnosis for admission in cardiac intensive care unit (CICU) have been observed, shifting from acute myocardial infarction or acute heart failure to non-cardiac diseases such as sepsis, acute respiratory failure or acute kidney injury. Moreover, thanks to the advances in scientific knowledge and higher availability, there has been increasing use of positive pressure mechanical ventilation which has its implications on the heart. Therefore, there is a growing need for Cardiac intensivists to quickly, noninvasively and repeatedly evaluate various hemodynamic conditions and the response to therapy. Transthoracic critical care echocardiography (CCE) currently represents an essential tool in CICU, as it is used to evaluate biventricular function and complications following acute coronary syndromes, identify the mechanisms of circulatory failure, acute valvular pathologies, tailoring and titrating intravenous treatment or mechanical circulatory support. This could be completed with trans-esophageal echocardiography (TOE), advanced echocardiography and lung ultrasound to provide a thorough evaluation and monitoring of CICU patients. However, CCE could sometimes be challenging as the acquisition of good-quality images is limited by mechanical ventilation, suboptimal patient position or recent surgery with drains on the chest. Moreover, there are some technical caveats that one should bear in mind while performing CCE in order to optimize its use and avoid misleading findings. The aim of this review is to highlight the key role of CCE, providing an updated overview of its main applications and possible pitfalls in order to facilitate its use in CICU for clinical decision-making.
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Affiliation(s)
- Hatem Soliman-Aboumarie
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
- 4 School of Cardiovascular Sciences and Medicine, King's College, London , United Kingdom
| | - Maria Concetta Pastore
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Eftychia Galiatsou
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Luna Gargani
- 3 Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Giulia Elena Mandoli
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ana Hurtado-Doce
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Nicholas Lees
- 1 Department of Anesthetics and Critical Care, Harefield Hospital, Royal Brompton and Harefield Hospitals, Guy's and St Thomas NHS Foundation Trust, London , United Kingdom
| | - Matteo Cameli
- 2 Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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22
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Feng J, Zhai Z, Wang Z, Huang L, Dong S, Liu K, Shi W, Lu G, Qin W. Speckle tracking imaging combined with myocardial comprehensive index to evaluate left ventricular function changes in patients with systemic lupus erythematosus. Echocardiography 2021; 38:1632-1640. [PMID: 34555198 DOI: 10.1111/echo.15189] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/17/2021] [Accepted: 08/15/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate early changes in left ventricular systolic function in patients with systemic lupus erythematosus (SLE) using three-dimensional speckle tracking imaging (3D-STI). METHODS A total of 30 SLE patients and 30 healthy people (control group) were selected, the patients were further divided into subgroups according to their Safety of Estrogens in Lupus Erythematosus National Assessment version of the SLE Disease Activity Index (SELENA-SLEDAI) score: ≤ 12: mild-to-moderate group; > 12: severe group. All participants were examined using 3D-STI, the 3D-STI parameters were obtained. Receiver operating curves (ROC) were prepared for above parameters and analyzed to identify correlations among 3D-STI parameters and high sensitivity-TropT (hs-TropT). RESULTS Compared with the control group, the absolute values of left ventricular end-diastolic volume (LVEDV), left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), global circumferential strain (GCS), left ventricular twist angle (LVtw), torsion (Tor) and myocardial comprehensive index (MCI) decreased, left ventricular end diastolic mass (LV EDmass), left ventricular end systolic mass (LV ESmass) and peak strain dispersion (PSD) increased in the mild-to-moderate and the severe groups (P2 < 0.05, P3 < 0.05). There was statistically significant difference in terms of 3D-STI parameters between the mild-to-moderate group and the severe group (P1 < 0.05). The highest area under the ROC for MCI was 0.909, the highest sensitivity for MCI was 90.00%, and the highest specificity for Tor was 86.67%. Correlation analysis showed that there was a good correlation between the MCI and hs-TropT (r = - 0.677). CONCLUSION 3D-STI technology may help detect early changes in left ventricular systolic function in patients with SLE.
