1
|
Tang SS, Shi R, Yang ZG, Wang J, Min CY, Yan WF, Zhang Y, Li Y. Incremental Effect of Mitral Regurgitation on Left Atrial Dysfunction and Atrioventricular Interaction in Hypertensive Patients by MRI. J Magn Reson Imaging 2023; 58:1125-1136. [PMID: 36733221 DOI: 10.1002/jmri.28604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/04/2023] [Accepted: 01/05/2023] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Mitral regurgitation may occur when hypertension causes left ventricular (LV) and left atrial (LA) remodeling. However, its role in LA function in hypertensive patients remains unclear. PURPOSE To explore how mitral regurgitation affects LA function in hypertension and to investigate atrioventricular interaction in hypertensive patients with mitral regurgitation. STUDY TYPE Retrospective. POPULATION A total of 193 hypertensive cases and 64 controls. FIELD STRENGTH/SEQUENCE A 3.0 T/balanced steady-state free precession. ASSESSMENT LA volume (LAV), LA strain (reservoir, conduit, and active), LA ejection fraction, and LV strain (global peak longitudinal [GLS], circumferential [GCS], and radial strain [GRS]) were evaluated and compared among groups. Regurgitant fraction (RF) was evaluated in regurgitation patients and used to subdivide patients into mild (RF: 0%-30%), moderate (RF: 30%-50%), and severe (RF: >50%) regurgitation categories. STATISTICAL TESTS One-way analysis of variance, Spearman and Pearson's correlation coefficients (r), and multivariable linear regression analysis. A P value <0.05 was considered statistically significant. RESULTS Hypertensive patients without mitral regurgitation showed significantly impaired LA reservoir and conduit functions and significantly decreased LV GLS but preserved pump function and LAV compared to controls (P = 0.193-1.0). Hypertensive cases with mild regurgitation (N = 22) had significantly enlarged LAV and further reduced LA reservoir function, while the group with moderate regurgitation (N = 20) showed significantly reduced LA pump function, further impaired conduit function, and significantly reduced LV strain. The severe regurgitation (N = 13) group demonstrated significantly more severely impaired LA and LV functions and LAV enlargement. Multivariable linear regression showed that regurgitation degree, GRS, GCS, and GLS were independently correlated with the LA reservoir, conduit, and active strain in hypertensive patients with mitral regurgitation. DATA CONCLUSION Mitral regurgitation may exacerbate LA and LV impairment in hypertension. Regurgitation degree, LV GRS, GCS, and GLS were independent determinants of the LA strain in hypertensive patients with mitral regurgitation, which demonstrated atrioventricular interaction. EVIDENCE LEVEL 4. TECHNICAL EFFICACY Stage 3.
Collapse
Affiliation(s)
- Si-Shi Tang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Department of Radiology, Chengdu Fifth People's Hospital, Chengdu, Sichuan, China
| | - Rui Shi
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Jin Wang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Chen-Yan Min
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Wei-Feng Yan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yi Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| |
Collapse
|
2
|
Sonaglioni A, Nicolosi GL, Bianchi S, Lombardo M. Obesity in pregnancy is a predictor of persistent subclinical myocardial dysfunction over postpartum period. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1895-1907. [PMID: 37726614 DOI: 10.1007/s10554-022-02579-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 02/23/2022] [Indexed: 11/05/2022]
Abstract
PURPOSE No previous study provided a complete functional evaluation of all cardiac chambers in pregnant women with obesity. Moreover, the impact of cardiovascular changes associated with obesity in pregnancy on maternal outcome is unclear. METHODS 46 consecutive pregnant women with obesity, defined by body mass index (BMI) ≥ 30 Kg/m2, and 83 age- (35.5 ± 4.1 vs. 34.1 ± 5.1 yrs, p = 0.11), ethnicity- (caucasian 65.2 vs. 66.3%, p = 0.90) and gestational week-matched (36.3 ± 1.7 vs. 36.5 ± 1.5 wks, p = 0.49) pregnant women without obesity (BMI < 30 Kg/m2) were examined in the first trimester (12-14 weeks), third trimester (36-38 weeks) and 6-10 weeks postpartum. All women underwent obstetric visit, blood tests and transthoracic echocardiography implemented with two-dimensional speckle tracking echocardiography analysis of biventricular and biatrial myocardial deformation indices at the three time points. Outcome was persistent subclinical myocardial dysfunction, defined as an absolute value of left ventricular global longitudinal strain (LV-GLS) less negative than - 20%, in postpartum. RESULTS Despite normal biventricular systolic function, all myocardial strain indices were significantly lower in pregnant women with obesity than controls. At 8.2 ± 2.2 weeks postpartum, LV-GLS remained less negative than - 20% in 86.9% of women with obesity in pregnancy. Maternal age (OR 1.68, 95%CI 1.14-2.48), third trimester BMI (OR 7.17, 95%CI 1.77-28.9) and third trimester neutrophil-to-lymphocyte ratio (NLR) (OR 1.75, 95%CI 1.22-2.51) were independently associated with outcome. Maternal age ≥ 35 years, BMI ≥ 30 Kg/m2 and NLR ≥ 5.5 were the optimal cut-off values for predicting persistent subclinical myocardial dysfunction in postpartum. CONCLUSIONS Pregnant women with obesity, age ≥ 35 yrs and low chronic inflammation have significantly increased risk of persistent subclinical myocardial dysfunction over postpartum.
Collapse
Affiliation(s)
- Andrea Sonaglioni
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy.
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy.
| | | | - Stefano Bianchi
- Department of Gynecology and Obstetrics, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - Michele Lombardo
- Department of Cardiology, Ospedale San Giuseppe MultiMedica IRCCS, Via San Vittore 12, 20123, Milano, Italy
| |
Collapse
|
3
|
Özyildiz A, Ergül E, Emlek N, Özyildiz A, Duman H, Çetin M. Effect of coronavirus disease-2019 infection on left atrial functions. J Cardiovasc Echogr 2022; 32:89-94. [PMID: 36249439 PMCID: PMC9558639 DOI: 10.4103/jcecho.jcecho_83_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/16/2022] [Accepted: 03/27/2022] [Indexed: 12/03/2022] Open
Abstract
Objective: Left atrial (LA) dysfunction is a crucial risk factor for cardiovascular events, and various pathologies may affect LA function. Coronavirus disease-2019 (COVID-19) is an ongoing global pandemic causing morbidity and mortality. In the present study, we aimed to evaluate LA functions in patients who recovered from COVID-19. Methods: Sixty consecutive patients recovered from COVID-19 and 60 healthy individuals as a control group were included in the study. Blood samples and echocardiography measurements were obtained from each subject. The two groups were compared in terms of demographic and echocardiographic characteristics. Results: In the COVİD-19 group, LA maximum volume (LAVmax) (P = 0.040), LA pre-A volume (LAVpre-A) (P = 0.014), and LA active emptying fraction (P = 0.027) were higher, while LA passive emptying fraction (P = 0.035) was lower. In addition, left ventricular ejection fraction (P = 0.006) and isovolumetric relaxation time (P = 0.008) were decreased in this group. Although LA volume index was higher in the COVID-19 group, it does not reach statistical significance. Conclusion: LA functions may be impaired in patients recovered from COVID-19 infection.
