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Duan Y, Ye L, Shu Q, Huang Y, Zhang H, Zhang Q, Ding G, Deng Y, Li C, Yin L, Wang Y. Abnormal left ventricular systolic reserve function detected by treadmill exercise stress echocardiography in asymptomatic type 2 diabetes. Front Cardiovasc Med 2023; 10:1253440. [PMID: 37928757 PMCID: PMC10622805 DOI: 10.3389/fcvm.2023.1253440] [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: 07/05/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Aims Subclinical left ventricular (LV) dysfunction may occur in T2DM patients at the early asymptomatic stage, and LV reserve function is a sensitive index to detect subtle LV dysfunction. The purpose of our study is (1) to assess the LV reserve function using treadmill exercise stress echocardiography (ESE) in asymptomatic type 2 diabetes mellitus (T2DM) patients; (2) to explore the link of serum biological parameters and LV reserve function. Methods This study included 84 patients with asymptomatic T2DM from September 2021 to July 2022 and 41 sex- and age-matched healthy controls during the corresponding period. All subjects completed treadmill ESE, LV systolic function-related parameters such as global longitudinal strain (GLS) and systolic strain rate (SRs), as well as diastolic function-related parameters such as E wave (E), early diastolic velocity (e'), E/e' ratio, early diastolic SR (SRe), and late diastolic SR (SRa) were compared at rest and immediately after exercise. The difference between LV functional parameters after treadmill exercise and its corresponding resting value was used to compute LV reserve function. In addition, the associations of LV reserve function and serum biological parameters were analyzed. Results Patients with T2DM did not significantly vary from the controls in terms of alterations in LV diastolic reserve measures, the changes of LVGLS and SRs (ΔGLS: 2.19 ± 2.72% vs. 4.13 ± 2.79%, P < 0.001 and ΔSRs:0.78 ± 0.33 s-1 vs. 1.02 ± 0.28 s-1, P < 0.001) in the T2DM group were both lower than those in the control group. Glycated hemoglobin (HbA1c), N-terminal pro-brain natriuretic peptide (NTproBNP), waist circumference, and high-sensitive C-reactive protein (hsCRP) were identified as independent predictors of LV systolic reserve by stepwise multiple linear regression analysis. Conclusion LV systolic reserve function, as measured by pre- and post-exercise differences in GLS and SRs were significantly impaired in patients with asymptomatic T2DM, whereas diastolic reserve remained normal during exercise and was comparable to that of the control group. This was different from previous findings. High levels of HbA1c, NTproBNP, hsCRP, and increasing waist circumference were independent predictors of LV systolic reserve.
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Affiliation(s)
- Yuyou Duan
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
| | - Luwei Ye
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinglan Shu
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yu Huang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hongmei Zhang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qingfeng Zhang
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Geqi Ding
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yan Deng
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Chunmei Li
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yi Wang
- School of Clinical Medicine, Southwest Medical University, Luzhou, China
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
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Miceli S, Cassano V, Clausi E, Armentaro G, Tallarico V, Dallimonti Perini D, Succurro E, Maio R, Perticone M, Hribal ML, Montalcini T, Andreozzi F, Sesti G, Sciacqua A. One-hour post-load glucose and subclinical left atrial myocardial dysfunction in hypertensive patients. Eur J Clin Invest 2023; 53:e14009. [PMID: 37096889 DOI: 10.1111/eci.14009] [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: 02/10/2023] [Revised: 04/03/2023] [Accepted: 04/06/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND Recently, studies demonstrated that normal glucose-tolerant subjects (NGT) with 1-h post-load plasma glucose value ≥155 mg/dL during oral glucose tolerance test (OGTT) (NGT ≥ 155) present an impaired cardio-metabolic profile, with subclinical myocardial damage. Atrial morphological and functional alterations, closely related to diastolic dysfunction, are important predictors of atrial fibrillation (AF), cardiovascular (CV) events and mortality in the entire population as well as in diabetic patients. The aim of our study was to evaluate subclinical atrial myocardial damage, assessed with speckle tracking echocardiography, in NGT≥155 mg/dL patients, comparing to NGT < 155 mg/dL subjects, impaired glucose tolerant (IGT) individuals and patients with newly diagnosed type 2 diabetes (T2DM). METHODS We enrolled 229 Caucasian patients. All subjects underwent anthropometrical and haemodynamic parameters evaluation, OGTT, advanced Colour-Doppler echocardiography with evaluation of main atrial and ventricular parameters. RESULTS As expected, from first to the fourth group there was a worsening of the metabolic profile as attested by fasting, 1- and 2-h post-load plasma glucose levels, during OGTT. Moreover, from NGT < 155 to T2DM group there was an impairment in reservoir and pump atrial function (PALS and PACS, respectively) (p < .0001). CONCLUSION Present data demonstrated for the first time that NGT≥155 subjects present subclinical atrial dysfunction. These results may be clinically relevant because they highlight how atrial myopathy occurs early in pre-diabetes stage regardless of fibrotic and morphological alterations of the ventricular myocardium.
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Affiliation(s)
- Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Velia Cassano
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elvira Clausi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Valeria Tallarico
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Daniele Dallimonti Perini
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Raffaele Maio
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Marta L Hribal
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Tiziana Montalcini
- Department of Experimental and Clinical Medicine, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
- Research Center for the Prevention and Treatment of Metabolic Diseases, University Magna Graecia of Catanzaro, Catanzaro, Italy
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Kurpas A, Supel K, Wieczorkiewicz P, Bodalska Duleba J, Zielinska M. Fibroblast Growth Factor 23: Potential Marker of Invisible Heart Damage in Diabetic Population. Biomedicines 2023; 11:1523. [PMID: 37371618 PMCID: PMC10294899 DOI: 10.3390/biomedicines11061523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/22/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
Two-dimensional speckle-tracking echocardiography (2DSTE) detects myocardial dysfunction despite a preserved left ventricular ejection fraction. Fibroblast growth factor 23 (FGF23) has become a promising biomarker of cardiovascular risk. This study aimed to determine whether FGF23 may be used as a marker of myocardial damage among patients with diabetes mellitus type 2 (T2DM) and no previous history of myocardial infarction. The study enrolled 71 patients with a median age of 70 years. Laboratory data were analyzed retrospectively. Serum FGF23 levels were determined using a sandwich enzyme-linked immunosorbent assay. All patients underwent conventional echocardiography and 2DSTE. Baseline characteristics indicated that the median time elapsed since diagnosis with T2DM was 19 years. All subjects were divided into two groups according to left ventricular diastolic function. Individuals with confirmed left ventricular diastolic dysfunction had significantly lower levels of estimated glomerular filtration rate and higher values of hemoglobin A1c. Global circumferential strain (GCS) was reduced in the majority of patients. Only an epicardial GCS correlated significantly with the FGF23 concentration in all patients. The study indicates that a cardiac strain is a reliable tool for a subtle myocardial damage assessment. It is possible that FGF23 may become an early diagnostic marker of myocardial damage in patients with T2DM.
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Affiliation(s)
- Anna Kurpas
- Department of Interventional Cardiology, Medical University of Lodz, 251 Pomorska Street, 92-213 Lodz, Poland; (A.K.); (P.W.); (M.Z.)
| | - Karolina Supel
- Department of Interventional Cardiology, Medical University of Lodz, 251 Pomorska Street, 92-213 Lodz, Poland; (A.K.); (P.W.); (M.Z.)
| | - Paulina Wieczorkiewicz
- Department of Interventional Cardiology, Medical University of Lodz, 251 Pomorska Street, 92-213 Lodz, Poland; (A.K.); (P.W.); (M.Z.)
| | | | - Marzenna Zielinska
- Department of Interventional Cardiology, Medical University of Lodz, 251 Pomorska Street, 92-213 Lodz, Poland; (A.K.); (P.W.); (M.Z.)