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Affiliation(s)
- Jia Feng
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Zijing Zhai
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Zhen Wang
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Lei Huang
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Shanshan Dong
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Kuichan Liu
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Wenrong Shi
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Guilin Lu
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
| | - Wenjuan Qin
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, China
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23
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Pastore MC, Mandoli GE, Sannino A, Dokollari A, Bisleri G, D'Ascenzi F, Cavigli L, Pasquini A, Lisi M, Ghionzoli N, Santoro C, Miglioranza MH, Focardi M, Patti G, Valente S, Mondillo S, Cameli M. Two and Three-Dimensional Echocardiography in Primary Mitral Regurgitation: Practical Hints to Optimize the Surgical Planning. Front Cardiovasc Med 2021; 8:706165. [PMID: 34307510 PMCID: PMC8295501 DOI: 10.3389/fcvm.2021.706165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022] Open
Abstract
Primary mitral regurgitation (MR) is the second most common valvular disease, characterized by a high burden in terms of quality of life, morbidity, and mortality. Surgical treatment is considered the best therapeutic strategy for patients with severe MR, especially if they are symptomatic. However, pre-operative echocardiographic evaluation is an essential step not only for surgical candidate selection but also to avoid post-operative complications. Therefore, a strong collaboration between cardiologists and cardiac surgeons is fundamental in this setting. A meticulous pre-operative echocardiographic exam, both with transthoracic or transesophageal echocardiography, followed by a precise report containing anatomical information and parameters should always be performed to optimize surgical planning. Moreover, intraoperative transesophageal evaluation is often required by cardiac surgeons as it may offer additive important information with different hemodynamic conditions. Three-dimensional echocardiography has recently gained higher consideration and availability for the evaluation of MR, providing more insights into mitral valve geometry and MR mechanism. This review paper aims to realize a practical overview on the main use of basic and advanced echocardiography in MR surgical planning and to provide a precise checklist with reference parameters to follow when performing pre-operative echocardiographic exam, in order to aid cardiologists to provide a complete echocardiographic evaluation for MR operation planning from clinical and surgical point-of-view.
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Affiliation(s)
- Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Anna Sannino
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy.,Baylor Research Institute, The Heart Hospital Baylor Plano, Plano, TX, United States
| | | | | | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Luna Cavigli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Annalisa Pasquini
- Department of Cardiovascular and Thoracic Sciences, Fondazione Policlinico Universitario A. Gemelli, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Università Cattolica del Sacro Cuore, Rome, Italy
| | - Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy.,Division of Cardiology, Department of Cardiovascular Diseases - Azienda Unità Sanitaria Locale (AUSL) Romagna, "Santa Maria delle Croci" Hospital, Ravenna, Italy
| | - Nicolò Ghionzoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | | | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Giuseppe Patti
- Maggiore della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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24
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Lisi M, Mandoli GE, Cameli M, Pastore MC, Righini FM, Benfari G, Rubboli A, D'Ascenzi F, Focardi M, Tsioulpas C, Bernazzali S, Maccherini M, Lisi E, Lindqvist P, Valente S, Mondillo S, Henein MY. Left atrial strain by speckle tracking predicts atrial fibrosis in patients undergoing heart transplantation. Eur Heart J Cardiovasc Imaging 2021; 23:829-835. [PMID: 34118154 DOI: 10.1093/ehjci/jeab106] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/13/2021] [Indexed: 12/20/2022] Open
Abstract
AIMS In patients with heart failure (HF), chronically raised left ventricular (LV) filling pressures lead to progressive left atrial (LA) dysfunction and fibrosis. We aimed to assess the correlation of LA reservoir strain (peak atrial longitudinal strain, PALS) by speckle tracking echocardiography (STE) and LA fibrosis assessed by myocardial biopsy in patients undergoing heart transplantation (HTx). METHODS AND RESULTS Forty-eight patients with advanced HF [mean age 51.2 ± 8.1 years, 29% females; LV ejection fraction ≤25% and New York Heart Association (NYHA) class III-IV] referred for HTx were enrolled and underwent pre-operative echocardiographic evaluation, right heart catheterization, and cardiopulmonary exercise testing. Exclusion criteria were non-sinus rhythm, mechanical ventilation, severe mitral/tricuspid regurgitation, or other valvular disease and poor acoustic window. After HTx, LA bioptic samples were collected and analysed to determine the extent of myocardial fibrosis (%). LA fibrosis showed correlation with PALS (R = -0.88, P < 0.0001), VO2max (R = -0.68, P < 0.0001), NYHA class (R = 0.66, P < 0.0001), LA stiffness (R = 0.58, P = 0.0002), and E/e' (R = 0.44, P = 0.005), while poorly correlated with E/A ratio (R = 0.23, P = 0.21). PALS had a good correlation with NYHA class (R = -0.64, P < 0.0001), PAoP (R = -0.61, P = 0.03) and VO2max (R = 0.57, P = 0.0001). Multivariate regression analysis identified PALS (beta = -0.91, P < 0.001) and LA Volume (beta = -0.19, P = 0.03) as predictors of LA Fibrosis, while E/e' was not a significant predictor (beta = 0.15, P = 0.08). CONCLUSION Emerging as a possible index of myocardial fibrosis in patients with advanced HF, PALS could help to optimize the management and the selection of those patients with irreversible LA structural damage for advanced therapeutic strategies.
