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Li M, Lv Q, Sun W, Zhang Y, Wu C, Zhang Y, Zhu S, Li H, Dong N, Li Y, Zhang L, Xie M. Prognostic value of right ventricular three-dimensional speckle-tracking strain in adult heart transplantation patients. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1275-1287. [PMID: 37027106 DOI: 10.1007/s10554-023-02842-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/20/2023] [Indexed: 06/09/2023]
Abstract
We aimed to investigate the prognostic value of three-dimensional right ventricular free wall longitudinal strain (3D-RV FWLS) in adult heart transplantation (HTx) patients, taking three-dimensional left ventricular global longitudinal strain (3D-LV GLS) into account. We prospectively enrolled 155 adult HTx patients. Conventional right ventricular (RV) function parameters, two-dimensional (2D) RV FWLS, 3D-RV FWLS, RV ejection fraction (RVEF), and 3D-LV GLS were obtained in all patients. All patients were followed for the endpoint of death and major adverse cardiac events. After a median follow-up of 34 months, 20 (12.9%) patients had adverse events. Patients with adverse events had higher incidence of previous rejection, lower hemoglobin, and lower 2D-RV FWLS, 3D-RV FWLS, RVEF and 3D-LV GLS (P < 0.05). In multivariate Cox regression, Tricuspid annular plane systolic excursion (TAPSE), 2D-RV FWLS, 3D-RV FWLS, RVEF and 3D-LV GLS were independent predictors of adverse events. The Cox model using 3D-RV FWLS (C-index = 0.83, AIC = 147) or 3D-LV GLS (C-index = 0.80, AIC = 156) was observed to predict adverse events more accurately than that with TAPSE, 2D-RV FWLS, RVEF or traditional risk model. Moreover, when added in nested models including previous ACR history, hemoglobin levels, and 3D-LV GLS, the continuous NRI (0.396, 95% CI 0.013 ~ 0.647; P = 0.036) of 3D-RV FWLS was significant. 3D-RV FWLS is a stronger independent predictor of adverse outcomes, and provides additive predictive value over 2D-RV FWLS and conventional echocardiographic parameters in adult HTx patients, taking 3D-LV GLS into account.
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Affiliation(s)
- Meng Li
- Department of Ultrasound in Medicine, Shanghai Institute of Ultrasound in Medicine, Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200233, People's Republic of China
| | - Qing Lv
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Wei Sun
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yanting Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Chun Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Yiwei Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Shuangshuang Zhu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - He Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China.
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China.
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277# Jiefang Avenue, Wuhan, 430022, China.
- Hubei Province Clinical Research Center for Medical Imaging, Wuhan, 430022, China.
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan, 430022, China.
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Sumin AN, Shcheglova AV, Korok EV, Sergeeva TJ. The Outcomes of Coronary Artery Bypass Surgery after 18 Months-Is There an Influence of the Initial Right Ventricle Diastolic Dysfunction? J Cardiovasc Dev Dis 2023; 10:jcdd10010018. [PMID: 36661913 PMCID: PMC9866549 DOI: 10.3390/jcdd10010018] [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: 11/29/2022] [Revised: 12/22/2022] [Accepted: 12/28/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND This study aimed to investigate the association of preoperative right heart filling indicators with outcomes after coronary artery bypass grafting (CABG) at an 18 month follow up. METHODS Patients who underwent CABG at a single center were included in this study. In addition to the baseline preoperative indicators and perioperative data, initial parameters of the right ventricle (RV) systolic and diastolic function were assessed. RESULTS Among the 189 patients, a total of 19 (10.0%) MACE (cardiovascular death, nonfatal myocardial infarction and stroke) were recorded during an 18 month follow up. In patients with the development of MACE during the initial examination, the following changes in RV function were revealed compared with the group without MACE: a decrease in the e't index (8.2 versus 9.6 cm/s, p = 0.029), an increase in the Et/e't ratio (5.25 vs. 4.42, p = 0.049) and more frequent presence of RV pseudonormal filling (p = 0.03). In the binary logistic regression analysis, the development of MACE 18 months after CABG was associated with the nonconduction of PCI before surgery, the presence of peripheral atherosclerosis, an increase in IVST and Et/e't and a decrease in LVEF. CONCLUSIONS RV diastolic dysfunction in the preoperative period was associated with the development of MACE within 18 months after CABG, and the ratio Et/e't was one of the independent predictors of MACE in a multiple regression analysis. This makes it expedient to include an assessment of not only systolic but also diastolic RV function in the preoperative examination. The inclusion of an assessment of RV diastolic function in the pre-CABG evaluation of patients deserves further study.