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Ghoreyshi-Hefzabad SM, Jeyaprakash P, Vo HQ, Gupta A, Ozawa K, Pathan F, Negishi K. Subclinical systolic dysfunction detected by 2D speckle tracking echocardiography in adults with diabetes mellitus: systematic review and meta-analysis of 6668 individuals with diabetes mellitus and 7218 controls. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:977-989. [PMID: 36995526 PMCID: PMC10160195 DOI: 10.1007/s10554-023-02810-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Accepted: 02/04/2023] [Indexed: 03/31/2023]
Abstract
PURPOSE Speckle tracking echocardiography (STE) can help to identify subclinical features of diabetic cardiomyopathy (DCM). There is, however, significant heterogeneity in the reported strain values in literature. We performed a systematic review and meta-analysis to compare cardiac systolic strain values assessed by 2D-STE in asymptomatic adults with diabetes mellitus (DM) and healthy controls. METHODS Five databases were searched, and a total of 41 valid studies (6668 individuals with DM and 7218 controls) were included for analysis. Pooled mean in each group and mean difference (MD) for left ventricular global longitudinal strain (LVGLS), LV global circumferential strain (LVGCS), LV global radial strain (LVGRS), LV longitudinal systolic strain rate (LVSR), left atrial reservoir strain (LARS) and right ventricular GLS (RVGLS) were assessed. RESULTS Patients with DM had overall 2 units lower LVGLS than healthy subjects 17.5% [16.8, 18.3], vs 19.5 [18.7, 20.4], MD = - 1.96 [- 2.27, - 1.64]. Other strain values were also lower in patients with DM: LVGCS (MD = - 0.89 [- 1.26, - 0.51]); LVGRS (MD = - 5.03 [- 7.18, - 2.87]); LVSR (MD = - 0.06 [- 0.10, - 0.03]); LARS (MD = - 8.41 [- 11.5, - 5.33]); and RVGLS (MD = - 2.41 [- 3.60, - 1.22]). Meta-regression identified higher body mass index (BMI) as the single contributor to worse LVGLS, LVGCS and LVSR. Those with higher Hemoglobulin A1c had worse RVGLS. CONCLUSION Myocardial strains were reduced in whole heart in patients with DM. The largest reduction was observed in LA reservoir strain, followed by RVGLS and LVGLS. Higher BMI in patients with DM is associated with worse LV strain values.
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Affiliation(s)
- Seyed-Mohammad Ghoreyshi-Hefzabad
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, Australia
| | - Prajith Jeyaprakash
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, Australia
- Department of Cardiology, Nepean Hospital, Kingswood, NSW, Australia
| | - Ha Q Vo
- Department of Cardiology, Nepean Hospital, Kingswood, NSW, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Alpa Gupta
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, Australia
| | - Koya Ozawa
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, Australia
| | - Faraz Pathan
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Kazuaki Negishi
- Sydney Medical School Nepean, Faculty of Medicine and Health, Charles Perkins Centre Nepean, The University of Sydney, Kingswood, Australia.
- Department of Cardiology, Nepean Hospital, Kingswood, NSW, Australia.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
- The University of Sydney, Kingswood, NSW, 2747, Australia.
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Role of Echocardiography in Diabetic Cardiomyopathy: From Mechanisms to Clinical Practice. J Cardiovasc Dev Dis 2023; 10:jcdd10020046. [PMID: 36826542 PMCID: PMC9959745 DOI: 10.3390/jcdd10020046] [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: 10/14/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
It has been well established that diabetes mellitus (DM) is considered as a core risk factor for the development of cardiovascular diseases. However, what is less appreciated is the fact that DM may affect cardiac function irrespective of cardiac pathologies to which it contributes, such as coronary artery disease and hypertension. Although echocardiography provides accurate and reproducible diagnostic and prognostic data in patients with DM, its use in these patients is still underappreciated, resulting in progression of DM-related heart failure in many patients. Hence, in the present review, we aimed to discuss the role of echocardiography in the contemporary management of diabetic cardiomyopathy (DCM), as well as the role of emerging echocardiographic techniques, which may contribute to earlier diagnosis and more appropriate management of this complication of DM. In order to improve outcomes, focus must be placed on early diagnosis of this condition using a combination of echocardiography and emerging biomarkers, but perhaps the more important thing is to change perspective when it comes to the clinical importance of DCM.
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From Structural to Functional Hypertension Mediated Target Organ Damage—A Long Way to Heart Failure with Preserved Ejection Fraction. J Clin Med 2022; 11:jcm11185377. [PMID: 36143024 PMCID: PMC9504592 DOI: 10.3390/jcm11185377] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 09/01/2022] [Accepted: 09/08/2022] [Indexed: 11/17/2022] Open
Abstract
Arterial hypertension (AH) is a major risk factor for the development of heart failure (HF) which represents one of the leading causes of mortality and morbidity worldwide. The chronic hemodynamic overload induced by AH is responsible for different types of functional and morphological adaptation of the cardiovascular system, defined as hypertensive mediated target organ damage (HMOD), whose identification is of fundamental importance for diagnostic and prognostic purposes. Among HMODs, left ventricular hypertrophy (LVH), coronary microvascular dysfunction (CMVD), and subclinical systolic dysfunction have been shown to play a role in the pathogenesis of HF and represent promising therapeutic targets. Furthermore, LVH represents a strong predictor of cardiovascular events in hypertensive patients, influencing per se the development of CMVD and systolic dysfunction. Clinical evidence suggests considering LVH as a diagnostic marker for HF with preserved ejection fraction (HFpEF). Several studies have also shown that microalbuminuria, a parameter of abnormal renal function, is implicated in the development of HFpEF and in predicting the prognosis of patients with HF. The present review highlights recent evidence on the main HMOD, focusing in particular on LVH, CMD, subclinical systolic dysfunction, and microalbuminuria leading to HFpEF.
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Cassano V, Miceli S, Armentaro G, Mannino GC, Fiorentino VT, Perticone M, Succurro E, Hribal ML, Andreozzi F, Perticone F, Sesti G, Sciacqua A. Oxidative Stress and Left Ventricular Performance in Patients with Different Glycometabolic Phenotypes. Nutrients 2022; 14:nu14061299. [PMID: 35334956 PMCID: PMC8950717 DOI: 10.3390/nu14061299] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/15/2022] [Accepted: 03/17/2022] [Indexed: 12/14/2022] Open
Abstract
The aim of the present study was to evaluate the possible correlation between oxidative stress and subclinical myocardial damage, assessed with speckle tracking echocardiography (STE), in normal glucose tolerance (NGT) patients with one-hour plasma glucose values ≥ 155 mg/dL (NGT ≥ 155), comparing them to NGT < 155 subjects, impaired glucose tolerance (IGT) and type 2 diabetes mellitus (T2DM) newly diagnosed patients. We enrolled 100 Caucasian patients. All subjects underwent OGTT. The serum values of oxidative stress markers (8-isoprostane and Nox-2) were assessed with an ELISA test. Echocardiographic recordings were performed using an E-95 Pro ultrasound system. We observed significant differences, among the four groups, for fasting plasma glucose (p < 0.0001), one-hour postload (p < 0.0001), and two-hour postload plasma glucose (p < 0.0001). As compared with NGT < 155, NGT ≥ 155 exhibited significantly worse insulin sensitivity and higher values of hs-CRP. No significant differences were observed between NGT ≥ 155 and IGT patients. There was a significant increase in 8-isoprostane (p < 0.0001) and Nox-2 (p < 0.0001), from the first to fourth group, indicating an increase in oxidative stress with the worsening of the metabolic status. Serum levels of 8-isoprostane and Nox-2 were significantly increased in NGT ≥ 155 compared to the NGT < 155 group, but similar to IGT. The global longitudinal strain (GLS) appeared progressively lower proceeding from the NGT < 155 to T2DM group (p < 0.0001). For similar values of left ventricular ejection fraction (LVEF), NGT ≥ 155 exhibited reduced GLS compared to NGT < 155 (p = 0.001), but similar to IGT patients. Our study demonstrated that NGT ≥ 155 subjects exhibit early functional impairment of myocardial contractile fibres, these alterations are correlated with increased oxidative stress.