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Affiliation(s)
- Matteo Lisi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Francesca Maria Righini
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | | | - Andrea Rubboli
- Division of Cardiology, Department of Cardiovascular Disease-AUSL Romagna, Ospedale S. Maria delle Croci, Ravenna, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | | | - Sonia Bernazzali
- Department of Cardiac Surgery, University of Siena, Siena, Italy
| | | | - Edoardo Lisi
- Department of Mathematics, Imperial College London, London, UK
| | - Per Lindqvist
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
| | - Serafina Valente
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Viale Bracci n° 1, 53100 Siena, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
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25
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Mandoli GE, D'Ascenzi F, Vinco G, Benfari G, Ricci F, Focardi M, Cavigli L, Pastore MC, Sisti N, De Vivo O, Santoro C, Mondillo S, Cameli M. Novel Approaches in Cardiac Imaging for Non-invasive Assessment of Left Heart Myocardial Fibrosis. Front Cardiovasc Med 2021; 8:614235. [PMID: 33937354 PMCID: PMC8081830 DOI: 10.3389/fcvm.2021.614235] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 03/22/2021] [Indexed: 12/21/2022] Open
Abstract
In the past, the identification of myocardial fibrosis was only possible through invasive histologic assessment. Although endomyocardial biopsy remains the gold standard, recent advances in cardiac imaging techniques have enabled non-invasive tissue characterization of the myocardium, which has also provided valuable insights into specific disease processes. The diagnostic accuracy, incremental yield and prognostic value of speckle tracking echocardiography, late gadolinium enhancement and parametric mapping modules by cardiac magnetic resonance and cardiac computed tomography have been validated against tissue samples and tested in broad patient populations, overall providing relevant clinical information to the cardiologist. This review describes the patterns of left ventricular and left atrial fibrosis, and their characterization by advanced echocardiography, cardiac magnetic resonance and cardiac computed tomography, allowing for clinical applications in sudden cardiac death and management of atrial fibrillation.