Collapse
|
4
|
Genovese D, Muraru D, Marra MP, Carrer A, Previtero M, Palermo C, Tarantini G, Parati G, Iliceto S, Badano LP. Left Atrial Expansion Index for Noninvasive Estimation of Pulmonary Capillary Wedge Pressure: A Cardiac Catheterization Validation Study. J Am Soc Echocardiogr 2021; 34:1242-1252. [PMID: 34311063 DOI: 10.1016/j.echo.2021.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pulmonary capillary wedge pressure (PCWP) plays a pivotal role in cardiac disease diagnosis and management. Right heart catheterization (RHC) invasively provides accurate PCWP measurement, but it is impractical for widespread use in all patients. The left atrial expansion index (LAEI), measured on transthoracic echocardiography, describes the relative left atrial volume increase during the left atrial reservoir phase. The aim of this study was to validate LAEI as a noninvasive parameter for PCWP estimation. METHODS A total of 649 chronic cardiac patients (mean age, 66 ± 14 years; mean PCWP, 14 ± 7.6 mm Hg; mean left ventricular ejection fraction, 50 ± 15%) who underwent both clinically indicated RHC and transthoracic echocardiography within 24 hours were retrospectively enrolled. Patients were randomly divided into derivation (n = 509) and validation (n = 140) cohorts. PCWP was measured during RHC and defined as elevated when >12 mm Hg. Transthoracic echocardiographic parameters and LAEI were measured offline, blinded to RHC results. RESULTS In the derivation cohort, LAEI correlated logarithmically with PCWP, and the log-transformed LAEI (lnLAEI) correlated linearly with PCWP (r = -0.73, P < .001). lnLAEI showed an independent and additive predictive role for PCWP estimation over clinical and diastolic dysfunction (DD) parameters. The diagnostic accuracy of lnLAEI for elevated PCWP identification (area under the curve = 0.875, P < .001; optimal lnLAEI cutoff < 4.02) was higher than either the single DD parameters or their combination. In the validation cohort, lnLAEI cutoff < 4.02 showed higher accuracy than the 2016 DD algorithm (88% vs 74%) for elevated PCWP identification. Finally, the equation PCWP = 38.3 - 6.2 × lnLAEI, obtained from the derivation cohort, predicted invasively measured PCWP in the validation cohort. CONCLUSIONS In a cohort of patients with various chronic cardiac diseases, lnLAEI performed better than DD parameters and the 2016 DD algorithm for PCWP estimation. lnLAEI might be a useful echocardiographic parameter for noninvasive PCWP estimation.
Collapse
Affiliation(s)
- Davide Genovese
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Denisa Muraru
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy; Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Anna Carrer
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Palermo
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy; Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy; Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| |
Collapse
|
5
|
Romano G, Magro S, Agnese V, Mina C, Di Gesaro G, Falletta C, Pasta S, Raffa G, Baravoglia CMH, Novo G, Gandolfo C, Clemenza F, Bellavia D. Echocardiography to estimate high filling pressure in patients with heart failure and reduced ejection fraction. ESC Heart Fail 2020; 7:2268-2277. [PMID: 32692489 PMCID: PMC7524233 DOI: 10.1002/ehf2.12748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023] Open
Abstract
AIMS Echocardiographic assessment of left ventricular filling pressures is performed using a multi-parametric algorithm. Unselected sample of patients with heart failure with reduced ejection fraction (HFrEF) patients may demonstrate an indeterminate status of diastolic indices making interpretation challenging. We sought to test improvement in the diagnostic accuracy of standard and strain echocardiography of the left ventricle and left atrium (LA) to estimate a pulmonary capillary wedge pressure (PCWP) > 15 mmHg in patients with HFrEF. METHODS AND RESULTS Out of 82 consecutive patients, 78 patients were included in the final analysis and right heat catheterization, and echocardiogram was performed simultaneously. According to the univariable analysis, E wave velocity, the ratio between E-wave/A-wave (E/A, area under the curve [AUC] = 0.81, respectively), isovolumic relaxation time (AUC = 0.83), pulmonary vein D wave (AUC = 0.84), pulmonary vein S/D Ratio (AUC = 0.85), early pulmonary regurgitation velocity (AUC = 0.80), and accelerationa time at right ventricular out-flow tract (RVOT AT, AUC = 0.84) identified with the highest accuracy PCWP > 15 mmHg. They were all tested in multivariate analysis, and they were not independently correlated with PCWP. Tricuspid regurgitation (TR) velocity was measurement with the highest predictive value in identifying PCWP > 15 mmHg (AUC = 0.89), compared with other established parameters such as the ratio between e-wave velocity divided by mitral annular e' velocity (E/e'), deceleration time, or LA indexed volume (LAVi), which all reached a lower accuracy level (AUC = 0.75; 0.78; 0.76). Among strain measures, global longitudinal strain in four chamber view (GLS 4ch), the ratio between e-wave velocity divided by mitral annular e' strain rate (E/e'sr), and LA longitudinal strain at the reservoir phase were helpful in estimating elevated PCWP (AUC = 0.77; 0.76; 0.75). According to multivariable analysis, the following two models had the greatest accuracy in detecting PCWP > 15 mmHg: (i) TR velocity, LAVi, and E wave velocity (receiver operating characteristic [ROC]-AUC = 0.98), (ii) AT RVOT, LAVi and GLS 4ch (ROC-AUC = 0.96). Neither E/A (ROC-AUC = 0.81) nor E/e' (ROC-AUC = 0.75) was an independent predictor when included in the model. The two MODELS were applicable to the entire population and demonstrated better agreement with the invasive reference (91% and 88%) than the guidelines algorithm (77%) regardless of the type of rhythm. CONCLUSIONS Our suggested echocardiographic approach could be used to potentially reduce the frequency of "doubtful" classification and increase the accuracy in predicting elevated left ventricular filling pressure leading to a decrease in the number of invasive assessment made by right heart catheterization.
Collapse
Affiliation(s)
- Giuseppe Romano
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Serena Magro
- Cardiology Unit and Cardiac Rehabilitation UnitCasa di Cura Candela S.P.A.PalermoItaly
| | - Valentina Agnese
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Chiara Mina
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Gabriele Di Gesaro
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Calogero Falletta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Salvatore Pasta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
- Fondazione Ri.MEDPalermoItaly
| | - Giuseppe Raffa
- Cardiac Surgery and Heart Transplantation Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Cesar Mario Hernandez Baravoglia
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Giuseppina Novo
- Dipartimento di Promozione della Salute, Materno‐Infantile, di Medicina Interna e Specialistica di Eccellenza “G. D'Alessandro”, CardiologiaUniversità di PalermoPalermoItaly
| | - Caterina Gandolfo
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Francesco Clemenza
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| | - Diego Bellavia
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic TransplantationIRCCS‐ISMETTPalermoItaly
| |
Collapse
|
6
|
Kadry K, Pagoulatou S, Mercier Q, Rovas G, Bikia V, Müller H, Adamopoulos D, Stergiopulos N. Biomechanics of diastolic dysfunction: a one-dimensional computational modeling approach. Am J Physiol Heart Circ Physiol 2020; 319:H882-H892. [PMID: 32822212 DOI: 10.1152/ajpheart.00172.2020] [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] [Indexed: 01/09/2023]
Abstract
Diastolic dysfunction (DD) is a major component of heart failure with preserved ejection fraction (HFpEF). Accordingly, a profound understanding of the underlying biomechanical mechanisms involved in DD is needed to elucidate all aspects of HFpEF. In this study, we have developed a computational model of DD by leveraging the power of an advanced one-dimensional arterial network coupled to a four-chambered zero-dimensional cardiac model. The two main pathologies investigated were linked to the active relaxation of the myocardium and the passive stiffness of the left ventricular wall. These pathologies were quantified through two parameters for the biphasic delay of active relaxation, which simulate the early and late-phase relaxation delay, and one parameter for passive stiffness, which simulates the increased nonlinear stiffness of the ventricular wall. A parameter sensitivity analysis was conducted on each of the three parameters to investigate their effect in isolation. The three parameters were then concurrently adjusted to produce the three main phenotypes of DD. It was found that the impaired relaxation phenotype can be replicated by mainly manipulating the active relaxation, the pseudo-normal phenotype was replicated by manipulating both the active relaxation and passive stiffness, and, finally, the restricted phenotype was replicated by mainly changing the passive stiffness. This article presents a simple model producing a holistic and comprehensive replication of the main DD phenotypes and presents novel biomechanical insights on how key parameters defining the relaxation and stiffness properties of the myocardium affect the development and manifestation of DD.NEW & NOTEWORTHY This study uses a complete and validated computational model of the cardiovascular system to simulate the two main pathologies involved in diastolic dysfunction (DD), i.e., abnormal active relaxation and increased ventricular diastolic stiffness. The three phenotypes of DD were successfully replicated according to literature data. We elucidate the biomechanical effect of the relaxation pathologies involved and how these pathologies interact to create the various phenotypes of DD.