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Affiliation(s)
- Velia Cassano
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
| | - Gaia Chiara Mannino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
| | - Vanessa Teresa Fiorentino
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
| | - Maria Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
- Research Center for the Prevention and Treatment of Metabolic Diseases, University of Catanzaro, 88100 Catanzaro, Italy
| | - Marta Letizia Hribal
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
- Research Center for the Prevention and Treatment of Metabolic Diseases, University of Catanzaro, 88100 Catanzaro, Italy
| | - Francesco Andreozzi
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
- Research Center for the Prevention and Treatment of Metabolic Diseases, University of Catanzaro, 88100 Catanzaro, Italy
| | - Francesco Perticone
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University Rome-Sapienza, 00185 Roma, Italy;
| | - Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, 88100 Catanzaro, Italy; (V.C.); (S.M.); (G.A.); (G.C.M.); (V.T.F.); (M.P.); (E.S.); (M.L.H.); (F.A.); (F.P.)
- Research Center for the Prevention and Treatment of Metabolic Diseases, University of Catanzaro, 88100 Catanzaro, Italy
- Correspondence: ; Tel.: +39-0961-3694103; Fax: +39-0961-3647192
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Qingfeng Z, Yi W, Wenhua L, Hongmei Z, Geqi D, Xuebing L, Chunmei L, Yan D, Lixue Y. Evaluation of left ventricular function by treadmill exercise stress echocardiography combined with layer‐specific strain technique in essential hypertension patients. J Clin Hypertens (Greenwich) 2022; 24:312-319. [PMID: 35188326 PMCID: PMC8924995 DOI: 10.1111/jch.14407] [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: 09/24/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this study was to evaluate the diagnostic utility of treadmill exercise stress echocardiography (TESE) combined with left ventricular (LV) layer‐specific strain (LSS) in subclinical myocardial and reserve function of hypertensive patients. A total of 55 hypertensive patients and 51 controls were evaluated during rest and exercise. Two‐dimensional speckle tracking (2DST) and LSS technique was used to measure longitudinal and circumferential strains at rest and peak exercise, strain difference characteristics were then evaluated. Compared to the control subjects, both longitudinal and circumferential LSS showed different degrees of reduction in hypertensive group, which was more pronounced at peak exercise. The global longitudinal endocardium strain (GLSendo) at rest was 24.4% ± 1.5% in the control group versus 20.4% ± 2.3% in the hypertensive group, while the difference was more obvious at peak state (control vs. hypertensive group, 30.8% ± 2.8% and 22.8% ± 2.9%, respectively). In particular, endocardial strain under exercise can be used as a sensitive indicator where the LV contractile reserve (CR) function of the three layers are all impaired. TESE combined with LSS might increase diagnostic accuracy of myocardial performance in hypertension patients.
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Affiliation(s)
- Zhang Qingfeng
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Wang Yi
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Li Wenhua
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Zhang Hongmei
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Ding Geqi
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Liu Xuebing
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Li Chunmei
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Deng Yan
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
| | - Yin Lixue
- Key laboratory of ultrasound in cardiac electrophysiology and biomechanics The Affiliated Sichuan Provincial People's Hospital of Electronic Science and Technology University of China Chengdu China
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9
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Lembo M, Manzi MV, Mancusi C, Morisco C, Rao MAE, Cuocolo A, Izzo R, Trimarco B. Advanced imaging tools for evaluating cardiac morphological and functional impairment in hypertensive disease. J Hypertens 2022; 40:4-14. [PMID: 34582136 PMCID: PMC10871661 DOI: 10.1097/hjh.0000000000002967] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 06/29/2021] [Accepted: 06/30/2021] [Indexed: 01/19/2023]
Abstract
Arterial hypertension represents a systemic burden, and it is responsible of various morphological, functional and tissue modifications affecting the heart and the cardiovascular system. Advanced imaging techniques, such as speckle tracking and three-dimensional echocardiography, cardiac magnetic resonance, computed tomography and PET-computed tomography, are able to identify cardiovascular injury at different stages of arterial hypertension, from subclinical alterations and overt organ damage to possible complications related to pressure overload, thus giving a precious contribution for guiding timely and appropriate management and therapy, in order to improve diagnostic accuracy and prevent disease progression. The present review focuses on the peculiarity of different advanced imaging tools to provide information about different and multiple morphological and functional aspects involved in hypertensive cardiovascular injury. This evaluation emphasizes the usefulness of the emerging multiimaging approach for a comprehensive overview of arterial hypertension induced cardiovascular damage.
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Affiliation(s)
- Maria Lembo
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
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10
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Sciacqua A, Succurro E, Armentaro G, Miceli S, Pastori D, Rengo G, Sesti G. Pharmacological treatment of type 2 diabetes in elderly patients with heart failure: randomized trials and beyond. Heart Fail Rev 2021; 28:667-681. [PMID: 34859336 DOI: 10.1007/s10741-021-10182-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/14/2021] [Indexed: 12/18/2022]
Abstract
Heart failure (HF) and type 2 diabetes mellitus (T2DM) represent two important public health problems, and despite improvements in the management of both diseases, they are responsible for high rates of hospitalizations and mortality. T2DM accelerates physiological cardiac aging through hyperglycemia and hyperinsulinemia. Thus, HF and T2DM are chronic diseases widely represented in elderly people who often are affected by numerous comorbidities with important functional limitations making it difficult to apply the current guidelines. Several antidiabetic drugs should be used with caution in elderly individuals with T2DM. For instance, sulfonylureas should be avoided due to the risk of hypoglycemia associated with its use. Insulin should be used with caution because it is associated with higher risk of hypoglycemia, and may determine fluid retention which can lead to worsening of HF. Thiazolindinediones should be avoided due to the increased risk of fluid retention and HF. Biguanides may lead to a slightly increased risk of lactic acidosis in particular in elderly individuals with impaired renal function. Dipeptidyl peptidase 4 (DPP-4) inhibitors are safe having few side effects, minimal risk of hypoglycemia, and a neutral effect on cardiovascular (CV) outcome, even if it has been reported that saxagliptin treatment is associated with increased risk of hospitalizations for HF (hHF). Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown a CV protection without a significant reduction in hHF. On the other hand, sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown a significant improvement in CV outcome, with a strong reduction of hHF and a positive impact on renal damage progression. However, it is necessary to consider the possible some side effects related to their use in elderly individuals including hypotension, bone fractures, and ketoacidosis.It is important to remark that elderly patients, in particular the very elderly, are not sufficiently represented in the trials; thus, the management and treatment of elderly diabetic patients with HF should be mainly based on the integration of scientific evidence with clinical judgment and patients' condition, with respect to the dignity and quality of life.
