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Multi-Parametric Diagnostic Approach and Potential Markers of Early Onset Subclinical Cardiovascular Disease in a Cohort of Children, Adolescents and Young Adults Vertically Infected with HIV on cART. J Clin Med 2021; 10:jcm10225455. [PMID: 34830737 PMCID: PMC8623100 DOI: 10.3390/jcm10225455] [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: 09/16/2021] [Revised: 10/29/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
Background: HIV infection and lifelong cART are responsible of an increase in cardiovascular risk. The aim of this study was to describe the subclinical cardiovascular disease and to identify early markers of cardiovascular damage in adolescents and young adults vertically infected with HIV on cART, through an innovative multi-parametric approach. Methods: We enrolled 52 patients vertically infected with HIV. Demographic records, traditional cardiovascular risk factors, laboratory findings and echocardiographic measurements were collected in a one-year routine follow up. The echocardiographic examination included measurements of the 2D and 3D ejection fraction (EF), E/A ratio, E/E′ ratio, carotid intima media thickness (cIMT), flow-mediated dilation (FMD) and global longitudinal strain (GLS). Results: At the time of enrolment, all the patients were on cART therapy. The viral load was suppressed in 95% of them. EF was normal in 94.2% of patients (66 ± 7.2%), and GLS (mean value: −20.0 ± 2.5%) was reduced in 29% of patients. The cIMT mean value was higher than the 95th centile for sex and age in 73%, and FMD was impaired in 45% of patients. Clinically evident disease was found in three patients: dilative cardiomyopathy in one, thoracic-abdominal aneurysm Crawford type II with a bilateral carotid dilation in one and carotid plaque with 30% of stenosis in a third patient. Conclusions: This study confirms the presence of clinical and subclinical cardiovascular disease in a very young population vertically infected with HIV, underlining the importance of an early, multi-parametric cardiovascular follow up.
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Wernhart S, Halle M. Echocardiographic E/A inversion and air trapping at rest are associated with an exaggerated blood pressure response in medically controlled hypertensives during bicycle ergometry. COGENT MEDICINE 2019. [DOI: 10.1080/2331205x.2019.1707014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Simon Wernhart
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Department of Cardiology, Fachkrankenhaus Kloster Grafschaft, Schmallenberg, Germany
| | - Martin Halle
- Department of Prevention, Rehabilitation and Sports Medicine, School of Medicine, Technical University of Munich, Munich, Germany
- Deutsches Zentrum für Herz-Kreislauf-Forschung e. V. (DZHK), Munich Heart Alliance, Munich, Germany
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Aggarwal SR, Herrington DM, Vladutiu CJ, Newman JC, Swett K, Gonzalez F, Kizer JR, Kominiarek MA, Tabb KM, Gallo LC, Talavera GA, Hurwitz BE, Rodriguez CJ. Higher number of live births is associated with left ventricular diastolic dysfunction and adverse cardiac remodelling among US Hispanic/Latina women: results from the Echocardiographic Study of Latinos. Open Heart 2017; 4:e000530. [PMID: 28674618 PMCID: PMC5471863 DOI: 10.1136/openhrt-2016-000530] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 09/06/2016] [Accepted: 11/17/2016] [Indexed: 01/19/2023] Open
Abstract
Introduction Female sex is a risk factor for heart failure with preserved ejection fraction (HFpEF). Previous literature suggests that some diastolic dysfunction (DD) develops during pregnancy and may persist postdelivery. Our objective was to examine the relationship between parity and cardiac structure and function in a population-based cohort. Methods Participants included 1172 Hispanic/Latina women, aged ≥45 years, enrolled in the Echocardiographic Study of Latinos from four US communities (Bronx, Miami, San Diego and Chicago). Standard echocardiographic techniques were used to measure cardiac volumes, left ventricular mass, systolic and diastolic function. Using sampling weights and survey statistics, multivariable linear and logistic regression models were constructed adjusting for age, body mass index, diabetes or prediabetes, systolic blood pressure, use of antihypertensive medications, smoking, total cholesterol and high-density lipoprotein cholesterol. Results In the target population, 5.0% were nulliparous (no live births) and 10.5% were grand multiparous (≥5 live births). Among the nulliparous women, 46% had DD as compared with 51%–58% of women with 1–4 live births and 81% of women with ≥5 live births (p<0.01). In full multivariate models, higher parity was significantly associated with greater left ventricular end-systolic volumes, end-diastolic volumes, left atrial volume indices and presence of DD (all p<0.01) but was not associated with ejection fraction. The log odds for having any grade of DD in grand-multiparous women was over three times that seen in nulliparous women (OR=3.4, 95% CI 1.5 to 7.9, p<0.01) in models further adjusted for income and education. Conclusions Higher parity is associated with increased cardiac mass, volumes and the presence of DD. Further studies are needed to elucidate this apparent deleterious relation and whether parity can help explain the increased risk of HFpEF in women.
