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Lin B, LeVee A, Cao L, Basho R, Tamarappoo B, Wei J, Shufelt C. Left ventricular global longitudinal strain is worse in BRCA mutation positive breast cancer patients prior to cancer treatment and premature menopause. Breast Cancer Res Treat 2024; 207:103-109. [PMID: 38717528 DOI: 10.1007/s10549-024-07344-4] [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: 12/04/2023] [Accepted: 04/10/2024] [Indexed: 07/09/2024]
Abstract
PURPOSE Breast cancer patients with mutations in human tumor suppressor genes BRCA1 and BRCA2 are at higher risk of cardiovascular disease (CVD) than the general population, as they are frequently exposed to cardiotoxic chemotherapy, anti-estrogen therapy, radiation, and/or oophorectomy for cancer-related treatment and prophylaxis. Animal and cell culture models suggest that BRCA mutations may play an independent role in heart failure. We sought to evaluate cardiac structure and function in female BRCA1 and BRCA2 mutation carriers with breast cancer compared to BRCA wildtype women with breast cancer. METHODS We performed a 1:2 age- and hypertension-matched retrospective cohort study comparing BRCA1 and BRCA2 mutation carriers (n = 38) versus BRCA wildtype controls (n = 76) with a new diagnosis of breast cancer. Echocardiographic data were obtained within 6 months of breast cancer diagnosis and prior to chemotherapy, anti-estrogen therapy, radiation, or oophorectomy. Left ventricular global longitudinal strain (LV-GLS), a highly sensitive marker of LV function, was measured using QLab 15 (Philips Healthcare). RESULTS In the total cohort of 114 patients with a new diagnosis of breast cancer, the median age was 45 ± 11 years and the prevalence of hypertension was 8%. There were no differences in traditional cardiovascular disease risk factors between cases and controls. BRCA carriers had lower LV-GLS (- 18.1% ± 4.7% vs. - 20.1% ± 3.8%, p = 0.02) and greater right atrial area (12.9 cm2 ± 2.7 cm2 vs. 11.8 cm2 ± 2.0 cm2, p = 0.04) compared to controls; however, both LV-GLS and right atrial area were within the normal range. Compared to controls, BRCA carriers had a trend toward worse LV posterior wall thickness (0.89 cm ± 0.15 cm vs. 0.83 cm ± 0.16 cm, p = 0.06) although not statistically significant. CONCLUSION In women with newly diagnosed breast cancer and prior to treatment, LV-GLS was worse in BRCA1 and BRCA2 mutation carriers compared to those with BRCA wildtype. These findings suggest that BRCA mutations may be associated with subtle changes in cardiac function. Whether differences in GLS translate to increased cardiovascular risk in women with BRCA mutations needs to be further characterized.
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Affiliation(s)
- Billy Lin
- Division of Cardiology, University of California Riverside, Riverside, CA, USA
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Alexis LeVee
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Louie Cao
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Reva Basho
- Department of Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
- Ellison Institute of Technology, Los Angeles, CA, USA
| | - Balaji Tamarappoo
- Department of Cardiology, University of Arizona School of Medicine, Phoenix, AZ, USA
| | - Janet Wei
- Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | - Chrisandra Shufelt
- Mayo Clinic Women's Health and Division of General Internal Medicine, Jacksonville, FL, USA.
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MacIver DH, Zhang H. Quantifying myocardial active strain energy density: A comparative analysis of analytic and finite element methods for estimating left ventricular wall stress and strain. Int J Cardiol 2024; 408:132139. [PMID: 38705203 DOI: 10.1016/j.ijcard.2024.132139] [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: 02/13/2024] [Revised: 04/03/2024] [Accepted: 05/02/2024] [Indexed: 05/07/2024]
Abstract
AIMS This study compared commonly used methods for calculating left ventricular wall stress with the finite element analysis and evaluated different approaches to strain estimation. We sought to improve the accuracy of contractance estimation by developing a novel stress equation. BACKGROUND Multiple methods for calculating LV contractile stress and strain exist. Contractance is derived from stress and strain information and is a measure of myocardial work per unit volume of muscle. Precise stress and strain information are essential for its accurate evaluation. METHODS AND RESULTS We compared widely used methods for stress and strain calculations across diverse clinical scenarios representing distinct types of left ventricular myocardial disease. Our analysis revealed significant discrepancies in both the stress and strain values obtained with different methods. However, a newly developed modified version of the Mirsky equation demonstrated close agreement with the finite element analysis results for circumferential stress, while the Lamé method produced results close to those of finite element analysis for longitudinal stress and improved contractance accuracy. CONCLUSION This study highlights significant inconsistencies in stress and strain values calculated using different methods, emphasising the potential impact on contractance calculations and subsequent clinical interpretation. We recommend adopting the Lamé method for longitudinal stress assessment and the modified Mirsky equation for circumferential stress analysis. These methods offer a balance between accuracy and feasibility, making them advantageous for clinical practice. By adopting these recommendations, we can improve the accuracy of LV wall stress and strain estimates, leading to more dependable contractance calculations, better prognostication and improved clinical decisions. CLINICAL AND TRANSLATIONAL IMPACT STATEMENT Accurately estimating myocardial stress and strain is of paramount significance in clinical practice because the calculation of the contractance, defined and quantified by myocardial active strain energy density, necessitates correct stress and strain data. Contractance, which assesses myocardial work per unit muscle volume, has emerged as a promising indicator of contractile function and a predictor of future risk. The new recommendations for calculating myocardial stress improve the reliability of calculating contractance and enhance the understanding of myocardial diseases.