Collapse
Affiliation(s)
- Karim Kadry
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Stamatia Pagoulatou
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Quentin Mercier
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Georgios Rovas
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Vasiliki Bikia
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Hajo Müller
- Department of Cardiology, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | - Nikolaos Stergiopulos
- Laboratory of Hemodynamics and Cardiovascular Technology, Ecole Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| |
Collapse
|
7
|
Hsiao CS, Hsiao SH. Relationship of left atrial expansion index to exercise tolerance, pretest probability of restenosis, and positive predictive value of treadmill test in coronary artery disease. Echocardiography 2020; 37:388-398. [PMID: 32077515 DOI: 10.1111/echo.14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2019] [Revised: 01/18/2020] [Accepted: 01/31/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Whether left atrial (LA) expansion index is associated with coronary restenosis, and exercise capacity (EC) reduction in coronary artery disease has not been established. METHODS This study analyzed 342 consecutive patients who had received a coronary stent implant. A treadmill exercise test (TET) was administered in all participants. The LA expansion indices were measured immediately before and after TET. Maximal EC measured on a breath-by-breath basis by a metabolic cart with gas analyzers and recorded as metabolic equivalent task. All patients with positive TET results received angiography, and those with restenosis received complete revascularization by either percutaneous coronary intervention (PCI) or bypass surgery. The LA expansion index and EC before and 1 month after PCI were then compared. RESULTS Out of 342 patients, 74 had positive TET results, and 54 had restenosis in angiography. Low LA expansion index was associated with poor EC. In patients with LA expansion index > 200%, only 5% had restenosis with 38.5% positive predictive value (PPV) of TET. In patients with LA expansion index < 100%, however, 64.3% had restenosis with 94.7% PPV of TET. Restenosis induced low pre-TET LA expansion index and further decline during TET. The LA expansion index significantly (P .001) improved from 133 ± 64% before PCI to184 ± 86% after PCI, and the improvement corresponded with EC recovery. A 10% reduction in LA expansion index was associated with a 15% increase in pretest probability of restenosis. CONCLUSION The LA expansion index is associated with EC, pretest probability of restenosis, and PPV of TET. Revascularization improves both EC and LA expansion index.
Collapse
Affiliation(s)
- Chao-Sheng Hsiao
- Department of Internal Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.,Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
8
|
Leone P, Cicco S, Prete M, Solimando AG, Susca N, Crudele L, Buonavoglia A, Colonna P, Dammacco F, Vacca A, Racanelli V. Early echocardiographic detection of left ventricular diastolic dysfunction in patients with systemic lupus erythematosus asymptomatic for cardiovascular disease. Clin Exp Med 2020; 20:11-19. [PMID: 31848778 DOI: 10.1007/s10238-019-00600-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 12/11/2019] [Indexed: 12/17/2022]
Abstract
Cardiovascular disease (CVD) is a major complication of systemic lupus erythematosus (SLE) and is now a leading cause of death for these patients. In this study, 23 SLE patients asymptomatic for CVD underwent a comprehensive echocardiographic examination to detect subclinical cardiac involvement. According to their SELENA-SLEDAI score, they were divided into two groups: SELENA-SLEDAI ≤ 12 (n = 13, 12 females) and SELENA-SLEDAI > 12 (n = 10, all females), indicative of mild-to-moderate and severe SLE, respectively. Patients in the latter group had significant increases in left ventricular (LV) mass, LV end-diastolic volume, left atrial volume and right heart parameters (pulmonary arterial pressure, tricuspid regurgitation velocity and diameter of the inferior cava) compared to the mild-to-moderate group. Alterations of the early to late diastolic trans-mitral flow velocity (E/A) were found in 39% of patients, equally distributed between the two groups. The Framingham score of all patients correlated directly with LV mass, interventricular septum thickness and posterior wall thickness, but did not significantly differ between patients with severe and mild-to-moderate SLE. These findings reveal the presence of early-stage, and thus clinically silent, diastolic dysfunction in patients with severe SLE. They demonstrate the poor predictive value of the Framingham score in CVD risk stratification of patients with SLE, thus highlighting the crucial role of echocardiography in the diagnostic workup of these patients.
Collapse
Affiliation(s)
- Patrizia Leone
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Sebastiano Cicco
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Marcella Prete
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Antonio Giovanni Solimando
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Nicola Susca
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Lucilla Crudele
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Alessio Buonavoglia
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Paolo Colonna
- Department of Cardiology, University Hospital Policlinico, Bari, Italy
| | - Franco Dammacco
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Angelo Vacca
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy
| | - Vito Racanelli
- Department of Biomedical Sciences and Human Oncology, Unit of Internal Medicine "Guido Baccelli", University of Bari Medical School, Policlinico - 11, Piazza G. Cesare, 70124, Bari, Italy.
| |
Collapse
|
9
|
Echocardiographic Evaluation of Left Ventricular Filling Pressure in Patients With Heart Failure With Preserved Ejection Fraction: Usefulness of Inferior Vena Cava Measurements and 2016 EACVI/ASE Recommendations. J Card Fail 2020; 26:507-514. [PMID: 32007555 DOI: 10.1016/j.cardfail.2020.01.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/09/2020] [Accepted: 01/23/2020] [Indexed: 12/20/2022]
Abstract
CONTEXT The left ventricular filling pressure (LVFP) is correlated to right atrial pressure (RAP) in heart failure. We compared diagnostic value of the inferior vena cava (IVC) measurements to the one of the 2016 echocardiographic recommendations to estimate LVFP in patients with suspected heart failure with preserved ejection fraction (HFpEF). METHODS Invasive hemodynamics and echocardiography were obtained within 48 hours in 132 consecutive patients with left ventricular ejection fraction ≥50%, and suspected pulmonary hypertension. Increased LVFP was defined by a pulmonary artery wedge pressure (PAWP) >15 mmHg. RESULTS Of 83 patients in sinus rhythm, a score of the 2016 recommendations ≥ 2 (E/e' ratio >14 and/or tricuspid regurgitation velocity >2.8 m/s and/or indexed left atrial volume>34 mL /m²) had a positive predictive value (PPV) of 63% for PAWP>15 mmHg, whereas a dilated IVC (>2.1 cm) and/or non-collapsible (≤50%) had a PPV of 82%. The net reclassification improvement was 0.39 (P < .05). In atrial fibrillation (AF), a dilated and/or non-collapsible IVC had an 86% PPV for PAWP>15 mmHg. The correlation between RAP and PAWP was 0.60, with 75.7% concordance (100/132) between dichotomized pressures (both RAP>8 mmHg and PAWP>15 mmHg and vice versa). CONCLUSION The IVC size and collapsibility is valuable to identify patients with HFpEF with high LVFP in both sinus rhythm and AF.
Collapse
|
10
|
Left atrial strain in left ventricular diastolic dysfunction: have we finally found the missing piece of the puzzle? Heart Fail Rev 2019; 25:409-417. [DOI: 10.1007/s10741-019-09889-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
11
|
Meimoun P, Djebali M, Botoro T, Djou Md U, Bidounga H, Elmkies F, Martis S, Clerc J. Left atrial strain and distensibility in relation to left ventricular dysfunction and prognosis in aortic stenosis. Echocardiography 2019; 36:469-477. [PMID: 30726555 DOI: 10.1111/echo.14258] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To test the relationship between left atrial (LA) distensibility (LAD), LA strain (LAS), and left ventricular (LV) dysfunction and prognosis in aortic stenosis (AS). METHODS Transthoracic Doppler echocardiography was performed prospectively in 102 consecutive patients with AS (77 with severe, 25 with moderate, mean age 77 years). LA volume was calculated by the area-length method in apical four- and two-chamber views, immediately before mitral valve opening (Volmax ) and at mitral valve closure (Volmin ). LAD was defined as (Volmax - Volmin ) × 100%/Volmin . LAS (mean of maximal strain from the 4-2 chamber views) was conducted using a dedicated software package. The endpoint was hospitalization for heart failure and death from any cause. RESULTS Left atrial strain, LAD, and LA vol/m² were significantly correlated with LV diastolic parameters, and PASP (all, P < 0.05). However, LAD and LAS but not LA vol/m² were significantly correlated with Charlson score, LV global longitudinal strain, and to transaortic mean gradient (all, P < 0.05). At a median follow-up of 25 months, 53 patients had an event. LAS, LAD, LA vol/m², and Charlson index were associated with events (all, P < 0.05). In multivariate analysis, LAD, LAS, and Charlson index (all, P < 0.01) remained independently associated with events. Using a ROC curve analysis, LAD ≤ 69% and LAS ≤ 17% were the best cutoffs associated with an event. CONCLUSION In patients with moderate to severe AS, LAD and LAS are associated with LV dysfunction, AS severity, and are independently linked to events.