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Affiliation(s)
- Angela Sciacqua
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy.
| | - Elena Succurro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Giuseppe Armentaro
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Sofia Miceli
- Department of Medical and Surgical Sciences, University Magna Græcia of Catanzaro, Campus Universitario di Germaneto, V.le Europa, 88100, Catanzaro, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Rengo
- Department of Translational Medical Sciences, University of Naples "Federico II", Naples, Italy
- Istituti Clinici Scientifici (ICS) Maugeri SPA, Società Benefit, IRCCS, Pavia, Italy
- Istituto Scientifico di Telese Terme, Telese, Terme, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, University Rome-Sapienza, Rome, Italy
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11
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Ghoreyshi-Hefzabad SM, Jeyaprakash P, Gupta A, Vo HQ, Pathan F, Negishi K. Three-Dimensional Global Left Ventricular Myocardial Strain Reduced in All Directions in Subclinical Diabetic Cardiomyopathy: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2021; 10:e020811. [PMID: 34585594 PMCID: PMC8649137 DOI: 10.1161/jaha.121.020811] [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] [Indexed: 12/03/2022]
Abstract
Background Three‐dimensional (3D) speckle tracking echocardiography can identify subclinical diabetic cardiomyopathy without geometric assumption and loss of speckle from out‐of‐plane motions. There is, however, significant heterogeneity among the previous reports. We performed a systematic review and meta‐analysis to compare 3D strain values between adults with asymptomatic, subclinical diabetes mellitus (ie, patients with diabetes mellitus without known clinical manifestations of cardiac disease) and healthy controls. Methods and Results After systematic review of 5 databases, 12 valid studies (544 patients with diabetes mellitus and 489 controls) were eligible for meta‐analysis. Pooled means and mean difference (MD) using a random‐effects model for 3D global longitudinal, circumferential, radial, and area strain were calculated. Patients with diabetes mellitus had an overall 2.31 percentage points lower 3D global longitudinal strain than healthy subjects (16.6%, 95% CI, 15.7–17.6 versus 19.0; 95% CI, 18.2–19.7; MD, −2.31, 95% CI, −2.72 to −2.03). Similarly, 3D global circumferential strain (18.9%; 95% CI, 17.5–20.3 versus 20.5; 95% CI, 18.9–22.1; MD, −1.50; 95% CI, −2.09 to −0.91); 3D global radial strain (44.6%; 95% CI, 40.2–49.1 versus 48.2; 95% CI, 44.7–51.8; MD, −3.47; 95% CI, −4.98 to −1.97), and 3D global area strain (30.5%; 95% CI, 29.2–31.8 versus 32.4; 95% CI, 30.5–34.3; MD, −1.76; 95% CI, −2.74 to −0.78) were also lower in patients with diabetes mellitus. Significant heterogeneity was noted between studies for all strain directions (inconsistency factor [I2], 37%–78%). Meta‐regression in subgroup analysis of studies using the most popular vendor found higher prevalence of hypertension as a significant contributor to worse 3D global longitudinal strain. Higher hemoglobulin A1c was the most significant contributor to worse 3D global circumferential strain in patients with diabetes mellitus. Conclusions Three‐dimensional myocardial strain was reduced in all directions in asymptomatic diabetic patients. Hypertension and hemoglobin A1c were associated with worse 3D global longitudinal strain and 3D global circumferential strain, respectively. Registration URL: https://www.crd.york.ac.uk/prospero; unique identifier: CRD42020197825.
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Affiliation(s)
- Seyed-Mohammad Ghoreyshi-Hefzabad
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia
| | - Prajith Jeyaprakash
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia.,Department of Cardiology Nepean Hospital Kingswood Australia
| | - Alpa Gupta
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia
| | - Ha Q Vo
- Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
| | - Faraz Pathan
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia.,Department of Cardiology Nepean Hospital Kingswood Australia
| | - Kazuaki Negishi
- Faculty of Medicine and Health Charles Perkins Centre Nepean Sydney Medical School NepeanThe University of Sydney Kingswood Australia.,Department of Cardiology Nepean Hospital Kingswood Australia.,Menzies Institute for Medical ResearchUniversity of Tasmania Hobart Tasmania Australia
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12
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Soufi Taleb Bendiab N, Ouabdesselam S, Henaoui L, Lopez-Sublet M, Monsuez JJ, Benkhedda S. Impact of Diabetes on Cardiac Function in Patients with High Blood Pressure. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18126553. [PMID: 34207036 PMCID: PMC8296398 DOI: 10.3390/ijerph18126553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 12/19/2022]
Abstract
Background: Although the combination of high blood pressure (HBP) and type 2 diabetes (T2DM) increases the risk of left ventricular (LV) dysfunction, the impact of T2DM on LV geometry and subclinical dysfunction in hypertensive patients and normal ejection fraction (EF) has been infrequently evaluated. Methods: Hypertensive patients with or without T2DM underwent cardiac echocardiography coupled with LV global longitudinal strain (GLS) assessment. Results: Among 200 patients with HBP (mean age 61.7 ± 9.7 years) and EF > 55%, 93 had associated T2DM. Patients with T2DM had a higher body mass index (29.9 ± 5.1 kg/m2 vs. 29.3 ± 4.7 kg/m2, p = 0.025), higher BP levels (158 ± 23/95 ± 13 vs. 142 ± 33/87 ± 12 mmHg, p = 0.003), a higher LV mass index (115.8 ± 32.4 vs. 112.0 ± 24.7 g/m2, p = 0.004), and higher relative wall thickness (0.51 ± 0.16 vs. 0.46 ± 0.12, p = 0.0001). They had more frequently concentric remodeling (20.4% vs. 16.8%, p < 0.001), concentric hypertrophy (53.7% vs. 48.6%, p < 0.001), elevated filling pressures (25.8 vs. 12.1%, p = 0.0001), indexed left atrial volumes greater than 28 mL/m2 (17.2 vs. 11.2%, p = 0.001), and a reduced GLS less than −18% (74.2 vs. 47.7%, p < 0.0001). After adjustment for BP and BMI, T2DM remains an independent determinant factor for GLS decline (OR = 2.26, 95% CI 1.11–4.61, p = 0.023). Conclusions: Left ventricular geometry and subclinical LV function as assessed with GLS are more impaired in hypertensive patients with than without T2DM. Preventive approaches to control BMI and risk of T2DM in hypertensive patients should be emphasized.
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Affiliation(s)
- Nabila Soufi Taleb Bendiab
- Department of Cardiology, Faculty of Medicine Aboubekr Belkaid, University Hospital Tlemcen, Tlemcen 13000, Algeria;
| | - Souhila Ouabdesselam
- Department of Cardiology, Mustapha University Hospital Center Algiers, Algiers 16000, Algeria; (S.O.); (S.B.)
- Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA University, Algiers 16000, Algeria
| | - Latefa Henaoui
- Department of Epidemiology, Faculty of Medicine Aboubekr Belkaid, University Hospital Tlemcen, Tlemcen 13000, Algeria;
| | - Marilucy Lopez-Sublet
- APHP Hôpital R Muret, Hôpitaux Universitaires de Paris Seine Saint Denis, 93270 Sevran, France;
- Centre d’HTA, Hôpital Avicenne,93000 Bobigny, France
| | - Jean-Jacques Monsuez
- APHP Hôpital R Muret, Hôpitaux Universitaires de Paris Seine Saint Denis, 93270 Sevran, France;
- Correspondence: ; Tel.: +33-1-41525832; Fax: +33-1-141525816
| | - Salim Benkhedda
- Department of Cardiology, Mustapha University Hospital Center Algiers, Algiers 16000, Algeria; (S.O.); (S.B.)