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Affiliation(s)
- David H MacIver
- Biological Physics Group, Department of Astronomy and Physics, University of Manchester, Manchester, United Kingdom; Department of Cardiology, Taunton & Somerset Hospital, United Kingdom.
| | - Henggui Zhang
- Biological Physics Group, Department of Astronomy and Physics, University of Manchester, Manchester, United Kingdom
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Zhu X, Tian Y, Shi Y, Lian J, Shen H, Li L, Wu H, Liu P. The Feasibility of Left Ventricular Strain and Strain Rate for Evaluating Hypertrophic Cardiomyopathy with Risk Factors of Sudden Cardiac Death by Feature-Tracking CMR. Am J Cardiol 2024; 222:51-57. [PMID: 38642869 DOI: 10.1016/j.amjcard.2024.04.025] [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: 12/18/2023] [Revised: 03/26/2024] [Accepted: 04/15/2024] [Indexed: 04/22/2024]
Abstract
Sudden cardiac death (SCD) represents the most severe complication of hypertrophic cardiomyopathy (HCM). However, the relation between strain, strain rate (SR), and risk factors in SCD risk stratification remains elusive. The study aimed to assess the attenuation of strain and SR in HCM by feature tracking cardiac magnetic resonance. All strain and SRs were obtained automatically by feature tracking, with manual adjustment of endocardial and epicardial borders. Strain indicators included left ventricular global longitudinal, circumferential, global radial strain (GRS), peak diastolic-longitudinal, circumferential, and radial SR. Patients were categorized into high-risk and low-risk groups for SCD based on the 2020 American Heart Association/American College HCM risk-SCD model. The correlation between strain/SR and SCD risk factors was assessed through Spearman correlation analysis. Furthermore, a multivariate logistic regression analysis was conducted to explore the factors that influence SCD risk in HCM patients. A total of 105 HCM patients were analyzed in this study, including 38 patients in the high-risk group, and 67 patients in the low-risk group. Compared with the low-risk group, the high-risk group exhibited significantly worse strain and SR (p <0.001). Furthermore, both circumferential and GRS and SR exhibited meaningful associations with risk factors for SCD. Additionally, GRS emerged as an independent risk factor for predicting heightened SCD risk in HCM patients (p <0.001). In conclusion, left ventricular strain and SR based on feature tracking-cardiac magnetic resonance can be evaluated for SCD risk and are strongly associated with SCD risk factors.
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Affiliation(s)
- Xinyu Zhu
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Yuan Tian
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ying Shi
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianxiu Lian
- Clinical & Technical Support, Philips Healthcare, Beijing, China
| | - Honghu Shen
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Lulu Li
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Haishan Wu
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Pengfei Liu
- Department of Magnetic Resonance, the First Affiliated Hospital of Harbin Medical University, Harbin, China.
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Odajima S, Nishimori M, Okamoto H, Hirata KI, Tanaka H. Scoring System for Prediction of Left Ventricular Longitudinal Myocardial Dysfunction in Preclinical Heart Failure Patients. Circ J 2024; 88:703-710. [PMID: 38246650 DOI: 10.1253/circj.cj-23-0798] [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] [Indexed: 01/23/2024]
Abstract
BACKGROUND Detection of left ventricular (LV) abnormalities is essential for patients with preclinical heart failure (HF) to delay progression to clinical HF. Global longitudinal strain (GLS) is a sensitive marker for the early occurrence of subtle abnormalities in LV function, but not all echocardiographic instruments can measure GLS.Methods and Results: We studied 853 preclinical HF patients to devise a scoring system for predicting low GLS (<16%). The associations of medical history and echocardiographic parameters with low GLS were evaluated using Cox proportional hazards analysis. Model 1 of the system consisted of medical history; for Model 2, conventional echocardiographic parameters were added to Model 1. For Model 1, a score ≥5 points meant prediction of low GLS with 90.2% sensitivity and 62.9% specificity (male=1 point, hypertension=4 points, dyslipidemia=1 point, atrial fibrillation=2 points, history of cardiac surgery=2 points). For Model 2, a score ≥4 points denotes prediction of low GLS with 80.3% sensitivity and 76.5% specificity (male=1 point, hypertension=2 points, atrial fibrillation=2 points, LV mass index >116 g/m2[male] or >96 g/m2[female]=1 point, LV ejection fraction <59%=2 points, E/e' >14=1 point). CONCLUSIONS Our scoring system provides an easy-to-use evaluation of LV longitudinal myocardial dysfunction, and may prove useful for risk stratification of patients with preclinical HF.