Collapse
Affiliation(s)
- Patrick Meimoun
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Manel Djebali
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Thierry Botoro
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Urbain Djou Md
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | | | | | - Sonia Martis
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Jérome Clerc
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| |
Collapse
|
12
|
Worley E, Rana B, Williams L, Robinson S. Left ventricular diastolic dysfunction: identifying presence by left atrial function. Echo Res Pract 2018; 5:97-104. [PMID: 30303678 PMCID: PMC6055508 DOI: 10.1530/erp-18-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Objective The left atrium (LA) is exposed to left ventricular pressure during diastole. Applying the 2016 American Society of Echocardiography left ventricular diastolic function (LVDF) guidelines, this study aims to investigate whether left atrial ejection fraction (LAEF) and left atrial active emptying fraction (LAAEF) are markers of diastolic dysfunction (LVDD). Methods Retrospective cohort of consecutive patients (n = 124) who underwent transthoracic echocardiography were studied. Doppler peak velocities of passive (MV E) and active filling (MV A) were measured and ratio E/A calculated. Tissue Doppler imaging parameters of peak early (e′) of the septal and lateral mitral annulus were measured, and average E/e′ ratio (E/e′) was calculated. Tricuspid regurgitation velocity, left atrial maximum volume, left atrial minimum volume and LA volume pre-contraction were measured, allowing calculation of LAEF and LAAEF. Subjects were assigned LVDF categories. Results Binomial logistic regression model (X2(2) = 48.924, P < 0.01) determined that LAEF and LAAEF predicted diastolic dysfunction with sensitivity 85.5% and specificity 78%. ROC curves determined good diagnostic accuracy for LAEF and LAAEF to predict LVDD, AUC 0.826 and 0.861 respectively. Logistic regression model (X2(2) = 39.525, P < 0.01) predicted those patients with E/e′ ≥14 using LAEF and LAAEF with sensitivity 51.6% and specificity 92.4%. Moderate correlations were found between E/e′ and log derivatives of LAEF and LAAEF. Conclusions A decline in LAAEF and LAEF is associated with worsening LVDD.
Collapse
Affiliation(s)
- Emily Worley
- Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Bushra Rana
- Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Lynne Williams
- Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| | - Shaun Robinson
- Royal Papworth Hospital, Papworth Everard, Cambridgeshire, UK
| |
Collapse
|
13
|
Lancellotti P, Galderisi M, Edvardsen T, Donal E, Goliasch G, Cardim N, Magne J, Laginha S, Hagendorff A, Haland TF, Aaberge L, Martinez C, Rapacciuolo A, Santoro C, Ilardi F, Postolache A, Dulgheru R, Mateescu AD, Beladan CC, Deleanu D, Marchetta S, Auffret V, Schwammenthal E, Habib G, Popescu BA. Echo-Doppler estimation of left ventricular filling pressure: results of the multicentre EACVI Euro-Filling study. Eur Heart J Cardiovasc Imaging 2018; 18:961-968. [PMID: 28444160 DOI: 10.1093/ehjci/jex067] [Citation(s) in RCA: 248] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2017] [Accepted: 03/13/2017] [Indexed: 11/13/2022] Open
Abstract
Aims The present Euro-Filling report aimed at comparing the diagnostic accuracy of the 2009 and 2016 echocardiographic grading algorithms for predicting invasively measured left ventricular filling pressure (LVFP). Method and results A total of 159 patients who underwent simultaneous evaluation of echo estimates of LVFP and invasive measurements of LV end-diastolic pressure (LVEDP) were enrolled at nine EACVI centres. Thirty-nine (25%) patients had a reduced LV ejection fraction (<50%), 77 (64%) were in NYHA ≥ II, and 85 (53%) had coronary artery disease. Sixty-four (40%) patients had elevated LVEDP (≥15 mmHg). Taken individually, all echocardiographic Doppler estimates of LVFP (E/A, E/e', left atrial volume, tricuspid regurgitation jet velocity) were marginally correlated with LVEDP. By using the 2016 recommendations, 65% of patients with normal non-invasive estimate of LVFP had normal LVEDP, while 79% of those with elevated non-invasive LVFP had elevated invasive LVEDP. By using 2009 recommendations, 68% of the patients with normal non-invasive LVFP had normal LVEDP, while 55% of those with elevated non-invasive LVFP had elevated LVEDP. The 2016 recommendations (sensitivity 75%, specificity 74%, positive predictive value 39%, negative predictive value 93%, AUC 0.78) identified slightly better patients with elevated invasive LVEDP (≥ 15 mmHg) as compared with the 2009 recommendations (sensitivity 43%, specificity 75%, positive predictive value 49%, negative predictive value 71%, AUC 0.68). Conclusion The present Euro-Filling study demonstrates that the new 2016 recommendations for assessing LVFP non-invasively are fairly reliable and clinically useful, as well as superior to the 2009 recommendations in estimating invasive LVEDP.
Collapse
Affiliation(s)
- Patrizio Lancellotti
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium.,Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Centre of Cardiological Innovation, Oslo, Norway
| | - Erwan Donal
- Cardiologie, CHU Rennes and LTSI-INSERM U 1099, Université Rennes 1, France
| | - Georg Goliasch
- Division of Cardiology, Second Department of Medicine, Medical University of Vienna, Vienna, Austria
| | - Nuno Cardim
- Multimodality Cardiac Imaging Department, Sports Cardiology and Cardiomyopathies centre Hospital da Luz, Lisbon, Portugal
| | - Julien Magne
- CHU Limoges, Hôpital Dupuytren, Pôle Coeur-Poumon-Rein, Cardiology Department, Limoges, France
| | - Sara Laginha
- Multimodality Cardiac Imaging Department, Sports Cardiology and Cardiomyopathies centre Hospital da Luz, Lisbon, Portugal
| | - Andreas Hagendorff
- Echokardiographie-Labore des Universitätsklinikums AöR, Department of Cardiology-Angiology, University of Leipzig, Leipzig, Germany
| | - Trine F Haland
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Centre of Cardiological Innovation, Oslo, Norway
| | - Lars Aaberge
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Centre of Cardiological Innovation, Oslo, Norway
| | - Christophe Martinez
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Antonio Rapacciuolo
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Ciro Santoro
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Federica Ilardi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | - Adriana Postolache
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Raluca Dulgheru
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Anca D Mateescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Carmen C Beladan
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Dan Deleanu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| | - Stella Marchetta
- GIGA Cardiovascular Science, Heart Valve Clinic, Imaging Cardiology, University of Liège Hospital, B-4000 Liege, Belgium
| | - Vincent Auffret
- Cardiologie, CHU Rennes and LTSI-INSERM U 1099, Université Rennes 1, France
| | - Ehud Schwammenthal
- Heart Center, Sheba Medical Center, Tel Hashomer, and Tel Aviv University, Ramat Aviv, Israel
| | - Gilbert Habib
- URMITE, Aix Marseille Université UM63, CNRS 7278, IRD 198, INSERM 1095 IHU - Méditerranée Infection.,APHM, La Timone Hospital, Cardiology Department, Marseille, France
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Bucharest, Romania
| |
Collapse
|
14
|
Utility of Left Atrial Expansion Index and Stroke Volume in Management of Chronic Systolic Heart Failure. J Am Soc Echocardiogr 2018; 31:650-659.e1. [DOI: 10.1016/j.echo.2018.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Indexed: 11/19/2022]
|
15
|
Kang SJ, Kwon YW, Hwang SJ, Kim HJ, Jin BK, Yon DK. Clinical Utility of Left Atrial Strain in Children in the Acute Phase of Kawasaki Disease. J Am Soc Echocardiogr 2018; 31:323-332. [PMID: 29305035 DOI: 10.1016/j.echo.2017.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND We aimed to evaluate the diagnostic utility of peak left atrial longitudinal strain (PALS) during left ventricular (LV) systole to differentiate children in the acute phase of Kawasaki disease (aKD) from controls. We also aimed to compare the diagnostic utility of PALS with those of conventional echocardiographic indices of diastolic function. METHODS Retrospectively measured PALS, LV longitudinal peak systolic strain, and strain rate obtained via velocity vector imaging were compared in a derivation cohort comprising 95 aKD and 67 controls. The utility of PALS in differentiating aKD from controls was compared with those of E/E', E/A, and maximum left atrial volume index (LAVImax). Derived cutoffs from receiver operating characteristic curves were validated in a separate validation cohort comprising 37 aKD and 19 controls. RESULTS In the derivation cohort, PALS was significantly decreased in aKD as compared with in controls. For differentiating aKD from controls, PALS outperformed E/E', E/A, and LAVImax. However, cutoffs of PALS (≤40% and ≤39%, before and after adjusting for the presence of significant mitral regurgitation and LV systolic dysfunction, respectively), like those of E/E', E/A, and LAVImax, showed low sensitivity and poor discriminative ability for differentiating aKD from controls. In the validation cohort, for differentiating aKD from controls, both cutoffs of PALS showed low sensitivity, like those of E/E', E/A, and LAVImax. CONCLUSION In aKD, impaired left atrial reservoir function could be detected as decreased PALS. For differentiating aKD from controls, PALS outperforms E/E', E/A, and LAVImax. However, like E/E', E/A, and LAVImax, PALS as a single parameter is limited in its clinical utility to differentiate aKD from controls because of its low sensitivity and poor discriminative ability.