- Cardiology Oncology Research Collaborative Group (CORCG), Faculty of Medicine BENYOUCEF BENKHEDDA University, Algiers 16000, Algeria
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13
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Minciună IA, Hilda Orășan O, Minciună I, Lazar AL, Sitar-Tăut AV, Oltean M, Tomoaia R, Puiu M, Sitar-Tăut DA, Pop D, Cozma A. Assessment of subclinical diabetic cardiomyopathy by speckle-tracking imaging. Eur J Clin Invest 2021; 51:e13475. [PMID: 33326612 DOI: 10.1111/eci.13475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/28/2020] [Accepted: 12/05/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Diastolic dysfunction is traditionally believed to be the first subclinical manifestation of diabetic cardiomyopathy (DCM), leading to systolic dysfunction and then overt heart failure. However, in the last few years, several studies suggested that systolic subclinical dysfunction measured by speckle-tracking echocardiography (STE) may appear ahead of diastolic dysfunction. In this review, the main endpoint is to show whether subclinical myocardial systolic dysfunction appears ahead of diastolic dysfunction and the implication this may have on the evolution and management of DCM. MATERIALS AND METHODS We performed a search in PubMed for all relevant publications on the assessment of DCM by STE from 1 June 2015 to 1 June 2020. RESULTS AND CONCLUSIONS The results illustrate that subclinical systolic dysfunction assessed by STE is present in early DCM stages, with or without the association of diastolic dysfunction. This could be a promising perspective for the early management of patients with DCM leading to the prevention of the overt form of disease.
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Affiliation(s)
- Ioan-Alexandru Minciună
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Olga Hilda Orășan
- Internal Medicine Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Iulia Minciună
- Regional Institute of Gastroenterology and Hepatology ''Octavian Fodor'', Cluj-Napoca, Romania
| | - Andrada-Luciana Lazar
- Dermatology Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Adela Viviana Sitar-Tăut
- Internal Medicine Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Monica Oltean
- Heart Institute ''Nicolae Stancioiu'', Cluj-Napoca, Romania
| | - Raluca Tomoaia
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Mihai Puiu
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Dan-Andrei Sitar-Tăut
- Faculty of Economics and Business Administration, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Dana Pop
- "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania.,Cardiology Department, Rehabilitation Hospital, Cluj-Napoca, Romania
| | - Angela Cozma
- Internal Medicine Department, "Iuliu Haţieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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14
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Tadic M, Cuspidi C, Pencic B, Vukomanovic V, Taddei S, Grassi G, Celic V. Association between myocardial work and functional capacity in patients with arterial hypertension: an echocardiographic study. Blood Press 2021; 30:188-195. [PMID: 33769171 DOI: 10.1080/08037051.2021.1902267] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE The aim of this study was to examine myocardial performance using pressure-strain loops in hypertensive patients with different level of blood pressure control. MATERIAL AND METHODS This cross-sectional study included 204 subjects (45 controls, 70 patients with well-controlled hypertension, 58 patients with uncontrolled hypertension and 31 patients with resistant hypertension) who underwent complete two-dimensional echocardiographic examination including two-dimensional speckle-tracking echocardiography. Pressure-strain curve was used to determine global myocardial work, constructive work, wasted work and work efficiency in all study participants. RESULTS Left ventricular (LV) longitudinal strain gradually reduced from controls throughout well-controlled hypertensive patients, to patients with uncontrolled and resistant hypertension. Global myocardial work was higher in patients with uncontrolled and resistant hypertension than in controls and well-controlled hypertension. Constructive work was also higher in all hypertensive patients than in controls. Global wasted work and work efficiency were similar between different groups. Global myocardial work index was associated with peak oxygen consumption independently of sex, age, body mass index (BMI), LV structural and functional parameters in all hypertensive participants. CONCLUSIONS Myocardial work was significantly deteriorated in patients with uncontrolled and resistant arterial hypertension compared to controls and well-controlled hypertensive patients. Global myocardial work was associated with functional capacity independent of clinical and echocardiographic parameters.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy.,Istituto Auxologico Italiano IRCCS, Clinical Research Unit, Meda, Italy
| | - Biljana Pencic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Vladan Vukomanovic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
| | - Stefano Taddei
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Guido Grassi
- Department of Medicine and Surgery, University Milano-Bicocca, Milano, Italy
| | - Vera Celic
- Department of Cardiology, University Hospital 'Dr. Dragisa Misovic - Dedinje', Belgrade, Serbia
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15
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Li XM, Jiang L, Guo YK, Ren Y, Han PL, Peng LQ, Shi R, Yan WF, Yang ZG. The additive effects of type 2 diabetes mellitus on left ventricular deformation and myocardial perfusion in essential hypertension: a 3.0 T cardiac magnetic resonance study. Cardiovasc Diabetol 2020; 19:161. [PMID: 32998742 PMCID: PMC7528579 DOI: 10.1186/s12933-020-01138-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/23/2020] [Indexed: 02/05/2023] Open
Abstract
Background Type 2 diabetes mellitus (T2DM) increases the risks of heart failure and mortality in patients with hypertension, however the underlying mechanism is unclear. This study aims to investigate the impact of coexisting T2DM on left ventricular (LV) deformation and myocardial perfusion in hypertensive individuals. Materials and methods Seventy hypertensive patients without T2DM [HTN(T2DM−)], forty patients with T2DM [HTN(T2DM+)] and 37 age- and sex-matched controls underwent cardiac magnetic resonance examination. Left ventricular (LV) myocardial strains, including global radial (GRPS), circumferential (GCPS) and longitudinal peak strain (GLPS), and resting myocardial perfusion indices, including upslope, time to maximum signal intensity (TTM), and max signal intensity (MaxSI), were measured and compared among groups by analysis of covariance after adjusting for age, sex, body mass index (BMI) and heart rate followed by Bonferroni’s post hoc test. Backwards stepwise multivariable linear regression analyses were performed to determine the effects of T2DM on LV strains and myocardial perfusion indices in patients with hypertension. Results Both GRPS and GLPS deteriorated significantly from controls, through HTN(T2DM−), to HTN(T2DM+) group; GCPS in HTN(T2DM+) group was lower than those in both HTN(T2DM−) and control groups. Compared with controls, HTN(T2DM−) group showed higher myocardial perfusion, and HTN(T2DM+) group exhibited lower perfusion than HTN(T2DM−) group and controls. Multiple regression analyses considering covariates of systolic blood pressure, age, sex, BMI, heart rate, smoking, indexed LV mass and eGFR demonstrated that T2DM was independently associated with LV strains (GRPS: p = 0.002, model R2= 0.383; GCPS: p < 0.001, model R2= 0.472; and GLPS: p = 0.002, model R2= 0.424, respectively) and perfusion indices (upslope: p < 0.001, model R2= 0.293; TTM: p < 0.001, model R2= 0.299; and MaxSI: p < 0.001, model R2= 0.268, respectively) in hypertension. When both T2DM and perfusion indices were included in the regression analyses, both T2DM and TTM were independently associated with GRPS (p = 0.044 and 0.017, model R2= 0.390) and GCPS (p = 0.002 and 0.001, model R2= 0.424), and T2DM but not perfusion indices was independently associated with GLPS (p = 0.002, model R2= 0.424). Conclusion In patients with hypertension, T2DM had an additive deleterious effect on subclinical LV systolic dysfunction and myocardial perfusion, and impaired myocardial perfusion by coexisting T2DM was associated with deteriorated LV systolic dysfunction.