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Affiliation(s)
- Alexey N. Sumin
- Correspondence: ; Tel.: +(3842)-64-44-61 or +8-903-940-8668; Fax: +(3842)-64-27-18
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Sumin AN, Shcheglova AV, Korok EV, Sergeeva TJ. Indicators of the Right Ventricle Systolic and Diastolic Function 18 Months after Coronary Bypass Surgery. J Clin Med 2022; 11:jcm11143994. [PMID: 35887758 PMCID: PMC9318021 DOI: 10.3390/jcm11143994] [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: 04/25/2022] [Revised: 07/07/2022] [Accepted: 07/07/2022] [Indexed: 12/10/2022] Open
Abstract
Objective. Right ventricular (RV) dysfunction after coronary artery bypass grafting (CABG) is associated with increased mortality and morbidity. In previous studies, the parameters of RV systolic function were mainly assessed, while the dynamics of RV diastolic function after surgery was practically not studied. The aim of this study was to study the dynamics of indicators of systolic and diastolic RV function after CABG as well as to identify factors associated with their presence. Methods. The study included 160 patients who underwent CABG and 36 volunteers with no history of coronary artery disease (CAD) as a control group. Echocardiographic examination of patients was performed to assess systolic and diastolic RV dysfunction before surgery and 18 months after CABG. A level of s’t < 10 cm/sec or TAPSE < 16 mm was considered as a sign of existing RV systolic dysfunction. RV diastolic dysfunction was defined as an Et/At ratio < 0.8 or >2.1 and/or an Et/et’ ratio > 6. Results. In CAD patients 18 months after CABG, there was an increase in the frequency of the right ventricular systolic (from 7.5% to 30%, p < 0.001) and diastolic (from 41.8% to 57.5%, p < 0.001) dysfunction. An increase in TAPSE (p = 0.007), a decrease in e’t (p = 0.005), and the presence of RV systolic dysfunction before surgery (p = 0.023) was associated with a significant increase in the likelihood of detecting RV systolic dysfunction 18 months after CABG (χ2(3) = 17.4, p = 0.001). High values of At before surgery (p = 0.021) and old myocardial infarction (p = 0.023) were significantly associated with an increased likelihood of detection of RV diastolic dysfunction 18 months after CABG (χ2(2) = 10.78, p = 0.005). Conclusions. This study demonstrated that in CAD patients 18 months after CABG, there was an increase in the frequency of right ventricular systolic and diastolic dysfunction. We also established the initial clinical, echocardiographic parameters, and perioperative complications associated with the presence of these changes in the postoperative period. The clinical and prognostic significance of the presence of systolic and/or diastolic RV dysfunction in patients 18 months after CABG remains to be explored.
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Affiliation(s)
- Alexey N. Sumin
- Correspondence: ; Tel.: +7-(3842)-64-44-61 or +7-8-903-940-8668; Fax: +7-(3842)-64-27-18
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Hardiman SC, Villan Villan YF, Conway JM, Sheehan KJ, Sobolev B. Factors affecting mortality after coronary bypass surgery: a scoping review. J Cardiothorac Surg 2022; 17:45. [PMID: 35313895 PMCID: PMC8935749 DOI: 10.1186/s13019-022-01784-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Previous research reports numerous factors of post-operative mortality in patients undergoing isolated coronary artery bypass graft surgery. However, this evidence has not been mapped to the conceptual framework of care improvement. Without such mapping, interventions designed to improve care quality remain unfounded. Methods We identified reported factors of in-hospital mortality post isolated coronary artery bypass graft surgery in adults over the age of 19, published in English between January 1, 2000 and December 31, 2019, indexed in PubMed, CINAHL, and EMBASE. We grouped factors and their underlying mechanism for association with in-hospital mortality according to the augmented Donabedian framework for quality of care. Results We selected 52 factors reported in 83 articles and mapped them by case-mix, structure, process, and intermediary outcomes. The most reported factors were related to case-mix (characteristics of patients, their disease, and their preoperative health status) (37 articles, 27 factors). Factors related to care processes (27 articles, 12 factors) and structures (11 articles, 6 factors) were reported less frequently; most proposed mechanisms for their mortality effects. Conclusions Few papers reported on factors of in-hospital mortality related to structures and processes of care, where intervention for care quality improvement is possible. Therefore, there is limited evidence to support quality improvement efforts that will reduce variation in mortality after coronary artery bypass graft surgery. Supplementary Information The online version contains supplementary material available at 10.1186/s13019-022-01784-z.