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Affiliation(s)
| | | | | | - Jill C Newman
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Katrina Swett
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | | | - Jorge R Kizer
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Karen M Tabb
- University of Illinois Urbana-Champaign, Urbana, Illinois, USA
| | - Linda C Gallo
- San Diego State University, San Diego, California, USA
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Nazário Leão R, Marques da Silva P. Diastolic dysfunction in hypertension. HIPERTENSION Y RIESGO VASCULAR 2017; 34:128-139. [PMID: 28268171 DOI: 10.1016/j.hipert.2017.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 01/26/2017] [Indexed: 12/21/2022]
Abstract
Hypertension and coronary heart disease, often coexisting, are the most common risk factors for heart failure. The progression of hypertensive heart disease involves myocardial fibrosis and alterations in the left ventricular geometry that precede the functional change, initially asymptomatic. The left ventricular diastolic dysfunction is part of this continuum being defined by the presence of left ventricular diastolic dysfunction without signs or symptoms of heart failure or poor left ventricular systolic function. It is highly prevalent in hypertensive patients and is associated with increased cardiovascular morbidity and mortality. Despite its growing importance in clinical practice it remains poorly understood. This review aims to present the epidemiological fundamentals and the latest developments in the pathophysiology, diagnosis and treatment of left ventricular diastolic dysfunction.
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Affiliation(s)
- R Nazário Leão
- Unidade Funcional Medicina 2, Hospital São José, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal; Nova Medical School, Lisboa, Portugal.
| | - P Marques da Silva
- Nova Medical School, Lisboa, Portugal; Núcleo de Investigação Arterial, Unidade Funcional Medicina 4, Hospital Santa Marta, Centro Hospitalar Lisboa Central - EPE, Lisboa, Portugal
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Farouk H, Albasmi M, El Chilali K, Mahmoud K, Nasr A, Heshmat H, Abdel-Moneim S, Baligh E. Left ventricular diastolic dysfunction in patients with chronic obstructive pulmonary disease: Impact of methods of assessment. Echocardiography 2017; 34:359-364. [PMID: 28165145 DOI: 10.1111/echo.13469] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND The prevalence of left ventricular (LV) diastolic dysfunction in patients with chronic obstructive pulmonary disease (COPD), using different echocardiographic parameters, varies widely in the literature. The highest prevalence of LV diastolic dysfunction was detected using the mitral inflow indexes that are commonly altered in these patients due to the associated tachycardia, reduced preload, and ventricular septal shift. In this study, we aimed at evaluating the impact of the used echocardiographic method of assessment on the prevalence of LV diastolic dysfunction in patients with COPD and normal LV systolic function. METHODS We studied 35 patients with COPD and 18 age-matched controls. A comprehensive approach to diagnose and grade the LV diastolic dysfunction was performed in accordance with the recommendations of the American Society of Echocardiography published in 2009. The results were compared with those of mitral inflow indexes. RESULTS LV diastolic dysfunction was reported in 20 patients using the mitral inflow indexes while in only 12 patients using the comprehensive approach (P=.021). Compared to the controls, LV diastolic dysfunction was significantly more common in patients using the mitral inflow indexes (P=.001), while no statistically significant difference was detected between both groups using the comprehensive approach (P=.1). CONCLUSION The prevalence of LV diastolic dysfunction in patients with COPD varies according to the used echocardiographic approach. Further studies are recommended to determine which approach is the most accurate in estimating the true prevalence of LV diastolic dysfunction among this group of patients.