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Affiliation(s)
- Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Vinco
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Giovanni Benfari
- Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, Institute of Advanced Biomedical Technologies, "G.d'Annunzio" University of Chieti-Pescara, Chieti, Italy.,Department of Clinical Sciences, Lund University, Malmö, Sweden.,Casa di Cura Villa Serena, Città Sant'Angelo, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Nicolò Sisti
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Oreste De Vivo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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26
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Pastore MC, Mandoli GE, Dokollari A, Bisleri G, D'Ascenzi F, Santoro C, Miglioranza MH, Focardi M, Cavigli L, Patti G, Valente S, Mondillo S, Cameli M. Speckle tracking echocardiography in primary mitral regurgitation: should we reconsider the time for intervention? Heart Fail Rev 2021; 27:1247-1260. [PMID: 33829389 PMCID: PMC9197800 DOI: 10.1007/s10741-021-10100-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/26/2021] [Indexed: 12/15/2022]
Abstract
Thanks to the improvement in mitral regurgitation (MR) diagnostic and therapeutic management, with the introduction of minimally invasive techniques which have considerably reduced the individual surgical risk, the optimization of the timing for MR “open” or percutaneous surgical treatment has become a main concern which has highly raised scientific interest. In fact, the current indications for intervention in MR, especially in asymptomatic patients, rely on echocardiographic criteria with high severity cut-offs that are fulfilled only when not only mitral valve apparatus but also the cardiac chambers’ structure and function are severely impaired, which results in poor benefits for post-operative clinical outcome. This led to the need of new indices to redefine the optimal surgical timing in these patients. Speckle tracking echocardiography provides early markers of cardiac dysfunction due to subtle myocardial impairment; therefore, it could offer pivotal information in this setting. In fact, left ventricular and left atrial strains have already shown evidence about their usefulness in recognizing MR impact not only on symptoms and quality of life but also on cardiovascular events and new-onset atrial fibrillation in these patients. Moreover, right ventricular strain could be used to identify those patients with advanced cardiac damage and different grades of right ventricular dysfunction, which entails higher risks for cardiac surgery that could overweigh surgical benefits. This review aims to describe the importance of reconsidering the timing of intervention in MR and to analyze the potential additive value of speckle tracking echocardiography in this clinical setting.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy. .,Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy.
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | | | - Gianluigi Bisleri
- Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Science, Federico II University Hospital Naples, Naples, Italy
| | | | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Giuseppe Patti
- Maggiore Della Carità Hospital, University of Eastern Piedmont, Novara, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Viale Bracci 16, Siena, Italy
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Jannasch A, Schnabel C, Galli R, Faak S, Büttner P, Dittfeld C, Tugtekin SM, Koch E, Matschke K. Optical coherence tomography and multiphoton microscopy offer new options for the quantification of fibrotic aortic valve disease in ApoE -/- mice. Sci Rep 2021; 11:5834. [PMID: 33712671 PMCID: PMC7955095 DOI: 10.1038/s41598-021-85142-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 02/25/2021] [Indexed: 01/31/2023] Open
Abstract
Aortic valve sclerosis is characterized as the thickening of the aortic valve without obstruction of the left ventricular outflow. It has a prevalence of 30% in people over 65 years old. Aortic valve sclerosis represents a cardiovascular risk marker because it may progress to moderate or severe aortic valve stenosis. Thus, the early recognition and management of aortic valve sclerosis are of cardinal importance. We examined the aortic valve geometry and structure from healthy C57Bl6 wild type and age-matched hyperlipidemic ApoE-/- mice with aortic valve sclerosis using optical coherence tomography (OCT) and multiphoton microscopy (MPM) and compared results with histological analyses. Early fibrotic thickening, especially in the tip region of the native aortic valve leaflets from the ApoE-/- mice, was detectable in a precise spatial resolution using OCT. Evaluation of the second harmonic generation signal using MPM demonstrated that collagen content decreased in all aortic valve leaflet regions in the ApoE-/- mice. Lipid droplets and cholesterol crystals were detected using coherent anti-Stokes Raman scattering in the tissue from the ApoE-/- mice. Here, we demonstrated that OCT and MPM, which are fast and precise contactless imaging approaches, are suitable for defining early morphological and structural alterations of sclerotic murine aortic valves.
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Affiliation(s)
- Anett Jannasch
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Fetscherstraße 76, 01307, Dresden, Germany.