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Lebeau R, Pagé M, Serri K, Pichette M, Lorenzo MD, Sauvé C, Vinet A, Poulin F. Right ventricular ejection fraction with cardiac magnetic resonance using a wall motion score. Arch Cardiovasc Dis 2022; 115:126-133. [DOI: 10.1016/j.acvd.2022.01.002] [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: 04/17/2021] [Revised: 12/30/2021] [Accepted: 01/04/2022] [Indexed: 11/25/2022]
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Subclinical right ventricular dysfunction in patients with mitral stenosis. J Echocardiogr 2022; 20:87-96. [PMID: 35040010 DOI: 10.1007/s12574-021-00554-5] [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: 09/25/2020] [Revised: 09/25/2021] [Accepted: 09/28/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Right ventricular (RV) dysfunction is a strong predictor of poor outcomes of patients with mitral stenosis (MS). The aim of this study was to detect a subclinical right ventricular dysfunction in patients with MS. METHODS We conducted a prospective study from January 2015 to June 2019 in 104 asymptomatic patients with MS (mean age: 46.1 ± 4.27 years), and compared to a group of 52 age and sex matched healthy subjects. Standard and speckle tracking echocardiography were performed; parameters of RV function were measured and compared. RESULTS Although they were in normal range, RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), tissue Doppler and pulsed wave Doppler RV myocardial performance index (MPI) and peak systolic velocity (S') were decreased in patients with MS (p < 0.05). The global RV longitudinal strain (LSGRV) and the longitudinal strain of the free wall of the right ventricular (LSFRV) were lower in patients with MS (p, respectively, at 0.001 and < 0.001), 53.5% (n = 47) of patients had LSFRV < - 20%. A significant difference was noted between LSFRV and 2D strain of the septal wall (p = 0.002). No difference was found between patients with severe MS and moderate MS regarding LSFRV and LSGRV. No correlation between LSFRV and FAC (p = 0.85), MPI (p = 0.62), TAPSE (p = 0.31) and S' (p = 0.78) was found. CONCLUSION Our study showed the presence of subclinical systolic dysfunction of the right ventricle in patients with MS.
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Muraru D, Badano LP, Nagata Y, Surkova E, Nabeshima Y, Genovese D, Otsuji Y, Guida V, Azzolina D, Palermo C, Takeuchi M. Development and prognostic validation of partition values to grade right ventricular dysfunction severity using 3D echocardiography. Eur Heart J Cardiovasc Imaging 2021; 21:10-21. [PMID: 31539046 DOI: 10.1093/ehjci/jez233] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/29/2019] [Accepted: 08/23/2019] [Indexed: 11/14/2022] Open
Abstract
AIMS Transthoracic 3D echocardiography (3DE) has been shown to be feasible and accurate to measure right ventricular (RV) ejection fraction (EF) when compared with cardiac magnetic resonance (CMR). However, RV EF, either measured with CMR or 3DE, has always been reported as normal (RV EF > 45%) or abnormal (RV EF ≤ 45%). We therefore sought to identify the partition values of RV EF to stratify RV dysfunction in mildly, moderately, or severely reduced as we are used to do with the left ventricle. METHODS AND RESULTS We used 3DE to measure RV EF in 412 consecutive patients (55 ± 18 years, 65% men) with various cardiac conditions who were followed for 3.7 ± 1.4 years to obtain the partition values which defined mild, moderate, and severe reduction of RV EF (derivation cohort). Then, the prognostic value of these partition values was tested in an independent population of 446 patients (67 ± 14 years, 58% men) (validation cohort). During follow-up, we recorded 59 cardiac deaths (14%) in the derivation cohort. Using K-Adaptive partitioning for survival data algorithm we identified four groups of patients with significantly different mortality according to RV EF: very low > 46%, 40.9% < low ≤ 46%, 32.1% < moderate ≤ 40.9%, and high ≤ 32.1%. To make the partition values easier to remember, we approximated them to 45%, 40%, and 30%. During 4.1 ± 1.2 year follow-up, 38 cardiac deaths and 88 major adverse cardiac events (MACE) (cardiac death, non-fatal myocardial infarction, ventricular fibrillation, or admission for heart failure) occurred in the validation cohort. The partition values of RV EF identified in the derivation cohort were able to stratify both the risk of cardiac death (log-rank = 100.1; P < 0.0001) and MACEs (log-rank = 117.6; P < 0.0001) in the validation cohort too. CONCLUSION Our study confirms the independent prognostic value of RV EF in patients with heart diseases, and identifies the partition values of RV EF to stratify the risk of cardiac death and MACE.