Collapse
Affiliation(s)
- Soo Jung Kang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
| | - Yoo Won Kwon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Seo Jung Hwang
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hyo Jin Kim
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Bo Kyeong Jin
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| |
Collapse
|
16
|
Kanar B, Ozben B, Kanar HS, Arsan A, Tigen K. Left atrial volume changes are an early marker of end-organ damage in essential hypertension: A multidisciplinary approach to an old problem. Echocardiography 2017; 34:1895-1902. [DOI: 10.1111/echo.13710] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Batur Kanar
- Department of Cardiology; Marmara University Faculty of Medicine; Istanbul Turkey
| | - Beste Ozben
- Department of Cardiology; Marmara University Faculty of Medicine; Istanbul Turkey
| | - Hatice Selen Kanar
- Department of Ophthalmology; Fatih Sultan Mehmet Training and Research Hospital; Istanbul Turkey
| | - Aysu Arsan
- Department of Ophthalmology; Dr. Lutfi Kirdar Training and Research Hospital; Istanbul Turkey
| | - Kursat Tigen
- Department of Cardiology; Marmara University Faculty of Medicine; Istanbul Turkey
| |
Collapse
|
17
|
The analysis of mitral annular disjunction detected by echocardiography and comparison with previously reported pathological data. J Echocardiogr 2017; 15:176-185. [DOI: 10.1007/s12574-017-0349-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 07/28/2017] [Accepted: 08/07/2017] [Indexed: 10/19/2022]
|
18
|
Kanar BG, Kanar HS, Karatay A, Tigen K, Sonmez A. Assessment of left atrium and diastolic dysfunction in patients with hypertensive retinopathy: A real-time three-dimensional echocardiography-based study. Clin Exp Hypertens 2017; 39:696-704. [PMID: 28758803 DOI: 10.1080/10641963.2017.1306543] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The fundoscopic examination of hypertensive patients, which is established hypertension-related target organ damage (TOD), tends to be underutilized in clinical practice. We sought to investigate the relationship between retinal alterations and left atrium (LA) volumes by means of real-time three-dimensional echocardiography (RT3DE). Our population consisted of 88 consecutive essential hypertensive patients (age 59.2 ± 1.2 years, 35 males). All subjects underwent a fundoscopy examination and were distributed into four groups according to the Keith-Wagener-Barker (KWB) classification. The four groups (KWB grades 0-3: including 26, 20, 26, and 16 patients, respectively) did not differ with regard to age, gender, or metabolic profile. There were no significant differences between groups with regard to parameters reflecting LV systolic function and diastolic dysfunction (DD) in two-dimensional echocardiography (2DE). Nevertheless, patients in the higher KWB category had higher values of LA volumes (LA maximal volume index, LA minimal volume index, preatrial contraction volume index, LA total stroke volume index, LA active stroke volume index, p < 0.001) regarding RT3DE. There is also a significant relationship between LA active stroke volume index (ASVI) and duration of hypertension (HT) (r: 0.68, p < 0.001). In the logistic regression analysis, ASVI was independent predictors of LV DD in patients with arterial hypertension (HT). Patients with arterial HT were found to have increased LA volumes and impaired diastolic functions. Assessment of the arterial HT patient by using RT3DE atrial volume analysis may facilitate early recognition of TOD, which is such a crucial determinant of cardiovascular mortality and morbidity.
Collapse
Affiliation(s)
- Batur Gonenc Kanar
- a Saglik Bakanligi Istanbul Sureyyapasa Gogus Hastaliklari ve Gogus Cerrahisi EA Hastanesi , Cardiology , Istanbul , Turkey
| | - Hatice Selen Kanar
- b Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi , Ophthalmology , Istanbul , Turkey
| | - Aysu Karatay
- c Lufti Kirdar Kartal Egitim ve Arastirma Hastanesi , Ophthalmology , Istanbul , Turkey
| | - Kursat Tigen
- d Marmara University Faculty of Medicine , Cardiology , Istanbul , Turkey
| | - Ayse Sonmez
- e Fatih Sultan Mehmet Egitim ve Arastirma Hastanesi , Ophthalmology , Istanbul , Turkey
| |
Collapse
|
19
|
Hsiao SH, Chiou KR. Renal function decline predicted by left atrial expansion index in non-diabetic cohort with preserved systolic heart function. Eur Heart J Cardiovasc Imaging 2017; 18:521-528. [DOI: 10.1093/ehjci/jew224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 09/26/2016] [Indexed: 11/13/2022] Open
|
20
|
Hsiao SH, Chiou KR. Diastolic Heart Failure Predicted by Left Atrial Expansion Index in Patients with Severe Diastolic Dysfunction. PLoS One 2016; 11:e0162599. [PMID: 27622475 PMCID: PMC5021281 DOI: 10.1371/journal.pone.0162599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/25/2016] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left atrial (LA) echocardiographic parameters are increasingly used to predict clinically relevant cardiovascular events. The study aims to evaluate the LA expansion index (LAEI) for predicting diastolic heart failure (HF) in patients with severe left ventricular (LV) diastolic dysfunction. METHODS This prospective study enrolled 162 patients (65% male) with preserved LV systolic function and severe diastolic dysfunction (132 grade 2 patients, 30 grade 3 patients). All patients had sinus rhythm at enrollment. The LAEI was calculated as (Volmax - Volmin) x 100% / Volmin, where Volmax was defined as maximal LA volume and Volmin was defined as minimal volume. The endpoint was hospitalization for HF withp reserved LV ejection fraction (HFpEF). RESULTS The median follow-up duration was 2.9 years. Fifty-four patients had cardiovascular events, including 41 diastolic and 8 systolic HF hospitalizations. In these 54 patients, 13 in-hospital deaths and 5 sudden out-of-hospital deaths occurred. Multivariate analyses revealed that HFpEF was associated with LAEI.and atrial fibrillation during follow-up. For predicting HFpEF, the LAEI had a hazard ratio of 1.197per 10% decrease. In patients who had HFpEF events, the LAEI significantly (P< 0.0001) decreased from 69±18% to 39±11% during hospitalization. Although the LAEI improved during follow-up (53±13%), it did not return to baseline. CONCLUSIONS The LAEI predicts HFpEF in patients with severe diastolic dysfunction; it worsens during HFpEF events and partially recovers during followup.