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Affiliation(s)
- Susumu Odajima
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Makoto Nishimori
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
- Division of Molecular Epidemiology, Kobe University Graduate School of Medicine
| | | | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
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Krljanac G, Apostolovic S, Polovina M, Maksimovic R, Nedeljkovic Arsenovic O, Djordjevic N, Stankovic S, Savic L, Djokovic A, Viduljevic M, Stankovic S, Asanin M. The follow-up of myocardial injury and left ventricular function after spontaneous coronary artery dissection. Front Cardiovasc Med 2023; 10:1276347. [PMID: 38034376 PMCID: PMC10682093 DOI: 10.3389/fcvm.2023.1276347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023] Open
Abstract
Monitoring patients with spontaneous coronary dissection (SCAD) is critical in their care, as there are no accepted recommendations. To this end, finding clinical or imaging predictors of recurrent events in these patients is essential for predicting adverse events and guiding treatment decisions between conservative medical therapy and percutaneous coronary intervention. Myocardial injury and left ventricular function after SCAD can be variable parameters that require monitoring. Echocardiography and cardiac magnetic resonance are two useful imaging techniques to do so. This review aims to analyze previously published results on monitoring myocardial injury and left ventricular function in SCAD patients while highlighting the potential benefits of contemporary imaging techniques that could further improve patient care in the future.
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Affiliation(s)
- Gordana Krljanac
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Svetlana Apostolovic
- Coronary Care Unit, Cardiology Clinic, University Clinical Center of Nis, Nis, Serbia
- Faculty of Medicine, University of Nis, Nis, Serbia
| | - Marija Polovina
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ruzica Maksimovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Nedeljkovic Arsenovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Center for Radiology and Magnetic Resonance Imaging, University Clinical Center of Serbia, Belgrade, Serbia
| | - Nemanja Djordjevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Stefan Stankovic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Lidija Savic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Aleksandra Djokovic
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Cardiology, University Hospital Center Bezanijska kosa, Belgrade, Serbia
| | - Mihajlo Viduljevic
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
| | - Sanja Stankovic
- Center for Medical Biochemistry, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Milika Asanin
- Cardiology Clinic, University Clinical Center of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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Wang X, Wei Z, Wang P, Zhou J, Feng M, Li M, Liu M, Wang J, Zhang X, Gao F, Xing C, Li J. Echocardiographic evaluation of cardiac reserve to detect subtle cardiac dysfunction in mice. Life Sci 2023; 331:122079. [PMID: 37696487 DOI: 10.1016/j.lfs.2023.122079] [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: 07/26/2023] [Revised: 08/23/2023] [Accepted: 09/06/2023] [Indexed: 09/13/2023]
Abstract
AIMS Cardiac reserve is a sensitive tool for early detection of cardiac dysfunction. However, cardiac reserve assessment by catecholamine stress echocardiography in mice varied in the doses of β-adrenergic agonists and the time point for measurements, which may lead to inaccurate readouts. This study aims to establish a standardized protocol for assessing cardiac reserve in mice. MAIN METHODS C57BL/6J mice under isoflurane anesthesia were intraperitoneally injected with varying doses of isoproterenol (Iso), and subjected to echocardiographic measurements. KEY FINDINGS Heart rate (HR), ejection fraction (EF), fractional shortening (FS), global longitudinal strain (GLS) and strain rate all reached peak values within 1-3 min after Iso injection at doses higher than 0.2 mg/kg. Compared with 0.1 mg/kg Iso, 0.2 mg/kg Iso resulted in higher HR, EF, FS and GLS, whereas doses higher than 0.2 mg/kg did not yield further increase. Cardiac response of female mice recapitulated main characteristics of those of male mice except that female mice displayed higher maximum HR and were more sensitive to higher doses of Iso. Furthermore, the advantages of present stress protocol over conventional baseline echocardiographic measurements were verified in comparisons of exercised vs. sedentary and aged vs. young mice for cardiac function evaluation. SIGNIFICANCE We developed a reproducible and sensitive approach to evaluate cardiac reserve by continuously monitoring cardiac function every minute for 3 min after 0.2 mg/kg Iso injection. This approach will enable detection of subtle cardiac dysfunction and accelerate innovative research in cardiac pathophysiology.
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Affiliation(s)
- Xinpei Wang
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Zihan Wei
- Department of Neurology, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Panpan Wang
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Jiaheng Zhou
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Mengya Feng
- The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, China
| | - Min Li
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Meijie Liu
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Jing Wang
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'an, China
| | - Xing Zhang
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Feng Gao
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China
| | - Changyang Xing
- Department of Ultrasound Medicine, Tangdu Hospital, Fourth Military Medical University, Xi'an, China.
| | - Jia Li
- Key Laboratory of Aerospace Medicine of the Ministry of Education, School of Aerospace Medicine, Fourth Military Medical University, Xi'an, China; Ministry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, Fourth Military Medical University, Xi'an, China.