| | - Christian Schnabel
- Department of Anesthesiology and Intensive Care Medicine and Clinical Sensoring and Monitoring, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Roberta Galli
- Department of Anesthesiology and Intensive Care Medicine and Clinical Sensoring and Monitoring, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Saskia Faak
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Fetscherstraße 76, 01307, Dresden, Germany
| | - Petra Büttner
- Department of Cardiology, Heart Center Leipzig At University Leipzig, Leipzig, Germany
| | - Claudia Dittfeld
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Fetscherstraße 76, 01307, Dresden, Germany
| | - Sems Malte Tugtekin
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Fetscherstraße 76, 01307, Dresden, Germany
| | - Edmund Koch
- Department of Anesthesiology and Intensive Care Medicine and Clinical Sensoring and Monitoring, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Dresden, Germany
| | - Klaus Matschke
- Department of Cardiac Surgery, Carl Gustav Carus Faculty of Medicine, Technische Universität Dresden, Heart Centre Dresden, Fetscherstraße 76, 01307, Dresden, Germany
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28
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Pastore MC, Mandoli GE, Contorni F, Cavigli L, Focardi M, D'Ascenzi F, Patti G, Mondillo S, Cameli M. Speckle Tracking Echocardiography: Early Predictor of Diagnosis and Prognosis in Coronary Artery Disease. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6685378. [PMID: 33623788 PMCID: PMC7875622 DOI: 10.1155/2021/6685378] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/12/2020] [Accepted: 01/23/2021] [Indexed: 01/24/2023]
Abstract
Echocardiography represents a first level technique for the evaluation of coronary artery disease (CAD) which supports clinicians in the diagnostic and prognostic workup of these syndromes. However, visual estimation of wall motion abnormalities sometimes fails in detecting less clear or transient myocardial ischemia and in providing accurate differential diagnosis. Speckle tracking echocardiography (STE) is a widely available noninvasive tool that could easily and quickly provide additive information over basic echocardiography, since it is able to identify subtle myocardial damage and to localize ischemic territories in accordance to the coronary lesions, obtaining a clear visualization with a "polar map" useful for differential diagnosis and management. Therefore, it has increasingly been applied in acute and chronic coronary syndromes using rest and stress echocardiography, showing good results in terms of prediction of CAD, clinical outcome, left ventricular remodeling, presence, and quantification of new/residual ischemia. The aim of this review is to illustrate the current available evidence on STE usefulness for the assessment and follow-up of CAD, discussing the main findings on bidimensional and tridimensional strain parameters and their potential application in clinical practice.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Francesco Contorni
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Giuseppe Patti
- University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Italy
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Mandoli GE, Pastore MC, Vasilijevaite K, Cameli P, D'Ascenzi F, Focardi M, Mondillo S, Cameli M. Speckle tracking stress echocardiography: A valuable diagnostic technique or a burden for everyday practice? Echocardiography 2020; 37:2123-2129. [PMID: 33145829 DOI: 10.1111/echo.14894] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/25/2020] [Accepted: 09/28/2020] [Indexed: 11/28/2022] Open
Abstract
Non-invasive screening for early diagnosis of coronary artery disease (CAD) represents a key element in the never-ending challenge to reduce cardiac death. Stress/rest electrocardiogram often lacks diagnostic accuracy, especially in asymptomatic patients, in fact the latest guidelines for the diagnosis and management of chronic coronary syndromes (CCS) stated the superiority of functional imaging techniques for the detection of subtle myocardial ischemia and the evaluation of myocardial viability (MV). Stress echocardiography is the most accessible and inexpensive imaging method for the study of CAD, either with pharmacological or with exercise provocative stress, based on visual wall-motion assessment. However, in some cases, such as small coronary lesions or microvascular angina, it loses its diagnostic power, therefore requiring a more sensitive approach. Accordingly, in the last years many authors investigated the possible additive value provided by the integration of an advanced but easy-to-obtain technique, that is speckle tracking imaging, to stress echocardiography, reaching promising results; nevertheless, its use is not included in the latest recommendations for CCS. The present review discusses the potential benefits from using a combination of speckle tracking and stress echocardiography for the early detection of myocardial ischemia and the assessment of MV and its suitability in different clinical scenarios, basing on the available evidence.