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Affiliation(s)
- Denisa Muraru
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Luigi P Badano
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Piazzale Brescia, 20, Milan, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy
| | - Yasufumi Nagata
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishiku, Kitakyushu, Japan
| | - Elena Surkova
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy.,Cardiac Division, Department of Echocardiography, Royal Brompton Hospital, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, Chelsea, London, UK
| | - Yosuke Nabeshima
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishiku, Kitakyushu, Japan
| | - Davide Genovese
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Yutaka Otsuji
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishiku, Kitakyushu, Japan
| | - Valentina Guida
- Istituto Auxologico Italiano, IRCCS, Cardiology Unit and Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Piazzale Brescia, 20, Milan, Italy
| | - Danila Azzolina
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Chiara Palermo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua School of Medicine, Via Giustiniani 2, Padua, Italy
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, School of Medicine, University of Occupational and Environmental Health, Iseigaoka 1-1, Yahatanishiku, Kitakyushu, Japan
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Feasibility, Reproducibility and Validation of Right Ventricular Volume and Function Assessment Using Three-Dimensional Echocardiography. Diagnostics (Basel) 2021; 11:diagnostics11040699. [PMID: 33919794 PMCID: PMC8070805 DOI: 10.3390/diagnostics11040699] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 11/24/2022] Open
Abstract
Three-dimensional echocardiography (3DE) is advised for right ventricular (RV) assessment. Data regarding the optimal acquisition settings and optimization are still scarce. We aimed to evaluate the feasibility, reproducibility and validation of 3DE for RV volume and function assessment, using cardiac magnetic resonance (CMR) as gold standard. Thirty healthy volunteers and 36 consecutive patients were prospectively included. CMR was performed in the latter. Standard apical four-chamber view (A4CV), focused A4CV and modified A4CV were used for 3DE RV acquisition. Feasibility (and the effect of changes in settings) was evaluated. Intra and interobserver analyses were performed by three observers (expert vs. novice). RV parameters by echocardiography were compared to CMR. Feasibility of acquisition was 16.7% for A4CV, 80.0% for focused A4CV and 16.7% for modified A4CV. Changes in settings had no significant influence on feasibility and further analysis. Intraobserver variability was good in both expert and novice, interobserver variability was good between experienced observers. Compared to CMR, 3DE volumes were significantly lower with fair to moderate correlation (EDV: 91.1 ± 24.4 mL vs. 144.3 ± 43.0 mL (p < 0.001), r = 0.653 and ESV: 48.1 ± 16.4 mL vs. 60.4 ± 21.2 mL (p < 0.001), r = 0.530, by multi-beat 3DE and CMR respectively). These findings suggest that standardization is needed in order to implement this technique in clinical practice, thus further studies are required.
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Smith NJ, Ramamurthi A, Joyce LD, Durham LA, Kohmoto T, Joyce DL. Temporary mechanical circulatory support prevents the occurrence of a low-output state in high-risk coronary artery bypass grafting: A case series. J Card Surg 2021; 36:864-871. [PMID: 33428241 DOI: 10.1111/jocs.15309] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 11/27/2020] [Accepted: 12/28/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Coronary artery bypass grafting (CABG) is a durable treatment for coronary artery disease. Left ventricular dysfunction (LVD) (a division of cardiothoracic surgery) (ejection fraction < 35%) significantly elevates perioperative risk for patients pursuing surgical revascularization. Periprocedural support with temporary mechanical circulatory support (tMCS) has shown benefit in this patient population. METHODS Four patients with ischemic cardiomyopathy and LVD underwent CABG at our institution between 2017 and 2018. Each patient received perioperative ventricular support using a microaxial tMCS device (Impella 5.0®). The occurrence of a postoperative low-output state (LOS) was assessed for as well as postoperative morbidity and mortality, device-specific complications, and tMCS support duration. RESULTS All patients survived to device explant without device-related complications. Two patients required reoperation for nondevice-related bleeding. All patients were without an LOS at 24 h postoperatively with cardiac indices of 2.9-3.6 L/min/m2 , normalized serum lactate, and vasoactive-inotrope scores of 0-12.0. There was a notably high incidence of acute renal failure (50%), which was observed in patients with preoperative cardiogenic shock. One patient died 10 days after the device explant. Of the three patients that survived to discharge, two were alive at the most recent follow-up. Postoperative device support varied widely (0-500 h). CONCLUSION Perioperative tMCS may be a viable strategy for preventing postoperative LOS in high-risk CABG patients with a low complication rate and acceptable morbidity. The application of microaxial tMCS devices in CABG is an area that warrants further investigation to delineate its impact on perioperative outcomes and potentially expand the indications for such devices.
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Affiliation(s)
- Nathan J Smith
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Adhitya Ramamurthi
- Department of Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lyle D Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Lucian A Durham
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Takushi Kohmoto
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David L Joyce
- Department of Surgery, Division of Cardiothoracic Surgery, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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Badano LP, Addetia K, Pontone G, Torlasco C, Lang RM, Parati G, Muraru D. Advanced imaging of right ventricular anatomy and function. Heart 2020; 106:1469-1476. [PMID: 32620556 DOI: 10.1136/heartjnl-2019-315178] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 12/18/2022] Open
Abstract
Right ventricular (RV) size and function are important predictors of cardiovascular morbidity and mortality in patients with various conditions. However, non-invasive assessment of the RV is a challenging task due to its complex anatomy and location in the chest. Although conventional echocardiography is widely used, its limitations in RV assessment are well recognised. New techniques such as three-dimensional and speckle tracking echocardiography have overcome the limitations of conventional echocardiography allowing a comprehensive, quantitative assessment of RV geometry and function without geometric assumptions. Cardiac magnetic resonance (CMR) and CT provide accurate assessment of RV geometry and function, too. In addition, tissue characterisation imaging for myocardial scar and fat using CMR and CT provides important information regarding the RV that has clinical applications for diagnosis and prognosis in a broad range of cardiac conditions. Limitations also exist for these two advanced modalities including availability and patient suitability for CMR and need for contrast and radiation exposure for CT. Hybrid imaging, which is able to integrate anatomical information (usually obtained by CT or CMR) with physiological and molecular data (usually obtained with positron emission tomography), can provide optimal in vivo evaluation of Rv functional impairment. This review summarises the clinically useful applications of advanced echocardiography techniques, CMR and CT for comprehensive assessment of RV size, function and mechanics.
