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Chen J, Wang X, Dong B, Liu C, Zhao J, Dong Y, Liang W, Huang H. Cardiac function and exercise capacity in patients with metabolic syndrome: A cross-sectional study. Front Cardiovasc Med 2022; 9:974802. [PMID: 36035938 PMCID: PMC9410700 DOI: 10.3389/fcvm.2022.974802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMetabolic syndrome is a pre-diabetes condition that is associated with increased cardiovascular morbidity and mortality. We aimed to explore how exercise capacity, cardiac structure, and function were affected in patients with metabolic syndrome.MethodsOutpatients with echocardiography and exercise stress test combined with impedance cardiography (ETT + ICGG) results available from Nov 2018 to Oct 2020 were retrospectively enrolled. Echocardiographic, ETT + ICG profiles, and exercise performance were compared between patients with metabolic syndrome and the ones without. Sensitivity analyses were performed excluding patients without established coronary heart disease and further 1:1 paired for age and gender, respectively. Multiple linear regression was used to find out related predictors for maximal metabolic equivalents (METs).ResultsThree hundred and twenty-third patients were included, among whom 97 were diagnosed as metabolic syndrome. Compared to patients without metabolic syndrome, echocardiography showed that patients with metabolic syndrome had a significantly lower E/A ratio (p < 0.001). Besides, they have larger left atrium, larger right ventricle, and thicker interventricular septum (all p < 0.001), but similar left ventricular ejection fraction (P = 0.443). ICG showed that patients with metabolic syndrome had significantly higher stroke volume at rest and maximum (p < 0.001), higher left cardiac work index at rest and maximum (p = 0.005), higher systemic vascular resistance (SVR) at rest (p < 0.001), but similar SVI (p = 0.888). During exercise, patients with metabolic syndrome had lower maximal METs (p < 0.001), and a higher proportion suffering from ST-segment depression during exercise (p = 0.009). Sensitivity analyses yielded similar results. As for the linear regression model, 6 independent variables (systolic blood pressure, BMI, E/A ratio, the height of O wave, the peak value of LCWi, and the baseline of SVR) had statistically significant effects on the maximal METs tested in exercise (R = 0.525, R2 = 0.246, P < 0.001).ConclusionPatients with metabolic syndrome had significant structural alteration, apparent overburden of left ventricular work index, pre-and afterload, which may be the main cause of impaired exercise tolerance.
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Affiliation(s)
- Jiming Chen
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Xing Wang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Bin Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Chen Liu
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Jingjing Zhao
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Yugang Dong
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
| | - Weihao Liang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
- Weihao Liang
| | - Huiling Huang
- Department of Cardiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- National Health Committee (NHC) Key Laboratory of Assisted Circulation, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Huiling Huang
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Hanafy OS, Khalil MM, Khater IM, Mohammed HS. Development of a new Python-based cardiac phantom for myocardial SPECT imaging. Ann Nucl Med 2021; 35:47-58. [PMID: 33068288 DOI: 10.1007/s12149-020-01534-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this work was to develop a digital dynamic cardiac phantom able to mimic gated myocardial perfusion single photon emission computed tomography (SPECT) images. METHODS A software code package was written to construct a cardiac digital phantom based on mathematical ellipsoidal model utilizing powerful numerical and mathematic libraries of python programing language. An ellipsoidal mathematical model was adopted to create the left ventricle geometrical volume including myocardial boundaries, left ventricular cavity, with incorporation of myocardial wall thickening and motion. Realistic myocardial count density from true patient studies was used to simulate statistical intensity variation during myocardial contraction. A combination of different levels of defect extent and severity were precisely modeled taking into consideration defect size variation during cardiac contraction. Wall thickening was also modeled taking into account the effect of partial volume. RESULTS It has been successful to build a python-based software code that is able to model gated myocardial perfusion SPECT images with variable left ventricular volumes and ejection fraction. The recent flexibility of python programming enabled us to manipulate the shape and control the functional parameters in addition to creating variable sized-defects, extents and severities in different locations. Furthermore, the phantom code also provides different levels of image filtration mimicking those filters used in image reconstruction and their influence on image quality. Defect extent and severity were found to impact functional parameter estimation in consistence to clinical examinations. CONCLUSION A python-based gated myocardial perfusion SPECT phantom has been successfully developed. The phantom proved to be reliable to assess cardiac software analysis tools in terms of perfusion and functional parameters. The software code is under further development and refinement so that more functionalities and features can be added.