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Anan R, Imoto T, Onizuka K, Watanabe H, Mori W, Murakoso M. Concentric hypertrophy geometry is a significant determinant of impaired global longitudinal strain in patients with normal cardiac structure and function. Heliyon 2023; 9:e16252. [PMID: 37265622 PMCID: PMC10230210 DOI: 10.1016/j.heliyon.2023.e16252] [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: 09/06/2022] [Revised: 05/05/2023] [Accepted: 05/10/2023] [Indexed: 06/03/2023] Open
Abstract
Background In recent years, the assessment of global longitudinal strain (GLS) derived by speckle-tracking analysis has become a clinically feasible alternative to left ventricular (LV) ejection fraction (LVEF) for the assessment of myocardial function. However, the determinant factors of impaired GLS in structurally and functionally normal patients are unclarified. The objective of this study was to elucidate the determinant factors of impaired GLS in structurally and functionally normal patients. Methods We evaluated structurally and functionally normal patients scheduled to undergo noncardiac surgery. The evaluated patient characteristics were age, sex, presence of hypertension, presence of diabetes mellitus, presence of hyperlipidemia, systolic blood pressure, and body mass index. The concentrations of B-type natriuretic peptide and high-sensitivity troponin I were measured. Echocardiography was performed to determine the LVEF, GLS, transmitral early diastolic velocity/transmitral atrial velocity ratio, LV mass index (LVMI), and relative wall thickness (RWT). Patients with preserved LVEF (≥50%) were divided into the normal GLS group (GLS ≤ -20%) and the impaired GLS group (GLS > -20%). On the basis of the RWT and LVMI values, the patients were categorized as having four types of LV geometry. Logistic regression analysis was performed to ascertain the determinant factors of impaired GLS. Results The study cohort comprised 75 structurally and functionally normal patients (age 67.7 ± 12.6 years, 45 men). The GLS was normal in 43 patients and impaired in 32 patients. There was a significant difference in RWT between the impaired and normal GLS groups. The evaluation based on the LV geometry showed that six of seven patients with concentric hypertrophy geometry had impaired GLS, and the GLS was significantly more impaired in patients with concentric hypertrophy geometry than in patients with normal geometry or eccentric hypertrophy geometry. Logistic regression analysis revealed that LV concentric hypertrophy geometry was a significant determinant factor of impaired GLS (odds ratio 22.4, P = 0.042). Conclusions Global longitudinal strain is more impaired in structurally and functionally normal patients with concentric hypertrophy geometry compared with those with eccentric hypertrophy geometry or normal geometry. In addition, concentric hypertrophy geometry is a significant determinant for impaired GLS in patients with normal cardiac structure and function.
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Affiliation(s)
- Ryuichiro Anan
- Department of Cardiology, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Tatsuya Imoto
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Kumi Onizuka
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Hideaki Watanabe
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Wakako Mori
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
| | - Mayu Murakoso
- Clinical Laboratory Department, National Hospital Organization Miyakonojo Medical Center, 5033-1, Iwayoshi-cho, Miyakonojo, 885-0014, Japan
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Cuspidi C, Gherbesi E, Faggiano A, Sala C, Carugo S, Grassi G, Tadic M. Targeting Left Ventricular Mechanics In Patients With Pheochromocytoma/Paraganglioma: An Updated Meta-analysis. Am J Hypertens 2023; 36:333-340. [PMID: 36617865 PMCID: PMC10413314 DOI: 10.1093/ajh/hpad006] [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: 11/20/2022] [Revised: 12/17/2022] [Accepted: 01/06/2023] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Numerous studies targeting left ventricular (LV) systolic function by measuring LV ejection fraction (LVEF) in patients with pheochromocytoma and paraganglioma (PPGL) either failed to reveal any impairment of this parameter or found a super-normal systolic function compared to essential hypertensives or normotensive controls. To provide an updated piece of information on LV systolic dysfunction in the PPGL setting, we performed a meta-analysis of speckle tracking echocardiography (STE) studies investigating LV mechanics via global longitudinal strain (GLS), a more sensitive index of LV systolic function than LVEF. METHODS A computerized search was performed using PubMed, OVID, EMBASE, and Cochrane library databases from inception until September 30, 2022. Full articles reporting data on LV GLS and LVEF in patients with PPGL and controls were considered suitable. RESULTS A total of 252 patients with PPGL and 187 controls were included in 6 studies. LV GLS was worse in the pooled PPGL group than in the control group (-17.3 ± 1.2 vs. -20.0 ± 0.6) with a standard means difference (SMD) of 1.13 ± 0.36 confidence interval (CI: 0.43-1.84, P = 0.002), whereas this was not the case for LVEF (67.3 ± 1.9 and 66.4 ± 1.6%, respectively), SMD: 0.12 ± 0.03, (CI: -0.41/0.65, P = 0.66). A meta-regression analysis in PPGL patients showed an inverse relationship between adrenergic activity and GLS (P < 0.0001). CONCLUSIONS Our findings suggest that early changes in LV systolic function not detectable by conventional echocardiography in the PPGL setting can be revealed by STE; therefore, STE implementation in the workup of patients with PPGL may improve the detection of subclinical systolic dysfunction.