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Affiliation(s)
- Luigi P Badano
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy .,Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Karima Addetia
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Gianluca Pontone
- Cardiovascular Imaging Department, Centro Cardiologico Monzino IRCCS, Milano, Italy
| | - Camilla Torlasco
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois, USA
| | - Gianfranco Parati
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
| | - Denisa Muraru
- Department of Cardiovascular, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milano, Italy.,Department of Medicine and Surgery, University of Milano-Bicocca, Milano, Italy
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Clinical utility of early postoperative cardiac multidetector computed tomography after coronary artery bypass grafting. Sci Rep 2020; 10:9186. [PMID: 32514056 PMCID: PMC7280270 DOI: 10.1038/s41598-020-66176-6] [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: 02/03/2020] [Accepted: 05/13/2020] [Indexed: 11/22/2022] Open
Abstract
We evaluated the clinical utility of early postoperative cardiac computed tomography (CT) for evaluating left ventricular (LV) function and predicting prognosis in patients who had undergone coronary artery bypass grafting (CABG). Of the 205 patients who underwent CABG from March 2011 to December 2014, 136 underwent early postoperative cardiac CT (within 30 days after CABG) and were enrolled as the study population. The baseline and postoperative follow-up echocardiographic findings, major adverse cardiac events (MACE), and death were recorded for a follow-up period (mean, 5.9 ± 1.1 years). Functional cardiac CT parameters were compared to echocardiographic measurements. The associations between cardiac CT findings and functional recovery and prognosis were evaluated by logistic regression analyses. The LVEF measured via cardiac CT was significantly higher (56.2 ± 11.5% vs. 61.9 ± 12.9%; p = 0.0002) compared to those via early postoperative echocardiography, but the wall motion score index (WMSI) was not significantly different (1.23 ± 0.33 vs. 1.21 ± 0.28, p = 0.5041) between the two methods. During the follow-up period, 17 patients (12.5%) died and 40 (29.4%) developed MACE. Both the LVEF and WMSI measured with early postoperative echocardiography (p = 0.0202 and odds ratio [OR] = 5.0171, p = 0.0039, respectively), and cardiac CT (OR = 0.9625, p = 0.0091 and OR = 14.3605, p = 0.0001, respectively) predicted MACE OR = 0.9630, but only the WMSI, measured using cardiac CT, predicted all-cause death (OR = 10.6017, p = 0.0035). In CABG patients, LVEF and the WMSI measured with early postoperative cardiac CT were comparable with echocardiography and predicted the development of MACE and all-cause death.
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Lejeune S, Roy C, Ciocea V, Slimani A, de Meester C, Amzulescu M, Pasquet A, Vancraeynest D, Beauloye C, Vanoverschelde JL, Gerber BL, Pouleur AC. Right Ventricular Global Longitudinal Strain and Outcomes in Heart Failure with Preserved Ejection Fraction. J Am Soc Echocardiogr 2020; 33:973-984.e2. [PMID: 32387031 DOI: 10.1016/j.echo.2020.02.016] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Right ventricular (RV) strain has emerged as an accurate tool for RV function assessment and is a powerful predictor of survival in patients with heart failure with reduced ejection fraction. However, its prognostic impact in patients with heart failure with preserved ejection fraction (HFpEF) remains unclear. The aim of this study was to compare the prognostic value of RV global longitudinal strain (RVGLS) by two-dimensional speckle-tracking echocardiographic (STE) imaging in patients with HFpEF against conventional RV function parameters. METHODS Patients with HFpEF were prospectively recruited, and 149 of 183 (81%) with analyzable STE RVGLS images constituted the final study population (mean age, 78 ± 9 years; 61% women), compared with 28 control subjects of similar age and sex. All control subjects and 120 patients also underwent cardiac magnetic resonance imaging. Patients were followed up for a primary end point of all-cause mortality and first heart failure hospitalization, and Cox regression analysis was performed. RESULTS Mean STE RVGLS was significantly altered in patients with HFpEF compared with control subjects (-21.7 ± 4.9% vs -25.9 ± 4.2%, P < .001). STE RVGLS correlated well with RV ejection fraction by cardiac magnetic resonance (r = -0.617, P < .001). Twenty-eight patients with HFpEF (19%) had impaired STE RVGLS (>-17.5%). During a mean follow-up period of 30 ± 9 months, 91 patients with HFpEF (62%) reached the primary end point. A baseline model was created using independent predictors of the primary end point: New York Heart Association functional class III or IV, hemoglobin level, estimated glomerular filtration rate, and the presence of moderate or severe tricuspid regurgitation. Impaired STE RVGLS provided significant additional prognostic value over this model (χ2 to enter = 7.85, P = .005). Impaired tricuspid annular plane systolic excursion and fractional area change, however, did not. CONCLUSIONS In patients with HFpEF, impaired RVGLS has strong prognostic value. STE RVGLS should be considered for systematic evaluation of RV function to identify patients at high risk for adverse events.