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Affiliation(s)
- Xue-Ming Li
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.,Department of Radiology, Sichuan Cancer Hospital and Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, 55# Lan 4 RenMing Road (South), Chengdu, 610041, Sichuan, People's Republic of China
| | - Li Jiang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Ying-Kun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, 20# South Renmin Road, Chengdu, 610041, Sichuan, People's Republic of China
| | - Yan Ren
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Pei-Lun Han
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Li-Qing Peng
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, 610041, Sichuan, People's Republic of China.
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16
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Tadic M, Cuspidi C, Pencic B, Grassi G, Celic V. Myocardial work in hypertensive patients with and without diabetes: An echocardiographic study. J Clin Hypertens (Greenwich) 2020; 22:2121-2127. [DOI: 10.1111/jch.14053] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/19/2020] [Accepted: 08/29/2020] [Indexed: 12/19/2022]
Affiliation(s)
- Marijana Tadic
- Department of Cardiology University Hospital “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Cesare Cuspidi
- Department of Medicine and Surgery University Milano‐Bicocca Milano Italy
- Clinical Research Unit Istituto Auxologico Italiano IRCCS Meda Italy
| | - Biljana Pencic
- Department of Cardiology University Hospital “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
| | - Guido Grassi
- Department of Medicine and Surgery University Milano‐Bicocca Milano Italy
| | - Vera Celic
- Department of Cardiology University Hospital “Dr. Dragisa Misovic ‐ Dedinje” Belgrade Serbia
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17
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Ancedy Y, Ederhy S, Jean ML, Nhan P, Soulat-Dufour L, Adavane-Scheuble S, Chauvet-Droit M, Boccara F, Cohen A. Does layer-specific strain using speckle tracking echocardiography improve the assessment of left ventricular myocardial deformation? A review. Arch Cardiovasc Dis 2020; 113:721-735. [PMID: 32891564 DOI: 10.1016/j.acvd.2020.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/25/2022]
Abstract
An increasing number of studies of left ventricular myocardial deformation have been published. Layer-specific strain using speckle tracking echocardiography to evaluate left ventricular function is not recommended in clinical practice. However, evaluation of myocardial mechanics using longitudinal and circumferential layer-specific strain enables the detection of subclinical impairment of myocardial deformation in various diseases. Unfortunately, normal values for longitudinal and circumferential strain have not been clearly defined. In normal subjects, layer-specific strain decreases from the endocardial to the epicardial layer, and from the apex to the base of the left ventricle. Although various studies have tried to define normal values for each layer in healthy subjects, studies with more subjects are needed. This tool has good reproducibility in terms of intraobserver and interobserver variability, but, as with monolayer strain, it has poor intervendor variability. Efforts that aim for standardization between vendors will be required before widespread use of this technique can be advocated.
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Affiliation(s)
- Yann Ancedy
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Stephane Ederhy
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Marie-Liesse Jean
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Pascal Nhan
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Laurie Soulat-Dufour
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Saroumadi Adavane-Scheuble
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Marion Chauvet-Droit
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Franck Boccara
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France
| | - Ariel Cohen
- Service de Cardiologie, Hôpital Saint-Antoine, AP-HP, Université Pierre-et-Marie-Curie, Paris-Sorbonne, 75571 Paris, France.
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18
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The relationship between functional capacity and left ventricular strain in patients with uncomplicated type 2 diabetes. J Hypertens 2020; 37:1871-1876. [PMID: 31045966 DOI: 10.1097/hjh.0000000000002125] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE We aimed to evaluate the association between functional capacity and left ventricular (LV) mechanics in the patients with uncomplicated type 2 diabetes. METHODS The present cross-sectional study included 80 controls and 70 uncomplicated diabetic patients. These participants underwent laboratory analysis, comprehensive echocardiographic examination and cardiopulmonary exercise testing. RESULTS Global longitudinal (-21.6 ± 2.8 vs. -18.4 ± 2.3%, P < 0.001) and circumferential (-22.0 ± 2.9 vs. -19.5 ± 2.6%, P < 0.001) strains were significantly reduced in diabetic participants. The same was found for longitudinal and circumferential endocardial, mid-myocardial and epicardial strains. Peak oxygen uptake (27.0 ± 4.3 vs. 20.7 ± 4.0 ml/kg/min, P < 0.001) and oxygen pulse (14.1 ± 3.0 vs. 11.6 ± 3.2 ml/beat, P < 0.001) were significantly lower in the diabetic group, while ventilation/carbon dioxide slope was significantly higher in these patients. In the whole study population glycosylated hemoglobin, as well as LV endocardial longitudinal and circumferential strains were independently of other clinical and echocardiographic parameters of LV structure, systolic and diastolic function associated with peak oxygen consumption and oxygen pulse. CONCLUSION Our investigation showed that diabetes equally affected all LV myocardial layers. Endocardial LV longitudinal and circumferential strains, as well as glycosylated hemoglobin - main parameter of glucose regulation, were independently associated with functional capacity in the whole study population. These findings indicate that determination of LV strain and functional capacity could detect subclinical target organ damage and prevent development of further complications in uncomplicated diabetes mellitus patients.
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19
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Badran HM, Ibrahim WA, Alaksher T, Soltan G. Impact of the left anterior descending artery wrapping around the left ventricular apex on cardiac mechanics in patients with normal coronary angiography. Egypt Heart J 2020; 72:33. [PMID: 32495302 PMCID: PMC7270221 DOI: 10.1186/s43044-020-00059-z] [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: 03/13/2020] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
Background We examined the impact of left anterior descending (LAD) wrapping on left ventricular (LV) mechanics in patients with normal coronary angiography. Seventy-one patients with evidence of normal coronary angiography (LAD wrapping: n = 52, 73%) and LAD non-wrapping (n = 19, 27%) were included in the study. Using 2D-strain imaging, we measured LV longitudinal and circumferential (circ) strain (εsys), systolic strain rate (SRsys), early (SRe) and atrial (SRa) diastolic SR, LV electromechanical dyssynchrony (TTP-SD), and LV twist and torsion in study groups. Results No significant difference in age, gender, body surface area (BSA), or ejection fraction (EF%) between groups. LAD-wrapping group showed higher deceleration time (DT) (P < 0.0001), global longitudinal εsys % (P < 0.02), circ SRa at the basal segments (P < .02), circ SRsys and SRe, and SRa (P < 0.0001) at the apical segments and apical rotation compared with the non-wrapped group. LV twist was correlated negatively with LV electromechanical dyssynchrony (r = .25, P < 0.03) and positively with longitudinal εsys (r = .47, P < .0001), circ εsys% (r = .55, P < .0001), circ SRsys (r = .23, P < .05), and circ SRe (r = .55, P < .0001). Using multivariate regression analysis, DT: OR 0.932, CI 0.877–0.991, and P < 0.02 and circ at atrial diastole (SRa): OR 0.000, CI .000–.271, and P < 0.03 were independent predictors of LAD wrapping around LV apex. Conclusion Wrapped LAD is associated with better myocardial relaxation and rotational mechanics in patients with normal coronary angiography. This could explain the worse prognosis in such population when LAD occlusion acutely emerges.