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Affiliation(s)
- Osama S Hanafy
- Department of Biophysics, Faculty of Science, Cairo University, Cairo, Egypt
| | - Magdy M Khalil
- Department of Physics, Faculty of Science, Helwan University, Cairo, Egypt.
| | - Ibrahim M Khater
- Department of Biophysics, Faculty of Science, Cairo University, Cairo, Egypt
| | - Haitham S Mohammed
- Department of Biophysics, Faculty of Science, Cairo University, Cairo, Egypt
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Nakae I, Hayashi H, Matsumoto T, Mitsunami K, Horie M. Clinical usefulness of a novel program "Heart Function View" for evaluating cardiac function from gated myocardial perfusion SPECT. Ann Nucl Med 2014; 28:812-23. [PMID: 25023232 DOI: 10.1007/s12149-014-0875-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Accepted: 06/22/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To investigate clinical usefulness of a novel program "Heart Function View (HFV)" for evaluating left ventricular (LV) function from myocardial perfusion SPECT (MPS), we compared LV functional parameters (F(x)) calculated by HFV with those obtained by the other similar programs QGS and cardioGRAF or by ultrasound echocardiography (UCG) and examined their correlations with clinical markers of heart failure: plasma BNP concentrations (BNPs) and exercise capacity. METHODS Studied patients (n = 60) underwent technetium-99m tetrofosmin quantitative gated MPS including treadmill exercise for examining heart disease. Myocardial stress images were acquired 30 min after the first tracer injection during maximal exercise. Three hours later, the second tracer was injected, and resting images were acquired. LV systolic F(x) [ejection fraction (EF), peak ejection rate (PER)] and diastolic F(x) [first third filling fraction (1/3FF), first third filling rate (1/3FR), peak filling rate (PFR), time to PFR (TPF)] were analyzed, and phase standard deviation (SD) and histogram bandwidth were obtained by phase analysis. RESULTS LV end-diastolic volume (EDV), end-systolic volume (ESV) and EF obtained from HFV were well correlated with those from QGS, cardioGRAF and UCG. A diastolic parameter Doppler E/e' from UCG was significantly with PFR from HFV. There were good correlations between LVEDV, LVESV, LVEF, PER, PFR, 1/3FR, TPF and 1/3FF from HFV and those from cardioGRAF. LVEF, PER, 1/3FR, and PFR were significantly correlated with plasma BNP concentrations. In patients with non-ischemic heart disease (n = 42), phase SD and histogram bandwidth were correlated negatively with exercise capacity or PFR. CONCLUSIONS HFV-derived LVF(x) are correlated with LVF(x) from the other programs or UCG, or with the clinical markers of heart failure and are thus useful in the functional assessment for patients with heart disease.
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Affiliation(s)
- Ichiro Nakae
- Department of Cardiovascular and Respiratory Medicine, Shiga University of Medical Science, Seta, Otsu, 520-2192, Japan,
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Bussoni MF, Guirado GN, Roscani MG, Polegato BF, Matsubara LS, Bazan SGZ, Matsubara BB. Diastolic function is associated with quality of life and exercise capacity in stable heart failure patients with reduced ejection fraction. Braz J Med Biol Res 2013; 46:803-8. [PMID: 24036912 PMCID: PMC3854427 DOI: 10.1590/1414-431x20132902] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2012] [Accepted: 06/21/2013] [Indexed: 11/22/2022] Open
Abstract
Exercise capacity and quality of life (QOL) are important outcome predictors in
patients with systolic heart failure (HF), independent of left ventricular (LV)
ejection fraction (LVEF). LV diastolic function has been shown to be a better
predictor of aerobic exercise capacity in patients with systolic dysfunction and
a New York Heart Association (NYHA) classification ≥II. We hypothesized that the
currently used index of diastolic function E/e' is associated with exercise
capacity and QOL, even in optimally treated HF patients with reduced LVEF. This
prospective study included 44 consecutive patients aged 55±11 years (27 men and
17 women), with LVEF<0.50 and NYHA functional class I-III, receiving optimal
pharmacological treatment and in a stable clinical condition, as shown by the
absence of dyspnea exacerbation for at least 3 months. All patients had
conventional transthoracic echocardiography and answered the Minnesota Living
with HF Questionnaire, followed by the 6-min walk test (6MWT). In a
multivariable model with 6MWT as the dependent variable, age and E/e' explained
27% of the walked distance in 6MWT (P=0.002; multivariate regression analysis).