Collapse
Affiliation(s)
- Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
| | - Kuan-Rau Chiou
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan, Republic of China
- School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
- * E-mail:
| |
Collapse
|
21
|
Sharifov OF, Schiros CG, Aban I, Denney TS, Gupta H. Diagnostic Accuracy of Tissue Doppler Index E/e' for Evaluating Left Ventricular Filling Pressure and Diastolic Dysfunction/Heart Failure With Preserved Ejection Fraction: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2016; 5:JAHA.115.002530. [PMID: 26811160 PMCID: PMC4859370 DOI: 10.1161/jaha.115.002530] [Citation(s) in RCA: 143] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Background Tissue Doppler index E/è is used clinically and in multidisciplinary research for estimation of left ventricular filling pressure (LVFP) and diastolic dysfunction (DD)/heart failure with preserved ejection fraction (HFpEF). Its diagnostic accuracy is not well studied. Methods and Results From the PubMed, Scopus, Embase, and Cochrane databases, we identified 24 studies reporting E/è and invasive LVFP in preserved EF (≥50%). In random‐effects models, E/è had poor to mediocre linear correlation with LVFP. Summary sensitivity and specificity (with 95% CIs) for the American Society of Echocardiography–recommended E/è cutoffs (lateral, mean, and septal, respectively) to identify elevated LVFP was estimated by using hierarchical summary receiver operating characteristic analysis. Summary sensitivity was 30% (9–48%), 37% (13–61%), and 24% (6–46%), and summary specificity was 92% (82–100%), 91% (80–99%), and 98% (92–100%). Positive likelihood ratio (LR+) was <5 for lateral and mean E/è. LR+ was slightly >10 for septal E/è obtained from 4 studies (cumulative sample size <220). For excluding elevated LVFP, summary sensitivity for E/è (lateral, mean, and septal, respectively) was 64% (38–86%), 36% (3–74%), and 50% (14–81%), while summary specificity was 73% (54–89%), 83% (49–100%), and 89% (66–100%). Because of data set limitations, meaningful inference for identifying HFpEF by using E/è could not be drawn. With the use of quality assessment tool for diagnostic accuracy studies (Quality Assessment of Diagnostic Accuracy Studies questionnaire), we found substantial risks of bias and/or applicability. Conclusions There is insufficient evidence to support that E/è can reliably estimate LVFP in preserved EF. The diagnostic accuracy of E/è to identify/exclude elevated LVFP and DD/HFpEF is limited and requires further validation in a well‐designed prospective clinical trial.
Collapse
Affiliation(s)
- Oleg F Sharifov
- Department of Medicine, University of Alabama at Birmingham, AL (O.F.S., C.G.S., H.G.)
| | - Chun G Schiros
- Department of Medicine, University of Alabama at Birmingham, AL (O.F.S., C.G.S., H.G.)
| | - Inmaculada Aban
- Department of Biostatistcs, University of Alabama at Birmingham, AL (I.A.)
| | - Thomas S Denney
- Department of Electrical and Computer Engineering, Auburn University, Auburn, AL (T.S.D.)
| | - Himanshu Gupta
- Department of Medicine, University of Alabama at Birmingham, AL (O.F.S., C.G.S., H.G.) VA Medical Center, Birmingham, AL (H.G.)
| |
Collapse
|
22
|
Hsiao SH, Chu KA, Wu CJ, Chiou KR. Left Atrial Expansion Index Predicts Left Ventricular Filling Pressure and Adverse Events in Acute Heart Failure With Severe Left Ventricular Dysfunction. J Card Fail 2016; 22:272-9. [PMID: 26805452 DOI: 10.1016/j.cardfail.2016.01.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 12/28/2015] [Accepted: 01/13/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND The power of left atrial (LA) parameters for predicting left ventricular (LV) filling pressure and adverse events in acute heart failure (HF) with severe LV dysfunction, either sinus rhythm or atrial fibrillation (AF), is not fully understood. METHODS AND RESULTS Echocardiography was performed in 141 patients with acute decompensated congestive HF and LV ejection fraction <35%, including 42 with permanent AF. The LA expansion index was calculated as (Volmax - Volmin) × 100%/Volmin, where Volmax was defined as maximal and Volmin as minimal LA volume. Of 141 patients, invasive LV filling pressures within 12 hours of LA expansion index measurement were available in 109. The end points were 3-year frequencies of HF hospitalization and all-cause mortality. Over a median follow-up of 3.1 years, 74 participants (52.5%) reached the end points (sinus vs AF group: 48.5% vs 61.9%, respectively; P = .047). Multivariate analysis revealed that adverse events of both groups were only independently associated with age and LA expansion index. Rates of adverse events were proportional to LA expansion index. There was a good logarithmic relationship between LA expansion index and LV filling pressure, regardless of presence or absence of AF. CONCLUSIONS LV filling pressure can be estimated well by LA expansion index, with or without AF. The LA expansion index predicts adverse events in HF patients with severe systolic dysfunction. (ClinicalTrials.gov number: NCT01307722).
Collapse
Affiliation(s)
- Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Kuo-An Chu
- Division of Chest Medicine, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chieh-Jen Wu
- Division of Cardiovascular Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Kuan-Rau Chiou
- School of Medicine, National Yang-Ming University, Taipei, Taiwan; Division of Cardiology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.
| |
Collapse
|
23
|
Dai M, Li KL, Qian DJ, Lu J, Zou YH, Cao YX, Yang ZY, Wang RX. Evaluation of left atrial function by speckle tracking echocardiography in patients with systemic lupus erythematosus. Lupus 2015; 25:496-504. [PMID: 26657736 DOI: 10.1177/0961203315619029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
Left atrial (LA) function plays a key role in maintaining optimal cardiac output. Left ventricular diastolic dysfunction (LVDD) has been reported in systemic lupus erythematosus (SLE), but whether LA functional abnormalities also occur in patients with SLE is unknown. Toward this aim we evaluated left atrial function and volume by strain and strain rate derived from speckle tracking echocardiography (STE) and their associations with LVDD. Sixty SLE patients were compared with age- and gender-matched normal controls. The LA strain (S) and strain rate (SR) during systole, early diastole and late diastole (SRs, SRe and SRa, respectively) were measured by STE. The LA volume index (LAVI), traditional parameters of LA and left ventricular diastolic function also were analysed. Global strain and positive SRe were significantly reduced in the SLE group compared with the control group (26.2% ± 9.5% vs 32.5% ± 9.8% and −2.4 ± 1.0 s−1 vs −3.1 ± 1.2 s−1, both p < 0.05). The SRs in the SLE and control groups were not significantly different (2.1 ± 0.7 s−1 vs 2.4 ± 0.8 s−1, p = 0.2). The positive SRa was increased in the SLE group compared with the control group (−2.1 ± 0.8 s−1 vs −1.6 ± 0.5 s−1, p < 0.05) and the LAVI was larger in the SLE group than in the control group (32.4 ± 8.0 vs 25.8 ± 7.1 ml/m2, p < 0.001). Patients with SLE exhibiting varying grades of LVDD displayed significant differences in LA parameters, including LAVI, SRs, SRe and SRa (all p < 0.05). Multivariate linear analysis additionally revealed that SLICC/ACR damage index (SDI) was independently and inversely associated with global strain, SRs and positive SRe. LA functions were changed in SLE patients, demonstrating impairment in conduit function, decrease in storage function and increase in pump function. Meanwhile, the magnitude of this impairment was predictively associated with the severity of LVDD. The results from this study demonstrate that STE is capable of detecting various aspects of LA functional impairment during SLE progression, and should be further explored as a diagnostic tool for improving the outcomes of SLE patients.