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Affiliation(s)
- Cesare Cuspidi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Elisa Gherbesi
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Andrea Faggiano
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Carla Sala
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Stefano Carugo
- Department of Clinical Sciences and Community Health, University of Milano, Italy
- Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Marijana Tadic
- Department of Cardiology, University Hospital “Dr.DragisaMisovic-Dedinje”, HerojaMilanaTepica 1,11000Belgrade, Serbia
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Sun ZY, Li Q, Li J, Zhang MW, Zhu L, Geng J. Echocardiographic evaluation of the right atrial size and function: Relevance for clinical practice. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 27:100274. [PMID: 38511096 PMCID: PMC10945901 DOI: 10.1016/j.ahjo.2023.100274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 01/12/2023] [Accepted: 02/13/2023] [Indexed: 03/22/2024]
Abstract
Right atrial (RA) structural and functional evaluations have recently emerged as powerful biomarkers for adverse events in various cardiovascular conditions. Quantitative analysis of the right atrium, usually performed with volume changes or speckle-tracking echocardiography (STE), has markedly changed our understanding of RA function and remodeling. Knowledge of reference echocardiographic values and measurement methods of RA volumes and myocardial function is a prerequisite to introduce RA quantitation in the clinical routine. This review describes the methodology, benefits and pitfalls of measuring RA size and function by echocardiography based on the current understanding of right atrial anatomy and physiological function and provides the current knowledge of right atrial function in related cardiac diseases.
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Affiliation(s)
- Zhen-Yun Sun
- Department of Diagnostic Ultrasound, Shandong First Medical University & Shandong Academy of Medical Sciences, China
| | - Qiao Li
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jun Li
- Department of Diagnostic Ultrasound, Shandong First Medical University & Shandong Academy of Medical Sciences, China
| | - Ming-Wei Zhang
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Ling Zhu
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
| | - Jing Geng
- Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan 250021, China
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10
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Doukas PG, Cascino GJ, Meng Z, Baldridge AS, Kang Y, Scherrer-Crosbie M, Akhter N. External validation of a heart failure risk score in patients with acute myeloid leukemia. Leuk Lymphoma 2023; 64:445-453. [PMID: 36331544 DOI: 10.1080/10428194.2022.2140289] [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: 11/06/2022]
Abstract
A 21-point risk score for heart failure (HF) has been developed for patients with acute myeloid leukemia (AML), stratifying patients into three groups: low, moderate, and high-risk. In this study, 193 patients with AML treated with anthracycline-based therapy were stratified using the risk score, and its prognostic utility for HF events and all-cause mortality at one year of follow-up were evaluated. HF occurred in 18% (34/193) of anthracycline-treated patients. Global longitudinal strain (GLS) was more negative among patients without HF events (-19 ± 3 vs. -17 ± 4%). One year incidence of HF was increased in the higher risk groups: 12% of low-risk, 24% of moderate-risk, and 50% of high-risk (p < 0.001). However, a higher risk score was not associated with an increased risk of all-cause mortality. This study provides external validation of a 21-point risk score for HF events but not all-cause mortality at one year in patients with AML.
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Affiliation(s)
- Peter G Doukas
- Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gregory J Cascino
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Zhiying Meng
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Abigail S Baldridge
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Yu Kang
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Nausheen Akhter
- Division of Cardiovascular Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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11
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Qin L, Zhu S, Liu P, Zhu L, Chen C, Gu S, Yang W, Zhou M, Yan F. Additional prognostic values of strain and strain rate over late gadolinium enhancement in hypertrophic cardiomyopathy patients. Int J Cardiol 2023; 370:427-434. [PMID: 36332750 DOI: 10.1016/j.ijcard.2022.10.174] [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: 06/19/2022] [Revised: 09/30/2022] [Accepted: 10/30/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Late gadolinium enhancement (LGE) has some shortcomings in the risk stratification in hypertrophic cardiomyopathy (HCM). Myocardial strain/strain rate (SR) can be acquired from unenhanced cardiovascular magnetic resonance (CMR) images and detect cardiac dysfunction sensitively. The present study aimed to evaluate the additional prognostic values of myocardial strain/SR beyond LGE for the risk stratification in patients with HCM. METHODS 293 patients with HCM who underwent CMR were enrolled in this prospective study. LGE/left ventricular (LV) mass, LV global strain, and SR were acquired based on CMR. Also, conventional clinical, echocardiography, and CMR parameters and established risk factors for HCM were evaluated. RESULTS 14/293 patients had major adverse cardiovascular events (MACEs) during the median follow-up of 15.0 months, including eight all-cause deaths, four resuscitated cardiac arrests and two cardiac transplantations. Peak systolic (PS)-global longitudinal SR (GLSR) was independently associated with MACEs (hazard ratio: 15.297, P < 0.001) after adjusting for conventional clinical characteristics, echocardiography, and CMR parameters. The model constructed by conventional variables plus PS-GLSR had significantly stronger predictive ability than the model constructed by conventional variables plus LGE/LV mass (C-statistic: 0.850 vs 0.708, P = 0.030). The addition of PS-GLSR to the conventional model also significantly improved the sensitivity (92.9% vs 71.4%) and specificity (71.0% vs 57.3%), and lowered false positives (81 patients vs 119 patients) compared to the addition of LGE/LV mass. CONCLUSION LV PS-GLSR derived from CMR has the potential to be a novel biomarker for risk stratification of HCM and provide additional prognostic value over LGE/LV mass.