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Affiliation(s)
- Sibille Lejeune
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Clotilde Roy
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Victor Ciocea
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Alisson Slimani
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Christophe de Meester
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Mihaela Amzulescu
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Agnes Pasquet
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - David Vancraeynest
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Christophe Beauloye
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Jean-Louis Vanoverschelde
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium; Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Anne-Catherine Pouleur
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Brussels, Belgium.
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Houard L, Benaets MB, de Meester de Ravenstein C, Rousseau MF, Ahn SA, Amzulescu MS, Roy C, Slimani A, Vancraeynest D, Pasquet A, Vanoverschelde JLJ, Pouleur AC, Gerber BL. Additional Prognostic Value of 2D Right Ventricular Speckle-Tracking Strain for Prediction of Survival in Heart Failure and Reduced Ejection Fraction. JACC Cardiovasc Imaging 2019; 12:2373-2385. [DOI: 10.1016/j.jcmg.2018.11.028] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/17/2018] [Accepted: 11/19/2018] [Indexed: 11/28/2022]
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14
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Rong LQ, Rahouma M, Neuburger PJ, Arguelles G, Emerson J, Mauer E, Tam C, Shore-Lesserson L, Pryor KO, Gaudino M. Use of Pulmonary Artery Pulsatility Index in Cardiac Surgery. J Cardiothorac Vasc Anesth 2019; 34:1220-1225. [PMID: 31653496 DOI: 10.1053/j.jvca.2019.09.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 09/16/2019] [Accepted: 09/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE This study evaluated whether the pulmonary artery pulsatility index (PAPi) collected before and after cardiopulmonary bypass (CPB) is predictive and diagnostic of new onset right ventricular (RV) failure in the elective cardiac surgical population. DESIGN This was a prospective observational study of patients who underwent cardiac surgery between 2017 and 2019. SETTING Weill Cornell Medicine, a single large academic medical center. PARTICIPANTS The study comprised 119 patients undergoing elective cardiac surgery. INTERVENTIONS Cardiopulmonary bypass, transesophageal echocardiography, pulmonary artery catheter, and elective cardiac surgery. MEASUREMENTS AND MAIN RESULTS Echocardiographic and hemodynamic data were collected at 2 time points: pre-CPB and post-chest closure/post-CPB. Patients with and without post-CPB RV dysfunction fractional area of change (<35%) were compared, and receiver operating characteristic curves were constructed. One hundred and nineteen patients undergoing elective surgery-coronary artery bypass grafting (23%), aortic valve replacement (21%), aortic surgery (19%), and combined surgery (37%)-were evaluated. Post-CPB RV dysfunction was associated with lower pre-CPB PAPi values (2.0 ± 1.0 v 2.5 ± 1.2; p = 0.001 and p = 0.03) and higher pre-CPB central venous pressure (8.3 ± 3.6 and 6.9 ± 2.7; p = 0.003 and p = 0.02, respectively). Pre-CPB PAPi (0.98 [95% confidence interval {CI} 0.96-0.99]), end systolic area (0.99 [95% CI 0.98-0.99]), and end diastolic area (1.01 [95% CI 1.001-1.02]) were independently associated with RV dysfunction in multivariable modeling, with a lower PAPi and end systolic area and higher end diastolic area demonstrating a greater risk of RV dysfunction post-CPB (post-CPB area under the curve for PAPi 0.80 [95% CI 0.71-0.88; sensitivity = 0.68, specificity = 0.93, optimal cutoff = 1.9]). CONCLUSIONS PAPi measured pre-CPB is a potential predictor and marker of post-CPB RV dysfunction and may have diagnostic utility in cardiac surgery. Additional, large-scale studies are needed to confirm this finding.
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Affiliation(s)
- Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY.