Collapse
Affiliation(s)
- M Dai
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - K L Li
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - D J Qian
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - J Lu
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Y H Zou
- Department of Rheumatology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Y X Cao
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - Z Y Yang
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| | - R X Wang
- Department of Cardiology, Wuxi People’s Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, China
| |
Collapse
|
24
|
Ilic I, Stankovic I, Vidakovic R, Jovanovic V, Vlahovic Stipac A, Putnikovic B, Neskovic AN. Relationship of ischemic times and left atrial volume and function in patients with ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention. Int J Cardiovasc Imaging 2015; 31:709-16. [PMID: 25648258 DOI: 10.1007/s10554-015-0603-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 01/27/2015] [Indexed: 01/06/2023]
Abstract
Little is known about the impact of duration of ischemia on left atrial (LA) volumes and function during acute phase of myocardial infarction. We investigated the relationship of ischemic times, echocardiographic indices of diastolic function and LA volumes in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). A total of 433 consecutive STEMI patients underwent echocardiographic examination within 48 h of primary PCI, including the measurement of LA volumes and the ratio of mitral peak velocity of early filling to early diastolic mitral annular velocity (E/e'). Time intervals from onset of chest pain to hospital admission and reperfusion were collected and magnitude of Troponin I release was used to assess infarct size. Patients with LA volume index (LAVI) ≥28 ml/m(2) had longer total ischemic time (410 ± 347 vs. 303 ± 314 min, p = 0.007) and higher E/e' ratio (15 ± 5 vs. 10 ± 3, p < 0.001) than those with LAVI <28 ml/m(2), while the indices of LA function were similar between the study groups (p > 0.05, for all). Significant correlation was found between E/e' and LA volumes at all stages of LA filling and contraction (r = 0.363-0.434; p < 0.001, for all) while total ischemic time along with E/e' and restrictive filling pattern remained independent predictor of LA enlargement. Increased LA volume is associated with longer ischemic times and may be a sensitive marker of increased left ventricular filling pressures in STEMI patients treated with primary PCI.
Collapse
Affiliation(s)
- Ivan Ilic
- Department of Cardiology, Clinical Hospital Center Zemun, Faculty of Medicine, University of Belgrade, Vukova 9, 11080, Belgrade, Serbia,
| | | | | | | | | | | | | |
Collapse
|
25
|
Li K, Wang R, Dai M, Lu J, Zou Y, Yang X. Evaluation of left atrial function by real-time 3-D echocardiography in patients with systemic lupus erythematosus. J Rheumatol 2014; 42:196-201. [PMID: 25512485 DOI: 10.3899/jrheum.140304] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Left atrial function plays a key role in maintaining an optimal cardiac output. Left ventricular diastolic dysfunction has been reported in systemic lupus erythematosus (SLE), but its effect on left atrial function has been largely overlooked. Our aim was to assess left atrial performance using real-time 3-D echocardiography (RT3DE) technology in patients with SLE. METHODS Our study included 102 patients with SLE without any cardiac symptoms, and 32 healthy controls. According to the Systemic Lupus International Collaborating Clinics/American College of Rheumatology Damage Index (SDI), all subjects were classified into 3 groups: healthy controls, patients with an SDI = 0, and patients with an SDI ≥ 1. RESULTS Left atrial volume indexed to body surface area was dilated in subjects with SLE, whereas the left atrial passive emptying fraction (EF) was lower. Left atrial active EF was significantly higher in the SDI = 0 group than in controls (46.4 ± 9.1% vs 30.0 ± 10.3%, p < 0.05); however, it was significantly lower in the SDI ≥ 1 group than in the SDI = 0 group (41.2 ± 9.8% vs 46.4 ± 9.1%, p < 0.05). By multivariate linear analysis, the SDI was independently and positively associated with left atrial volume index and inversely associated with left atrial total function. CONCLUSION Our study demonstrated that left atrial mechanical function and volume are impaired in SLE, particularly in patients with an SDI ≥ 1 and disease activity. RT3DE may have better diagnostic value than traditional echo indexes in detecting subclinical cardiac dysfunction in patients with SLE.
Collapse
Affiliation(s)
- Kulin Li
- From the Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou; and the Department of Cardiology, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.K. Li, MD; X. Yang, MD, Professor, Department of Cardiology, First Affiliated Hospital of Soochow University; R. Wang, MD, Professor; M. Dai, MD; J. Lu, MD, Department of Cardiology; Y. Zou, MD, Professor, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University
| | - Ruxing Wang
- From the Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou; and the Department of Cardiology, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.K. Li, MD; X. Yang, MD, Professor, Department of Cardiology, First Affiliated Hospital of Soochow University; R. Wang, MD, Professor; M. Dai, MD; J. Lu, MD, Department of Cardiology; Y. Zou, MD, Professor, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University
| | - Min Dai
- From the Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou; and the Department of Cardiology, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.K. Li, MD; X. Yang, MD, Professor, Department of Cardiology, First Affiliated Hospital of Soochow University; R. Wang, MD, Professor; M. Dai, MD; J. Lu, MD, Department of Cardiology; Y. Zou, MD, Professor, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University
| | - Juan Lu
- From the Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou; and the Department of Cardiology, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.K. Li, MD; X. Yang, MD, Professor, Department of Cardiology, First Affiliated Hospital of Soochow University; R. Wang, MD, Professor; M. Dai, MD; J. Lu, MD, Department of Cardiology; Y. Zou, MD, Professor, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University
| | - Yaohong Zou
- From the Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou; and the Department of Cardiology, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.K. Li, MD; X. Yang, MD, Professor, Department of Cardiology, First Affiliated Hospital of Soochow University; R. Wang, MD, Professor; M. Dai, MD; J. Lu, MD, Department of Cardiology; Y. Zou, MD, Professor, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University
| | - Xiangjun Yang
- From the Department of Cardiology, First Affiliated Hospital of Soochow University, Suzhou; and the Department of Cardiology, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University, Wuxi, China.K. Li, MD; X. Yang, MD, Professor, Department of Cardiology, First Affiliated Hospital of Soochow University; R. Wang, MD, Professor; M. Dai, MD; J. Lu, MD, Department of Cardiology; Y. Zou, MD, Professor, Department of Rheumatology, Wuxi People's Hospital affiliated to Nanjing Medical University.
| |
Collapse
|
26
|
Tadic M, Cuspidi C. The influence of type 2 diabetes on left atrial remodeling. Clin Cardiol 2014; 38:48-55. [PMID: 25403642 DOI: 10.1002/clc.22334] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/02/2014] [Accepted: 08/12/2014] [Indexed: 01/18/2023] Open
Abstract
The influence of type 2 diabetes mellitus on cardiac remodeling has been evaluated for decades; however, the majority of investigations were focused only on the left ventricle. The impact of diabetes on the left atrial (LA) function is less researched. LA enlargement has been shown as an independent predictor of cardiovascular morbidity and mortality in the general and diabetic population; however, LA dysfunction has been proven to be an independent predictor only in the general population. There are not much follow-up data about the influence of diabetes on LA function. New echocardiographic techniques, such as 2-dimensional speckle tracking imaging, provide more accurate, sensitive, and reliable information about LA function than traditional, volumetric methods. The aim of this review was to summarize the most recent reports about the influence of diabetes on LA function, as well as to discuss the possible mechanisms and potential clinical implications of the relationship between diabetes and LA remodeling.
Collapse
Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje,", Belgrade, Serbia
| | | |
Collapse
|
27
|
Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Nagase N, Ara N, Oki T. Association of left atrial reservoir function with left atrial structural remodeling related to left ventricular dysfunction in asymptomatic patients with hypertension: evaluation by two-dimensional speckle-tracking echocardiography. Clin Exp Hypertens 2014; 37:155-65. [PMID: 25050647 DOI: 10.3109/10641963.2014.933962] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Left atrial (LA) structural and functional abnormalities are vital steps on the pathway toward heart failure with preserved ejection fraction in asymptomatic patients. The purpose of this study was to assess the relationship of LA function, particularly reservoir function, with LA structural remodeling related to the left ventricular (LV) dysfunction in asymptomatic patients with hypertension (HT) using conventional, tissue Doppler, and 2-D speckle-tracking echocardiography. Fifty age-matched healthy individuals and 140 patients with HT, including 75 with LA volume index (LAVI)<29 ml/m2 (normal LA group) and 65 with LAVI≥29 ml/m2 (large LA group), were enrolled. We defined peak early diastolic transmitral flow velocity/peak early diastolic mitral annular motion velocity (E/e')/peak systolic LA strain (S-LAs) as LA diastolic stiffness. The LV mass index, relative LV wall thickness, peak atrial systolic transmitral flow velocity, LA total, active, and passive emptying volume indexes, and E/e'/S-LAs were greatest, and S-LAs, peak early diastolic LA strain, peak systolic LV longitudinal strain and circumferential strain rate, and peak early diastolic LV radial strain rate were lower in the large LA group compared with control and/or normal LA group. Multivariate linear regression analysis revealed that aging, LA remodeling, and LV systolic and diastolic dysfunction are defined as strong predictors related to increased LA diastolic stiffness in the large LA group. HT alters LA dynamics significantly, with resultant increased LA volume and diastolic stiffness related to LV diastolic and systolic dysfunction, even in asymptomatic patients. Earlier treatment with reninangiotensin system inhibitors may improve abnormal LA-LV interaction in this patient population.