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Affiliation(s)
| | | | | | - Ghada Soltan
- Menoufia University, P.O box 34, 55-El Gish street, Tanta, Egypt
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20
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Tadic M, Cuspidi C, Calicchio F, Grassi G, Mancia G. Diagnostic algorithm for HFpEF: how much is the recent consensus applicable in clinical practice? Heart Fail Rev 2020; 26:1485-1493. [PMID: 32346825 DOI: 10.1007/s10741-020-09966-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Heart failure with preserved ejection fraction (HFpEF) represents an important cardiovascular entity with increasing prevalence and relatively high mortality. The agreement about diagnostic algorithm for HFpEF is still missing. Echocardiographic approach remains the cornerstone in HFpEF diagnosis. Echocardiographic diastolic stress test provides numerous useful parameters that correlated well with indexes obtained by cardiac catheterization. Recently published consensus recommended new scoring system that included functional and structural echocardiographic parameters, as well as biomarkers. The new score for evaluation of HFpEF introduces a new set of parameters and proposed novel cutoff values for some of them. There are several important points that need to be resolved before full acceptance and clinical usage. First, some cutoff values are new and represent the result of expert consensus, without previous validation. Second, many patients with hypertension, obesity, and diabetes would be referred for further investigations as the result of this scoring, which is difficult to achieve in clinical circumstances. Third, the consensus equalized non-invasive and invasive diastolic stress tests in diagnosing of HFpEF, which is not a small issue. Namely, even though cardiac catheterization provides the final confirmation of elevated left ventricular filling pressures, it is still an invasive method, associated with procedural risk and other limitations. The aim of this review was to summarize the current knowledge diagnosis of HFpEF, as well as the recent consensus about diagnostic algorithm in patients with suspected HFpEF with its advantages and disadvantages.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Heroja Milana Tepica 1, Belgrade, 11000, Serbia.
| | - Cesare Cuspidi
- University of Milan-Bicocca, Milan, Italy.,Clinical Research Unit, Istituto Auxologico Italiano, Viale della Resistenza 23, 20036, Meda, Italy
| | | | | | - Giuseppe Mancia
- University of Milan-Bicocca, Milan, Italy.,Policlinico di Monza, Monza, Italy
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21
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Tadic M, Cuspidi C. Left ventricular strain and arterial hypertension: Is longitudinal strain ready for primetime? J Clin Hypertens (Greenwich) 2020; 22:683-685. [PMID: 32073217 DOI: 10.1111/jch.13833] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 02/03/2020] [Accepted: 02/04/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Hospital "Dr. Dragisa Misovic - Dedinje", Belgrade, Serbia
| | - Cesare Cuspidi
- Clinical Research Unit, University of Milan-Bicocca and Istituto Auxologico Italiano, Meda, Italy
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22
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Right Heart Remodeling in Patients with End-Stage Alcoholic Liver Cirrhosis: Speckle Tracking Point of View. J Clin Med 2019; 8:jcm8091285. [PMID: 31443575 PMCID: PMC6780282 DOI: 10.3390/jcm8091285] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/11/2019] [Accepted: 08/20/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Data regarding cardiac remodeling in patients with alcoholic liver cirrhosis are scarce. We sought to investigate right atrial (RA) and right ventricular (RV) structure, function, and mechanics in patients with alcoholic liver cirrhosis. METHODS This retrospective cross-sectional investigation included 67 end-stage cirrhotic patients, who were referred for evaluation for liver transplantation and 36 healthy controls. All participants underwent echocardiographic examination including strain analysis, which was performed offline. RESULTS RV basal diameter and RV thickness were significantly higher in patients with cirrhosis. Conventional parameters of the RV systolic function were similar between the observed groups. Global, endocardial, and epicardial RV longitudinal strains were significantly lower in patients with cirrhosis. Active RA function was significantly higher in cirrhotic patients than in controls. The RA reservoir and conduit strains were significantly lower in cirrhotic patients, while there was no difference in the RA contractile strain. Early diastolic and systolic RA strain rates were significantly lower in cirrhotic patients than in controls, whereas there was no difference in the RA late diastolic strain rate between the two groups. Transaminases and bilirubin correlated negatively with RV global longitudinal strain and RV-free wall strain in patients with end-stage liver cirrhosis. The Model for End-stage Liver Disease (MELD) score, predictor of 3-month mortality, correlated with parameters of RV structure and systolic function, and RA active function in patients with end-stage liver cirrhosis. CONCLUSIONS RA and RV remodeling is present in patients with end-stage liver cirrhosis even though RV systolic function is preserved. Liver enzymes, bilirubin, and the MELD score correlated with RV and RA remodeling.
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23
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Bogdanović J, Ašanin M, Krljanac G, Lalić NM, Jotić A, Stanković S, Rajković N, Stošić L, Rasulić I, Milin J, Popović D, Bogdanović L, Lalić K. Impact of acute hyperglycemia on layer-specific left ventricular strain in asymptomatic diabetic patients: an analysis based on two-dimensional speckle tracking echocardiography. Cardiovasc Diabetol 2019; 18:68. [PMID: 31159858 PMCID: PMC6545629 DOI: 10.1186/s12933-019-0876-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 05/28/2019] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Hyperglycemia has detrimental effect on ischemic myocardium, but the impact of acute hyperglycemia on the myocardium in asymptomatic diabetic patients has not been fully elucidated. Thus, this follow-up study was aimed to investigate the effects and reversibility of acute hyperglycemia on regional contractile function of left ventricle (LV) in diabetic patients without cardiovascular disease. METHODS The two-dimensional speckle tracking echocardiography (2D-STE), including multilayer strain analysis, was used for evaluation of global and regional LV function in asymptomatic, normotensive patients with uncomplicated diabetes, with acute hyperglycemia ( ≥ 11.1 mmol/l) (Group A, n = 67), or with optimal metabolic control (fasting plasma glucose < 7 mmol/l and HbA1c < 7%) (Group B, n = 20), while 20 healthy individuals served as controls (Group C). In group A, after 72 h of i.v. continuous insulin treatment (at the time euglycemia was achieved) (second examination) and after 3 months following acute hyperglycemia (third examination) 2D-STE was repeated. RESULTS Global longitudinal strain (GLS) (- 19.6 ± 0.4%) in Group A was significantly lower in comparison to both groups B (- 21.3 ± 0.4%; p < 0.05) and C (- 21.9 ± 0.4%; p < 0.01) at baseline, while we could not detect the differences between groups B and C. Peak systolic longitudinal endocardial (Endo), mid-myocardial (Mid) and epicardial (Epi) layer strain were significantly lower in group A at baseline compared to both groups B and C. Deterioration in peak systolic circumferential strain was observed at basal LV level, in all three layers (Endo, Mid and Epi) and in mid-cavity LV level in Epi layer in group A in comparison to group C. Moreover, in group A, after euglycemia was achieved (at second and third examination) GLS, as well as peak longitudinal and circumferential strain remain the same. CONCLUSION Acute hyperglycemia in asymptomatic diabetic patients has significant negative effects on systolic LV myocardial mechanics primarily by reducing GLS and multilayer peak systolic longitudinal and circumferential strain which was not reversible after three months of good glycemic control.