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Affiliation(s)
- Heba Farouk
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Maged Albasmi
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Karim El Chilali
- Department of Cardiology, Essen University Hospital, Essen, Germany
| | - Kareem Mahmoud
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Abdo Nasr
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Hussein Heshmat
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Samah Abdel-Moneim
- Department of Pulmonary Medicine, Cairo University Hospitals, Cairo, Egypt
| | - Essam Baligh
- Department of Cardiovascular Medicine, Cairo University Hospitals, Cairo, Egypt
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Ammar A, Mahmoud K, Elkersh A, Kasemy Z. A randomised controlled trial comparing the effects of propofol with isoflurane in patients with diastolic dysfunction undergoing coronary artery bypass graft surgery. Anaesthesia 2016; 71:1308-1316. [DOI: 10.1111/anae.13564] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2016] [Indexed: 11/28/2022]
Affiliation(s)
- A. Ammar
- Statistics and Community Medicine; Minoufiya Faculty of Medicine; Shebin Elkoam Egypt
| | - K. Mahmoud
- Statistics and Community Medicine; Minoufiya Faculty of Medicine; Shebin Elkoam Egypt
| | - A. Elkersh
- Statistics and Community Medicine; Minoufiya Faculty of Medicine; Shebin Elkoam Egypt
| | - Z. Kasemy
- Statistics and Community Medicine; Minoufiya Faculty of Medicine; Shebin Elkoam Egypt
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Lee SH, Kim KW, Joo HC, Yoo KJ, Youn YN. Predictors and Clinical Impacts of Aggravated Left Ventricular Diastolic Dysfunction After Off-Pump Coronary Artery Bypass Grafting. Circ J 2016; 80:1937-45. [PMID: 27477845 DOI: 10.1253/circj.cj-16-0165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND To determine the predictors of aggravated left ventricular diastolic dysfunction (LVDD) in patients undergoing off-pump coronary artery bypass grafting (OPCAB) and to compare late outcomes according to the aggravated LVDD. METHODS AND RESULTS OPCAB was performed in 1,101 patients (2001-2013). LVDD was classified as normal, mild, moderate or severe. Patients were divided into 2 groups: non-aggravated LVDD (group I) and aggravated LVDD (group II). The primary endpoint was aggravation of LVDD. The secondary endpoint was late mortality and morbidity such as major adverse cardiac and cerebrovascular events (MACCE) related to LVDD aggravation postoperatively. There were 894 patients in group I and 207 in group II. Multivariate analysis revealed that preoperative peripheral artery obstructive disease (PAOD) (P=0.04), renal failure (P<0.01), and A' velocity (P<0.01) anticipated aggravated LVDD. The Cox hazards model revealed that aggravated LVDD was a poor prognostic factor for MACCE (P<0.01) and overall survival (P<0.01). The Kaplan-Meier survival curve showed that aggravated LVDD was related to poor late outcomes (freedom from MACCE, P=0.01; overall survival, P<0.01). CONCLUSIONS Aggravated LVDD significantly affects late clinical outcomes after OPCAB and preoperative PAOD, renal failure, and A' velocity might be predictors. (Circ J 2016; 80: 1937-1945).