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
| | - Peter J Neuburger
- Department of Anesthesiology, New York University Hospital, New York, NY
| | | | | | - Elizabeth Mauer
- Department of Healthcare Policy and Research, Weill Cornell Medicine, New York, NY
| | - Christopher Tam
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | | | - Kane O Pryor
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY
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Grønlykke L, Korshin A, Holmgaard F, Kjøller SM, Gustafsson F, Nilsson JC, Ravn HB. Severe loss of right ventricular longitudinal contraction occurs after cardiopulmonary bypass in patients with preserved right ventricular output. Int J Cardiovasc Imaging 2019; 35:1661-1670. [DOI: 10.1007/s10554-019-01616-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/25/2019] [Indexed: 11/28/2022]
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16
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Yu PJ, Lin D, Catalano M, Cassiere H, Kohn N, Hartman A. Predictors of Increased Length of Hospital Stay in Patients with Severe Cardiomyopathy Undergoing Coronary Artery Bypass Grafting. J Cardiothorac Vasc Anesth 2019; 33:2703-2708. [PMID: 31084990 DOI: 10.1053/j.jvca.2019.03.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/06/2019] [Accepted: 03/08/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Predictors of operative outcome in patients with severely depressed left ventricular ejection fraction (LVEF) undergoing coronary artery bypass grafting (CABG) remain poorly defined. This study aims to identify preoperative variables that are associated with increased postoperative length of hospital stay or operative mortality in this patient population. DESIGN Retrospective study. SETTING Single tertiary care university hospital. PARTICIPANTS Patients undergoing isolated CABG between January 2012 and March 2017 with an LVEF ≤ 25%. INTERVENTIONS Isolated CABG. MEASUREMENTS AND MAIN RESULTS Primary endpoint was a composite of prolonged length of stay, defined as postoperative length of stay >7 days or operative mortality. Of the 201 patients, 99 (49.3%) met the primary endpoint. Patient comorbidities, clinical presentation, presence of Q-waves on electrocardiogram, and echocardiographic parameters including ventricular dimensions and right heart dysfunction were not associated with the primary endpoint. On multivariable analysis, patients who were not on preoperative beta-blockers, patients with preoperative albumin of <3.5 g/dL, and higher Society of Thoracic Surgeons Predicted Risk of Mortality score were associated with increased prolonged length of stay or death. CONCLUSIONS More than half of patients with severely depressed LVEF undergoing isolated CABG are able to be discharged within 7 days postoperatively. The absence of preoperative beta-blockers, low preoperative albumin levels, and higher Society of Thoracic Surgeons Predicted Risk of Mortality score are associated with more complicated or slower postoperative recovery after CABG in this patient population.
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Affiliation(s)
- Pey-Jen Yu
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY.
| | - Dishen Lin
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Michael Catalano
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Hugh Cassiere
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
| | - Nina Kohn
- The Feinstein Institute for Medical Research, Manhasset, NY
| | - Alan Hartman
- Division of Cardiovascular and Thoracic Surgery, Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
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Yamazaki S, Numata S, Inoue T, Itatani K, Morimoto K, Ohira S, Manabe K, Yokota I, Yaku H. Impact of right ventricular volume and function evaluated using cardiovascular magnetic resonance imaging on outcomes after surgical ventricular reconstruction†. Eur J Cardiothorac Surg 2018; 54:867-874. [DOI: 10.1093/ejcts/ezy189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Accepted: 04/06/2018] [Indexed: 01/08/2023] Open
Affiliation(s)
- Sachiko Yamazaki
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Numata
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Tomoya Inoue
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Keiichi Itatani
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kazuki Morimoto
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Suguru Ohira
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kaichiro Manabe
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Hitoshi Yaku
- Department of Cardiovascular Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Patscheider H, Lorbeer R, Auweter S, Schafnitzel A, Bayerl C, Curta A, Rathmann W, Heier M, Meisinger C, Peters A, Bamberg F, Hetterich H. Subclinical changes in MRI-determined right ventricular volumes and function in subjects with prediabetes and diabetes. Eur Radiol 2018; 28:3105-3113. [PMID: 29423576 DOI: 10.1007/s00330-017-5185-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 10/14/2017] [Accepted: 11/07/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aim of this study was to assess subclinical changes in right ventricular volumes and function in subjects with prediabetes and diabetes and controls without a history of cardiovascular disease. METHODS Data from 400 participants in the KORA FF4 study without self-reported cardiovascular disease who underwent 3-T whole-body MRI were obtained. The right ventricle was evaluated using the short axis and a four-chamber view. Diabetes was defined according to WHO criteria. Associations between glucose tolerance and right ventricular parameters were assessed using multivariable adjusted linear regression models. RESULTS Data from 337 participants were available for analysis. Of these, 43 (13%) had diabetes, 87 (26%) had prediabetes, and 207 (61%) were normoglycaemic controls. There was a stepwise decrease in right ventricular volumes in men with prediabetes and diabetes in comparison with controls, including right ventricular end-diastolic volume (β = -20.4 and β = -25.6, respectively; p ≤ 0.005), right ventricular end-systolic volume (β = -12.3 and β = -12.7, respectively; p ≤ 0.037) and right ventricular stroke volume (β = -8.1 and β = -13.1, respectively, p ≤ 0.016). We did not observe any association between prediabetes or diabetes and right ventricular volumes in women or between prediabetes or diabetes and right ventricular ejection fraction in men and women. CONCLUSIONS This study points towards early subclinical changes in right ventricular volumes in men with diabetes and prediabetes. KEY POINTS • MRI was used to detect subclinical changes in right ventricular parameters. • Diabetes mellitus is associated with right ventricular dysfunction. • Impairment of right ventricular volumes seems to occur predominantly in men.