Collapse
Affiliation(s)
- Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization , Tokushima , Japan and
| | | | | | | | | | | | | |
Collapse
|
28
|
Yeh J, Aiyagari R, Gajarski RJ, Zamberlan MC, Lu JC. Left Atrial Deformation Predicts Pulmonary Capillary Wedge Pressure in Pediatric Heart Transplant Recipients. Echocardiography 2014; 32:535-40. [DOI: 10.1111/echo.12679] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jay Yeh
- Department of Pediatrics; Division of Pediatric Cardiology; University of California Davis Medical Center; Sacramento California
| | - Ranjit Aiyagari
- Department of Pediatrics and Communicable Diseases; Division of Pediatric Cardiology; University of Michigan; Ann Arbor Michigan
| | - Robert J. Gajarski
- Department of Pediatrics and Communicable Diseases; Division of Pediatric Cardiology; University of Michigan; Ann Arbor Michigan
| | - Mary C. Zamberlan
- Department of Pediatrics and Communicable Diseases; Division of Pediatric Cardiology; University of Michigan; Ann Arbor Michigan
| | - Jimmy C. Lu
- Department of Pediatrics and Communicable Diseases; Division of Pediatric Cardiology; University of Michigan; Ann Arbor Michigan
| |
Collapse
|
29
|
Hatipoglu S, Ozdemir N, Babur Guler G, Omaygenc MO, Bakal RB, Kahveci G, Unkun T, Sahin G, Kaymaz C. Left atrial expansion index is an independent predictor of diastolic dysfunction in patients with preserved left ventricular systolic function: a three dimensional echocardiography study. Int J Cardiovasc Imaging 2014; 30:1315-23. [PMID: 24958524 DOI: 10.1007/s10554-014-0476-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 06/16/2014] [Indexed: 11/29/2022]
Abstract
In the absence of mitral valve disease left atrial (LA) volume is a marker of diastolic dysfunction and its severity. This study investigated the relationship between left ventricular (LV) end diastolic pressure (LVEDP) and LA volumes and phasic atrial functions detected by real-time full volume three-dimensional echocardiography (RT3DE), in a patient population with preserved LV systolic function. Seventy-two (39 female and 33 male; mean age 56.1 ± 9.0 years) stable patients with normal LV ejection fraction (EF) undergoing cardiac catheterization were studied. All patients underwent comprehensive echocardiographic examination just before catheterization and LVEDP was obtained. In addition to conventional echocardiographic measurements and Doppler indices; by using RT3DE LA maximum, minimum and pre-a-wave volumes were measured; LA total, passive and active emptying volumes and fractions were calculated. LV systolic function was assessed by EF and global longitudinal strain by speckle tracking. RT3DE minimum LA volume index, RT3DE active LAEF and LA expansion index (EI) were statistically significant univariate predictors of LVEDP ≥ 16 mmHg. When age and hypertension adjusted multivariate analysis was performed EI [β = -1.741, p = 0.015; OR 0.175; 95 % CI (0.043-0.717)] was an independent predictor of elevated LVEDP. RT3DE evaluation of LA function during entire cardiac cycle has incremental value for the diagnosis of diastolic dysfunction in patients with preserved EF. We suggest that RT3DE evaluation of LA may find clinical application in this field.
Collapse
Affiliation(s)
- Suzan Hatipoglu
- Department of Cardiology, Kartal Kosuyolu Heart Education and Research Hospital, Istanbul, Turkey,
| | | | | | | | | | | | | | | | | |
Collapse
|
30
|
Abstract
BACKGROUND The left atrial (LA) expansion index for predicting atrial fibrillation (AF) in a relatively low-risk cohort is not fully understood. METHODS AND RESULTS In this prospective study of 2,200 dypnea patients, the LA expansion index was calculated as (Volmax-Volmin)×100%/Volmin, where Volmax was defined as maximum LA volume and Volmin was defined as minimum volume. The endpoints were 2-year frequency of AF, including both paroxysmal and persistent. Of the 180 participants (8.2%) who had AF attacks over a median follow-up of 2.7 years, 90 (4.1%) had at least 1 episode of persistent AF. Compared to patients with paroxysmal AF, those with persistent AF had a much lower LA expansion index (100±59% vs. 44±24%). LA expansion index was associated exponentially with the incidence of persistent AF. Independent predictors of AF included age, renal function impairment, pulmonary artery systolic pressure, and LA expansion index. Persistent AF, however, had significant independent associations only with prior heart failure, renal function impairment, diastolic dysfunction, and LA expansion index (odds ratio, 0.970; 95% confidence interval: 0.959-0.981 per 1% increase, P<0.0001). Compared to other parameters, LA expansion index <61.4% was the best cut-off point to predict persistent AF. CONCLUSIONS The LA expansion index is associated with the presence of AF, and a reduced LA expansion index has a strong association with persistent AF.
Collapse
Affiliation(s)
- Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital
| | | |
Collapse
|
31
|
Hsiao SH, Chiou KR. Left atrial expansion index predicts all-cause mortality and heart failure admissions in dyspnoea. Eur J Heart Fail 2013; 15:1245-52. [PMID: 23703107 DOI: 10.1093/eurjhf/hft087] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIMS The power of left atrial (LA) parameters for predicting adverse events in relatively low-risk groups is not fully understood. This study investigated whether the LA expansion index predicts heart failure (HF) and all-cause mortality in subjects with dyspnoea. METHODS AND RESULTS Echocardiography was performed to identify causes of dypnoea in 1735 patients. The LA expansion index was calculated as (Volmax - Volmin) × 100%/Volmin, where Volmax was defined as the maximal LA volume and Volmin was defined as the minimal LA volume. The endpoints were 2-year frequencies of HF hospitalization and all-cause mortality. Over a median follow-up of 2.7 years, 91 participants reached endpoints. Rates of adverse events were exponentially proportional to the LA expansion index. For predicting adverse events, the LA expansion index was better than the maximal indexed LA volume and tissue Doppler parameters. Hospitalization for HF was independently associated with age, LVEF, pulmonary artery systolic pressure, LA expansion index, and history of prior HF. All-cause mortality was associated with age, pulmonary artery systolic pressure, and LA expansion index. Compared with the highest quartile of the LA expansion index, the lowest quartile had a 3.1-fold higher hazard of HF events and a 17.8-fold higher hazard of all-cause mortality. CONCLUSIONS The LA expansion index predicts adverse events in patients with dyspnoea. The prognostic power of the index exceeds that of other well-established echocardiographic parameters such as E/e' and maximal indexed LA volume. Trial registration NCT01171040.
Collapse
Affiliation(s)
- Shih-Hung Hsiao
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, Republic of China
| | | |
Collapse
|
32
|
Chen S, Yuan J, Zhang J, Qiao S, Duan F, Lv X, Hu F, Yang W, Yang Y. Assessment of Atrial Conduction Abnormalities in Patients with Hypertrophic Cardiomyopathy Before and One Year after Alcohol Septal Ablation. Cardiology 2012; 123:254-60. [DOI: 10.1159/000345295] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 10/08/2012] [Indexed: 11/19/2022]
|