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Affiliation(s)
- Le Qin
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Siqi Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Peng Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Lan Zhu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chihua Chen
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Shengjia Gu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenjie Yang
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Mi Zhou
- Department of Cardiovascular Surgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Fuhua Yan
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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Use of P wave indices to evaluate efficacy of catheter ablation and atrial fibrillation recurrence: a systematic review and meta-analysis. J Interv Card Electrophysiol 2022; 65:827-840. [PMID: 35488962 DOI: 10.1007/s10840-022-01147-7] [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: 12/21/2021] [Accepted: 01/31/2022] [Indexed: 12/16/2022]
Abstract
BACKGROUND To investigate the changes of P wave indices in atrial fibrillation (AF) patients after catheter ablation and the association between P wave indices and AF recurrence. METHODS PubMed, Embase, and Cochrane Database were searched through September 15th 2021 for studies on the association between P wave indices and AF with catheter ablation. Heterogeneity was estimated using the I2 statistic, the random effects model was used to calculate the pooled results, and summary receiver operating characteristic curve (SROC) was used to evaluate the predictive value. RESULTS Among included fourteen studies with 1674 AF patients, we found significantly decreased P wave dispersion (Pdis) (mean difference [MD]: - 6.5 ms, 95% confidence interval [95% CI]: - 11.81 to - 1.18, P = 0.02) after cryoballoon ablation (CBA) or radiofrequency ablation (RFA), and maximum P wave (Pmax) (MD: - 8.57 ms, 95% CI: - 17.03 to - 0.10, P = 0.05) after RFA only, but increased minimum P wave (Pmin) (MD: 3.43 ms, 95% CI: 1.07 to 5.79, P < 0.01) after CBA only. Pdis measured before ablation was remarkably higher (MD: 5.79 ms, 95% CI: 2.23 to 9.36, P < 0.01) in patients with recurrence than without; meanwhile, Pmax was higher measured both before and after ablation (MD: 6.49 ms, 95% CI: 2.30 to 10.69, P < 0.01 and MD: 11.2 ms, 95% CI: 2.88 to 19.52, P < 0.01). Furthermore, SROC analysis showed acceptable predictive efficiencies of Pdis (AUC = 0.776) and Pmax (AUC = 0.759) for AF recurrence. CONCLUSION Pdis was significantly decreased after AF catheter ablation. Higher Pdis and Pmax may have predictive values for AF recurrence.
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The Effects of Device-Based Cardiac Contractility Modulation Therapy on Left Ventricle Global Longitudinal Strain and Myocardial Mechano-Energetic Efficiency in Patients with Heart Failure with Reduced Ejection Fraction. J Clin Med 2022; 11:jcm11195866. [PMID: 36233734 PMCID: PMC9573486 DOI: 10.3390/jcm11195866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Virtually all patients with heart failure with reduced ejection fraction have a reduction of myocardial mechano-energetic efficiency (MEE). Cardiac contractility modulation (CCM) is a novel therapy for the treatment of patients with HFrEF, in whom it improves the quality of life and functional capacity, reduces hospitalizations, and induces biventricular reverse remodeling. However, the effects of CCM on MEE and global longitudinal strain (GLS) are still unknown; therefore, this study aims to evaluate whether CCM therapy can improve the MEE of patients with HFrEF. Methods: We enrolled 25 patients with HFrEF who received an Optimizer Smart implant (the device that develops CCM therapy) between January 2018 and January 2021. Clinical and echocardiographic evaluations were performed in all patients 24 h before and six months after CCM therapy. Results: At six months, follow-up patients who underwent CCM therapy showed an increase of left ventricular ejection fraction (30.8 ± 7.1 vs. 36.1 ± 6.9%; p = 0.032) as well a rise of GLS 10.3 ± 2.7 vs. −12.9 ± 4.2; p = 0.018), of MEE (32.2 ± 10.1 vs. 38.6 ± 7.6 mL/s; p = 0.013) and of MEE index (18.4 ± 6.3 vs. 24.3 ± 6.7 mL/s/g; p = 0.022). Conclusions: CCM therapy increased left ventricular performance, improving left ventricular ejection fraction, GLS, as well as MEE and MEEi.
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14
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Rucker D, Joseph J. Defining the Phenotypes for Heart Failure With Preserved Ejection Fraction. Curr Heart Fail Rep 2022; 19:445-457. [PMID: 36178663 DOI: 10.1007/s11897-022-00582-x] [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] [Accepted: 08/24/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) imposes a significant burden on society and healthcare. The lack in efficacious therapies is likely due to the significant heterogeneity of HFpEF. In this review, we define various phenotypes based on underlying comorbidities or etiologies, discuss phenotypes arrived at by novel methods, and explore therapeutic targets. RECENT FINDINGS A few studies have used machine learning methods to uncover sub-phenotypes within HFpEF in an unbiased manner based on clinical features, echocardiographic findings, and biomarker levels. We synthesized the literature and propose three broad phenotypes: (1) young, with few comorbidities, usually obese and with low natriuretic peptide levels, (2) obese with substantive cardiometabolic burden and comorbidities and impaired ventricular relaxation, (3) old, multimorbid, with high rates of atrial fibrillation, renal and coronary artery disease, chronic obstructive pulmonary disease, and left ventricular hypertrophy. We also propose potential therapeutic strategies for these phenotypes.