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Affiliation(s)
- Jelena Bogdanović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia
| | - Milika Ašanin
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Clinic for Cardiology, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Gordana Krljanac
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Clinic for Cardiology, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Nebojša M Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Aleksandra Jotić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Sanja Stanković
- Center for Medical Biochemistry, Clinical Center of Serbia, Pasterova 2, Belgrade, 11000, Serbia
| | - Nataša Rajković
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Ljubica Stošić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia.,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia
| | - Iva Rasulić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia
| | - Jelena Milin
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Institute for Medical Statistics and Informatics, dr Subotića 15, Belgrade, 11000, Serbia
| | - Dragana Popović
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia
| | - Ljiljana Bogdanović
- Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.,Institute for Pathology, dr Subotića 1, Belgrade, 11000, Serbia
| | - Katarina Lalić
- Clinic for Endocrinology, Diabetes and Metabolic Diseases, Clinical Center of Serbia, dr Subotića 13, Belgrade, 11000, Serbia. .,Faculty of Medicine, University of Belgrade, dr Subotića 8, Belgrade, 11000, Serbia.
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24
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Shiino K, Yamada A, Scalia GM, Putrino A, Chamberlain R, Poon K, Walters DL, Chan J. Early Changes of Myocardial Function After Transcatheter Aortic Valve Implantation Using Multilayer Strain Speckle Tracking Echocardiography. Am J Cardiol 2019; 123:956-960. [PMID: 30594290 DOI: 10.1016/j.amjcard.2018.12.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 12/05/2018] [Accepted: 12/13/2018] [Indexed: 02/06/2023]
Abstract
Transcatheter aortic valve implantation (TAVI) is an effective therapeutic option for severe symptomatic aortic valve stenosis (AS) with intermediate or high surgical risk. The purpose of this study was to examine the effects of TAVI on left ventricular (LV) mechanics using multilayer global longitudinal strain (GLS) by 2D speckle-tracking echocardiography. A total of 119 patients (mean age 83 ± 7.0 years, male 54%) with severe symptomatic AS and normal LV ejection fraction (LVEF) underwent echocardiography at baseline and 1 month after TAVI. Global longitudinal strain was measured from the endocardial layer (GLSendo), mid-ventricular layer (GLSmyo), epicardial layer (GLSepi) and full thickness of myocardium (GLSwhole). There was significant improvement in all 3 layers of GLS after TAVI compared with baseline, but there was no significant change in LVEF. The relative % increment in GLS in each layer strain were 11.2 ± 23.4% (GLSendo), 13.4 ± 33.0% (GLSmyo) and 18.0 ± 46.6% (GLSepi) with significant difference between GLSendo and GLSepi (p < 0.05). In conclusion, multilayer GLS is more sensitive than conventional LVEF to detect early improvement in LV systolic function after TAVI in patients with severe AS. There is a disproportional improvement in different layers with least improvement in the endocardium. Multilayer strain analysis may provide new insights into understanding mechanics of AS.
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25
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Xing Y, Shi J, Yan Y, Liu Y, Chen Y, Kong D, Shu X, Pan C. Subclinical myocardial dysfunction in coronary slow flow phenomenon: Identification by speckle tracking echocardiography. Microcirculation 2018; 26:e12509. [PMID: 30365186 DOI: 10.1111/micc.12509] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Revised: 10/13/2018] [Accepted: 10/19/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVE This study aimed to determine whether STE could help detect subclinical myocardial dysfunction in patients with CSFP. METHODS Sixty patients with CSFP confirmed by CAG and 51 controls with normal coronary flow were prospectively enrolled. Coronary angiographic data and conventional and speckle tracking echocardiographic parameters of the LV and RV were obtained for every subject. RESULTS Compared with controls, CSFP patients presented with higher BMI and TG levels, but lower HDL-C levels. Conventional echocardiographic parameters of biventricular systolic and diastolic function did not differ between the two groups (all P > 0.05). The GLS of the LV and RV was significantly impaired in CSFP patients compared with that in controls (-19.03% vs -21.42%, P < 0.001 and -19.72% vs -22.96%, P = 0.001, respectively). The myocardial impairment pattern of CSFP patients was homogenous in the RV and heterogeneous in the LV, where only endo- and mid-myocardial layers were affected. LV-GLS and RV-GLS were found to be well correlated with mTFC and HDL-C in CSFP groups (r = 0.463 vs r = 0.439; r = -0.569 vs r = -0.552, all P < 0.05). ROC curve analysis demonstrated that LV-GLS-endo had the highest AUC (0.867, P < 0.001) for predicting subclinical myocardial impairment in CSFP patients. CONCLUSIONS Subclinical myocardial systolic dysfunction occurs in both ventricles, and GLS could be an effective method to detect early-stage myocardial impairment in patients with CSFP.
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Affiliation(s)
- Yumeng Xing
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Jing Shi
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yan Yan
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Yu Liu
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Yongle Chen
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Dehong Kong
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
| | - Xianhong Shu
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.,Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, Shanghai, China
| | - Cuizhen Pan
- Department of Echocardiography, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China
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26
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Yılmaztepe MA, Uçar FM. Layer-specific strain analysis in patients with suspected stable angina pectoris and apparently normal left ventricular wall motion. Cardiovasc Ultrasound 2018; 16:25. [PMID: 30257673 PMCID: PMC6158830 DOI: 10.1186/s12947-018-0144-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 09/12/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-invasive imaging tests are widely used in the evaluation of stable angina pectoris (SAP). Despite these tests, non-significant coronary lesions are not a rare finding in patients undergoing elective coronary angiography (CAG). Two-dimensional (2D) speckle tracking global longitudinal strain (GLS) imaging is a more sensitive and accurate technique for measuring LV function than conventional 2D methods. Layer-specific strain analysis is a relatively new method that provides endocardial and epicardial myocardial layer assessment. The aim of the present study was to evaluate longitudinal layer-specific strain (LSS) imaging in patients with suspected SAP. METHODS Patients who underwent CAG for SAP were retrospectively screened. A total of 79 patients with no history of heart disease and wall motion abnormalities were included in the study. Forty-three patients with coronary lesions > 70% constituted the coronary artery disease (CAD) group and 36 patients without significant CAD constituted the control group. Layer-specific GLS transmural, endocardium, and epicardium values (GLS-trans, GLS-endo, and GLS-epi, respectively) were compared between the groups. RESULTS Patients in the CAD group had significantly lower GLS values in all layers (GLS-trans: -18.2 + 2.4% vs -22.2 + 2.2% p < .001; GLS-endo: -20.8 + 2.8% vs -25.3 + 2.6%, p < .001; GLS-epi: 15.9 + 2.4% vs -19.5 + 1.9%, p < .001). Multivariate adjustment demonstrated GLS-trans as the only independent predictor of CAD [OR:0.472, CI (0.326-0.684), p < .001]. Additionally, the GLS values were all lower in myocardial perfusion scintigraphy (MPS) true-positive patients compared with MPS false-positive patients (GLS-trans: -17.7 ± 2.4 vs. -21.9 ± 2.4%, p < .001; GLS-endo: -20.2 ± 2.9% vs -24.9 ± 2.9%, P < .001; GLS-epi: 15.4 ± 2.6% vs. -19.2 ± 1.8%, P < .001). CONCLUSION Resting layer-specific strain as assessed by 2D speckle tracking analysis demonstrated that GLS values were reduced in all layers of myocardium with SAP and with no wall motion abnormalities. LSS analysis can improve the identification of patients with significant CAD but further prospective larger scale studies are needed to put forth the incremental value of LSS analysis over transmural GLS.
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Affiliation(s)
| | - Fatih Mehmet Uçar
- Department of Cardiology, School of Medicine, Trakya University, 22030, Edirne, Turkey
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