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Affiliation(s)
- Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | | | - Paolo Cameli
- Department of Clinical Medical and Neurosciences, Respiratory Disease and Lung Transplantation Section, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Marta Focardi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
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30
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Cameli M, Pastore MC, Soliman Aboumarie H, Mandoli GE, D'Ascenzi F, Cameli P, Bigio E, Franchi F, Mondillo S, Valente S. Usefulness of echocardiography to detect cardiac involvement in COVID-19 patients. Echocardiography 2020; 37:1278-1286. [PMID: 32654210 PMCID: PMC7404652 DOI: 10.1111/echo.14779] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 05/27/2020] [Accepted: 06/07/2020] [Indexed: 12/19/2022] Open
Abstract
Coronavirus disease 2019 (COVID‐19) outbreak is a current global healthcare burden, leading to the life‐threatening severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). However, evidence showed that, even if the prevalence of COVID‐19 damage consists in pulmonary lesions and symptoms, it could also affect other organs, such as heart, liver, and spleen. Particularly, some infected patients refer to the emergency department for cardiovascular symptoms, and around 10% of COVID‐19 victims had finally developed heart injury. Therefore, the use of echocardiography, according to the safety local protocols and ensuring the use of personal protective equipment, could be useful firstly to discriminate between primary cardiac disease or COVID‐19–related myocardial damage, and then for assessing and monitoring COVID‐19 cardiovascular complications: acute myocarditis and arrhythmias, acute heart failure, sepsis‐induced myocardial impairment, and right ventricular failure derived from treatment with high‐pressure mechanical ventilation. The present review aims to enlighten the applications of transthoracic echocardiography for the diagnostic and therapeutic management of myocardial damage in COVID‐19 patients.
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Affiliation(s)
- Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | | | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Paolo Cameli
- Department of Clinical Medical and Neurosciences, Respiratory Disease and Lung Transplantation Section, Le Scotte Hospital, University of Siena, Siena, Italy
| | - Elisa Bigio
- Anesthesiology Unit, Alta Val D'Elsa Hospital, Siena, Italy
| | - Federico Franchi
- Department of Medical Biotechnologies, Anesthesia and Intensive Care, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Serafina Valente
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
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31
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Sisti N, Mandoli GE, Sciaccaluga C, Valente S, Mondillo S, Cameli M. Insight into Atrial Fibrillation in LVAD Patients: From Clinical Implications to Prognosis. Pulse (Basel) 2020; 8:2-14. [PMID: 32999873 DOI: 10.1159/000506600] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/14/2020] [Indexed: 12/21/2022] Open
Abstract
The use of left ventricular assist devices (LVADs), whether for destination therapy or bridge to transplantation, has gained increasing validation in recent years in patients with advanced heart failure. Arrhythmias can be the most challenging variables in the management of such patients but the main attention has always been focused on ventricular arrhythmias given the detrimental impact on mortality. Nevertheless, atrial fibrillation (AF) is the most common rhythm disorder associated with advanced heart failure and may therefore characterize the LVADs' pre- and postimplantation periods. Indeed, the consequences of AF in the population suffering from standard heart failure may require a more comprehensive evaluation in the presence of or in sight of an LVAD, making the AF clinical management in these patients potentially complex. Several studies have been based on this subject with different and often conflicting results, leaving many questions unresolved. The purpose of this review is to summarize the main pieces of evidence about the clinical impact of AF in LVAD patients, underlining the main implications in terms of hemodynamics, thromboembolic risk, bleeding and prognosis. Therapeutic considerations about the clinical management of these patients are also made according to the latest evidence.
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Affiliation(s)
- Nicolò Sisti
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | | | | | - Serafina Valente
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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32
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Pastore MC, De Carli G, Mandoli GE, D'Ascenzi F, Focardi M, Contorni F, Mondillo S, Cameli M. The prognostic role of speckle tracking echocardiography in clinical practice: evidence and reference values from the literature. Heart Fail Rev 2020; 26:1371-1381. [PMID: 32219615 DOI: 10.1007/s10741-020-09945-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Speckle tracking echocardiography (STE) is a second-level echocardiographic technique which has gradually gained relevance in the last years. It allows semi-automatic quantification of myocardial deformation and function, overcoming most of the limitations characterizing basic echocardiography and providing an early detection of cardiac impairment. Today, its feasibility and usefulness are highly supported by literature. In particular, several studies demonstrated that STE could provide additional prognostic information beyond conventional echocardiographic and traditional clinical parameters. Moreover, a recent standardization of speckle tracking analysis regarding all cardiac chambers paved the way for the integration of STE in diagnostic and prognostic protocols for particular clinical settings. The aim of this review is to describe the prognostic role of STE in different clinical scenarios basing on currently available evidence.
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Affiliation(s)
- Maria Concetta Pastore
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy.
| | - Giuseppe De Carli
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy
| | - Marta Focardi
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy
| | - Francesco Contorni
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy
| | - Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Viale Bracci 1, Siena, Italy
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