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Affiliation(s)
- Dane Rucker
- Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - Jacob Joseph
- Massachusetts Veterans Epidemiology Research & Information Center, Veterans Affairs Boston Healthcare System, Cardiology Section (111), 1400 VFW Parkway, West Roxbury, Boston, MA, 02132, USA. .,Department of Medicine, Brigham & Women's Hospital, Boston, MA, USA.
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15
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Should atrial function be routinely assessed in hypertrophic cardiomyopathy? Rev Port Cardiol 2022; 41:781-782. [DOI: 10.1016/j.repc.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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16
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Gao Q, Liu P, Lv T, Yang Y, Zhang P. Utility of speckle-tracking echocardiography for predicting atrial fibrillation following ischemic stroke: a systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1771-1780. [PMID: 37726516 DOI: 10.1007/s10554-022-02570-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 02/12/2022] [Indexed: 11/05/2022]
Abstract
Undiagnosed atrial fibrillation (AF) is one of the main sources of cryptogenic stroke. And strain indices measured by speckle-tracking echocardiography are associated with atrial remodeling supposed to be the substrate of AF. Therefore, there is a strong need for evaluating the utility of speckle-tracking echocardiography to predict the likelihood of AF in patients with cryptogenic stroke. PubMed, Embase and Cochrane Database were searched for studies. The random-effects model was used to calculate the pooled results, and summary receiver operating characteristic curve (SROC) analysis was performed to show the overall predictive value. There were 1483 patients with cryptogenic stroke from 8 studies. Meta-analysis showed that strain indices including global longitudinal strain (GLS) (mean difference [SMD]: - 0.22, 95% confidence interval [95% CI] - 0.40 to - 0.04), left atrial reservoir strain (εR), (SMD: - 0.87, 95% CI - 1.26 to - 0.48, conduit strain (εCD) (SMD: - 0.56, 95% CI - 0.81 to - 0.30), contractile strain (εCT) (SMD: - 1.00, 95% CI - 1.39 to - 0.61), and left atrial reservoir strain rate (SRe) (SMD: - 0.54, 95% CI - 0.80 to - 0.28) measured at the period of cryptogenic stroke was significantly decreased in patients with AF occurrence compared to without. SROC analysis suggested an acceptable predictive efficiency of εR for AF occurrence (AUC = 0.799). For patients after cryptogenic stroke, GLS, εR, εCD, εCT and SRe were significantly decreased in AF occurrence compared with non-occurrence. But there was no value in left atrial reservoir strain rate (SRs) and contractile strain rate (SRa) for predicting AF.
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Affiliation(s)
- Qinggele Gao
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China
| | - Peng Liu
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China
| | - Tingting Lv
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China
| | - Ying Yang
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China
| | - Ping Zhang
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China.
- Department of Cardiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, No. 168 Litang Road, Changping District, Beijing, 102218, China.
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Stoichescu-Hogea G, Buleu FN, Christodorescu R, Sosdean R, Tudor A, Ember A, Brie DM, Drăgan S. Contribution of Global and Regional Longitudinal Strain for Clinical Assessment of HFpEF in Coronary and Hypertensive Patients. Medicina (B Aires) 2021; 57:medicina57121372. [PMID: 34946317 PMCID: PMC8707191 DOI: 10.3390/medicina57121372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/12/2021] [Accepted: 12/15/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Contribution of global and regional longitudinal strain (GLS) for clinical assessment of patients with heart failure with preserved ejection fraction (HFpEF) is not well established. We sought to evaluate subclinical left ventricular dysfunction secondary to coronary artery disease (CAD) in HFpEF patients compared with hypertensive patients and age-matched healthy subjects. Material and methods: This was a retrospective study that included 148 patients (group 1 = 62 patients with HFpEF, group 2 = 46 hypertensive patients, and group 3 = 40 age-matched control subjects). Peak systolic segmental, regional (basal, mid, and apical), and global longitudinal strain were assessed for each study group using two-dimensional speckle-tracking echocardiography (2D-STE). Results: GLS values presented statistically significant differences between the three groups (p < 0.001); markedly increased values (more negative) were observed in the control group (−20.2 ± 1.4%) compared with HTN group values (−18.4 ± 3.0%, p = 0.031) and with HFpEF group values (−17.6 ± 2.3%, p < 0.001). The correlation between GLS values and HTN stages was significant, direct, and average (Spearman coefficient rho = 0.423, p < 0.001). GLS had the greatest ability to detect patients with HFpEF when HFpEF + CAD + HTN diastolic dysfunction (n = 30) + CON diastolic dysfunction (n = 2) from HFpEF + CAD + HTN + CON was analyzed. (optimal GLS limit of −19.35%, area under curve = 0.833, p < 0.001). Conclusions: Global longitudinal strain can be used for clinical assessment in differentiating coronary and hypertensive patients at higher risk for development of systolic dysfunction.