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Affiliation(s)
- Hannah Patscheider
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Roberto Lorbeer
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Sigrid Auweter
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Anina Schafnitzel
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Christian Bayerl
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Adrian Curta
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany
| | - Wolfgang Rathmann
- Department of Biometry and Epidemiology, German Diabetes Centre, Duesseldorf, Germany
| | - Margit Heier
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany.,KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany.,KORA Myocardial Infarction Registry, Central Hospital of Augsburg, Augsburg, Germany
| | - Annette Peters
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Centre of Environmental Health, Neuherberg, Germany.,German Centre for Diabetes Research (DZD e.V.), Neuherberg, Germany.,German Centre for Cardiovascular Disease Research (DZHK e.V.), Munich, Germany
| | - Fabian Bamberg
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany.,Department of Diagnostic and Interventional Radiology, University of Tuebingen, Tuebingen, Germany
| | - Holger Hetterich
- Institute of Clinical Radiology, Ludwig-Maximilian-University Hospital, Marchioninistr. 15, 81377, Munich, Germany.
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Davierwala PM, Leontyev S, Verevkin A, Rastan AJ, Mohr M, Bakhtiary F, Misfeld M, Mohr FW. Temporal Trends in Predictors of Early and Late Mortality After Emergency Coronary Artery Bypass Grafting for Cardiogenic Shock Complicating Acute Myocardial Infarction. Circulation 2017; 134:1224-1237. [PMID: 27777292 DOI: 10.1161/circulationaha.115.021092] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 07/26/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cardiogenic shock after acute myocardial infarction is an indication for emergent coronary artery bypass grafting in patients not amenable to percutaneous coronary intervention. Our study aimed to evaluate and identify risk factors for early and long-term outcomes in such patients. METHODS A total of 508 patients who underwent coronary artery bypass grafting for cardiogenic shock complicating acute myocardial infarction between January 2000 and June 2014 were divided into 3 time cohorts: 2000 to 2004 (n=204), 2005 to 2009 (n=166), and 2010 to 2014 (n=138). Predictors of in-hospital mortality for each time cohort and long-term mortality for all patients were identified by logistic and Cox regression analyses, respectively. RESULTS Mean age was 68.3±9.8 years. Of the 508 patients, 78.5% had 3-vessel and 47.1% had left main disease. Left ventricular function <30% was observed in 44.1% of patients, with 30.4%, 37.9%, 52.9%, and 3.1% requiring preoperative resuscitation, ventilation, intra-aortic balloon pump, and extracorporeal membrane oxygenation support, respectively. Overall in-hospital mortality was 33.7%; declined from 42.2% to 30.7% to 24.6%, respectively, for the 3 time cohorts (P=0.02); and was independently predicted by serum lactate >4 mmol/L (odds ratio [OR], 4.78; 95% confidence interval, 2.88-7.95; P<0.0001), ST-segment-elevation myocardial infarction (OR, 2.10; 95% confidence interval, 1.36-3.26; P=0.001), age >75 years (OR, 2.01; 95% confidence interval, 1.06-3.85; P=0.03), and left ventricular ejection fraction <30% (OR, 1.83; 95% confidence interval, 1.15-2.91; P=0.01). Cumulative survival was 42.6±2.0% and 33.4±2.0% at 5 and 10 years, respectively, and correspondingly improved to 64.3±3.0% and 49.8±3.0% in hospital survivors. Serum lactate >4 mmol/L (OR, 2.2; P<0.0001), incremental age (OR, 1.05; P<0.0001), New York Heart Association class IV (OR, 1.33; P=0.02), diabetes mellitus (OR, 1.39; P=0.005), and preoperative inotropic (OR, 2.61; P=0.001) and extracorporeal membrane oxygenation (OR, 1.68; P=0.05) support predicted late mortality. CONCLUSIONS Emergency coronary artery bypass grafting in patients with acute myocardial infarction complicated by cardiogenic shock is associated with a high in-hospital mortality, which showed a significant decline with time. Hospital survivors have good long-term outcomes, which demonstrate the beneficial effect of surgical revascularization. Preoperative serum lactate >4 mmol/L is a strong predictor of both early and late mortality.
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Affiliation(s)
- Piroze M Davierwala
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr).
| | - Sergey Leontyev
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Alexander Verevkin
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Ardawan J Rastan
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Matthias Mohr
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Farhad Bakhtiary
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Martin Misfeld
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
| | - Friedrich W Mohr
- From Department of Cardiac Surgery, Heart Center, University of Leipzig, Leipzig, Germany (P.M.D., S.L., A.V., F.B., M. Misfeld, F.W.M.); Department of Cardiovascular Surgery, Heart and Circulatory Center, Rotenburg an der Fulda, Germany (A.J.R.); and Medizinische Klinik II, Sana Kliniken, Lübeck, Germany (M. Mohr)
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