No association was found between walk distance and LVEF or mitral annulus
systolic velocity. Only normalized left atrium volume, a sensitive index of
diastolic function, was associated with decreased QOL. Despite the small number
of patients included, this study offers evidence that diastolic function is
associated with physical capacity and QOL and should be considered along with
ejection fraction in patients with compensated systolic HF.
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Affiliation(s)
- M F Bussoni
- Universidade Estadual Paulista, Departamento de Clínica Médica, Faculdade de Medicina de Botucatu, BotucatuSP, Brasil
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Abstract
Diastolic dysfunction, often seen with increasing age, is associated with reduced exercise capacity and increased mortality. Mortality rates in older individuals are linked to the development of disability, which may be preceded by functional limitations. The goal of this study was to identify which echocardiographic measures of diastolic function correlate with physical function in older subjects. A total of 36 men and women from the Louisiana Healthy Aging Study, age 62-101 yr, received a complete echocardiographic exam and performed the 10-item continuous-scale physical-functional performance test (CS-PFP-10). After adjustment for age and gender, left atrial volume index (ρ = -0.59; p = .0005) correlated with the total CS-PFP-10 score. Increased left atrial volume index may be a marker of impaired performance of activities of daily living in older individuals.
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Romero-Farina G, Aguadé-Bruix S, Pizzi MN, Cuberas-Borrós G, De León G, Castell-Conesa J, García-Dorado D, Candell-Riera J. [Analysis of the diastolic function by myocardial perfusion gated SPECT after coronary revascularization in acute myocardial infarction]. Rev Esp Med Nucl Imagen Mol 2012; 32:8-12. [PMID: 23159107 DOI: 10.1016/j.remn.2012.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2012] [Revised: 04/08/2012] [Accepted: 04/15/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the evolutive changes in diastolic function after percutaneous coronary revascularization (PCR) in acute myocardial infarction (AMI), using myocardial perfusion gated SPECT. METHODS Thirty-two patients (mean 61.9±9.7 years, 7 women) were studied by two at rest gated SPECT: the first gated-SPECT-1 was performed with an injection of a dose of (99m)Tc-tetrofosmin prior to PCR and the second gated-SPECT-2 between the fourth and fifth weeks after AMI. Changes of peak filling rate (PFR) and the time to peak filling rate (TTPF) were assessed between both studies, and were related to the extent of salvaged myocardium (SM), end-diastolic (EDV) and end-systolic (ESV) volumes, and left ventricular ejection fraction (LVEF) changes. RESULTS An improvement was observed in diastolic function parameters Gated-SPECT-2: PFR increased significantly (P=0.011) while the TTPF decreased without reaching statistical significance (P=0.288). In multivariate analysis, adjusted by clinical and coronary variables, improvement of PFR was significantly associated with percentage of SM (P=0.030), increase in LVEF (P=0.004) and with ESV volume reduction (P=0.005). Improvement of TTPF was only related significantly to the percentage of SM (P=0.046). PFR increased 0.01 EDV/sec. and TTPF decreased 1.14ms for each cm(2) increase of the area of SM. CONCLUSIONS After PCR in AMI, the myocardial perfusion gated SPECT makes it possible to assess the significant improvement in diastolic function mainly related to the amount of MS.
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Affiliation(s)
- G Romero-Farina
- Unidad de Cardiología Nuclear, Hospital Universitario Vall d'Hebron, Institut de Recerca, Universidad Autónoma de Barcelona, Barcelona, España.
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