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Affiliation(s)
- Gheorghe Stoichescu-Hogea
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
| | - Florina Nicoleta Buleu
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Correspondence: (F.N.B.); (R.C.); Tel.: +40-724-351-393 (F.N.B.); +40-744-641-279 (R.C.)
| | - Ruxandra Christodorescu
- Department of Internal Medicine, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania
- Correspondence: (F.N.B.); (R.C.); Tel.: +40-724-351-393 (F.N.B.); +40-744-641-279 (R.C.)
| | - Raluca Sosdean
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Institute of Cardiovascular Diseases Timișoara, 13 Gheorghe Adam Street, 300310 Timișoara, Romania
| | - Anca Tudor
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Andreea Ember
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
| | - Daniel Miron Brie
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania;
| | - Simona Drăgan
- Department of Cardiology, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania; (G.S.-H.); (R.S.); (A.E.); (D.M.B.); (S.D.)
- Department of Functional Sciences, “Victor Babes” University of Medicine and Pharmacy, E. Murgu Square No. 2, 300041 Timisoara, Romania;
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Kim IC, Kim H, Lee HJ, Kim JY, Kim JY. Cardiac Imaging of Acute Myocarditis Following COVID-19 mRNA Vaccination. J Korean Med Sci 2021; 36:e229. [PMID: 34402228 PMCID: PMC8369314 DOI: 10.3346/jkms.2021.36.e229] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 08/02/2021] [Indexed: 12/11/2022] Open
Abstract
Increasing rates of coronavirus disease 2019 (COVID-19) vaccination coverage will result in more vaccine-related side effects, including acute myocarditis. In Korea, we present a 24-year-old male with acute myocarditis following COVID-19 vaccination (BNT162b2). His chest pain developed the day after vaccination and cardiac biomarkers were elevated. Echocardiography showed minimal pericardial effusion but normal myocardial contractility. Electrocardiography revealed diffuse ST elevation in lead II, and V2-5. Cardiac magnetic resonance images showed the high signal intensity of T2- short tau inversion recovery image, the high value of T2 mapping sequence, and late gadolinium enhancement in basal inferior and inferolateral wall. It was presumed that COVID-19 mRNA vaccination was probably responsible for acute myocarditis. Clinical course of the patient was favorable and he was discharged without any adverse event.
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Affiliation(s)
- In Cheol Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
- Department of Cardiology, School of Medicine & Institute of Medical Science, Keimyung University, Daegu, Korea
| | - Hyungseop Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea.
| | - Hee Jeong Lee
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Ji Yoon Kim
- Division of Cardiology, Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Jin Young Kim
- Department of Radiology, Keimyung University Dongsan Medical Center, Daegu, Korea
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Minhas AS, Gilotra NA, Goerlich E, Metkus T, Garibaldi BT, Sharma G, Bavaro N, Phillip S, Michos ED, Hays AG. Myocardial Work Efficiency, A Novel Measure of Myocardial Dysfunction, Is Reduced in COVID-19 Patients and Associated With In-Hospital Mortality. Front Cardiovasc Med 2021; 8:667721. [PMID: 34195234 PMCID: PMC8236710 DOI: 10.3389/fcvm.2021.667721] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/22/2021] [Indexed: 12/15/2022] Open
Abstract
Background: Although troponin elevation is common in COVID-19, the extent of myocardial dysfunction and its contributors to dysfunction are less well-characterized. We aimed to determine the prevalence of subclinical myocardial dysfunction and its association with mortality using speckle tracking echocardiography (STE), specifically global longitudinal strain (GLS) and myocardial work efficiency (MWE). We also tested the hypothesis that reduced myocardial function was associated with increased systemic inflammation in COVID-19. Methods and Results: We conducted a retrospective study of hospitalized COVID-19 patients undergoing echocardiography (n = 136), of whom 83 and 75 had GLS (abnormal >-16%) and MWE (abnormal <95%) assessed, respectively. We performed adjusted logistic regression to examine associations of GLS and MWE with in-hospital mortality. Patients were mean 62 ± 14 years old (58% men). While 81% had normal left ventricular ejection fraction (LVEF), prevalence of myocardial dysfunction was high by STE; [39/83 (47%) had abnormal GLS; 59/75 (79%) had abnormal MWE]. Higher MWE was associated with lower in-hospital mortality in unadjusted [OR 0.92 (95% CI 0.85-0.99); p = 0.048] and adjusted models [aOR 0.87 (95% CI 0.78-0.97); p = 0.009]. In addition, increased systemic inflammation measured by interleukin-6 level was associated with reduced MWE. Conclusions: Subclinical myocardial dysfunction is common in COVID-19 patients with clinical echocardiograms, even in those with normal LVEF. Reduced MWE is associated with higher interleukin-6 levels and increased in-hospital mortality. Non-invasive STE represents a readily available method to rapidly evaluate myocardial dysfunction in COVID-19 patients and can play an important role in risk stratification.
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Affiliation(s)
- Anum S Minhas
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nisha A Gilotra
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erin Goerlich
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Thomas Metkus
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Brian T Garibaldi
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Garima Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Nicole Bavaro
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Susan Phillip
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Erin D Michos
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Allison G Hays
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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