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Affiliation(s)
- Seung Hyun Lee
- Division of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University Health System
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- awyx] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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10
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2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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11
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC)Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J 2016; 37:2129-2200. [PMID: 27206819 DOI: 10.1093/eurheartj/ehw128] [Citation(s) in RCA: 8876] [Impact Index Per Article: 1109.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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12
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 and 1880=1880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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13
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- #] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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14
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 8029-- -] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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15
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2016. [DOI: 10.1093/eurheartj/ehw128 order by 1-- gadu] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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16
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Ponikowski P, Voors AA, Anker SD, Bueno H, Cleland JGF, Coats AJS, Falk V, González-Juanatey JR, Harjola VP, Jankowska EA, Jessup M, Linde C, Nihoyannopoulos P, Parissis JT, Pieske B, Riley JP, Rosano GMC, Ruilope LM, Ruschitzka F, Rutten FH, van der Meer P. 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur J Heart Fail 2016; 18:891-975. [DOI: 10.1002/ejhf.592] [Citation(s) in RCA: 4631] [Impact Index Per Article: 578.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Ohara T, Iwano H, Thohan V, Kitzman DW, Upadhya B, Pu M, Little WC. Role of Diastolic Function in Preserved Exercise Capacity in Patients with Reduced Ejection Fractions. J Am Soc Echocardiogr 2015; 28:1184-93. [PMID: 26232892 DOI: 10.1016/j.echo.2015.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Indexed: 01/20/2023]
Abstract
BACKGROUND Some patients with markedly reduced ejection fractions (EFs) (<35%) have preserved exercise performance greater than predicted for age and gender. Because diastolic function may be a determinant of exercise performance, this study was conducted to test the hypothesis that patients with preserved exercise tolerance despite EFs < 35% may have relatively normal diastolic function. METHODS Sixty-five subjects with EFs < 35% who underwent exercise Doppler echocardiography and had no inducible ischemia were retrospectively examined. Forty-five subjects with normal EFs (>60%) and preserved exercise capacity were analyzed as a control group. RESULTS Sixteen of 65 patients with EFs < 35% had greater than predicted normal exercise capacity for their age and gender, and the remaining 49 patients had reduced exercise capacity. Patients with reduced EFs and preserved exercise capacity had E/e' ratios (mean, 10 ± 4) similar to those of control subjects (mean, 10 ± 3) and lower than those with reduced exercise tolerance (mean, 16 ± 8) (P < .01). In addition, they had better diastolic filling patterns and smaller left atrial sizes than patients with EFs < 35% and reduced exercise capacity. Multivariate logistic regression analyses indicated that E/e' ratio was an independent predictor of preserved exercise capacity in patients with reduced EFs. CONCLUSIONS Relatively intact diastolic function contributes to preserved exercise capacity in patients with reduced EFs (<35%).
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Affiliation(s)
- Takahiro Ohara
- Division of Cardiology and CCU, National Cerebral and Cardiovascular Center, Suita, Japan.
| | - Hiroyuki Iwano
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Vinay Thohan
- Aurora Cardiovascular Services, Milwaukee, Wisconsin
| | - Dalane W Kitzman
- Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bharathi Upadhya
- Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Min Pu
- Cardiology Section, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - William C Little
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
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Çetin S, Süha Ç, Mustafa G, Gökhan VM, Keskin G, Göksal K, Yeter E, Ekrem Y, Doğan M, Mehmet D, Öztürk MA, Akif ÖM. Infliximab, an anti-TNF-alpha agent, improves left atrial abnormalities in patients with rheumatoid arthritis: preliminary results. Cardiovasc J Afr 2015; 25:168-75. [PMID: 25192300 PMCID: PMC4170177 DOI: 10.5830/cvja-2014-036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 06/13/2014] [Indexed: 11/25/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality. In the current prospective study, we addressed the impact of RA on left atrial (LA) function and electrical remodelling. Further, we tried to demonstrate the effects of infliximab, an anti-TNFalpha agent, on echocardiographical LA abnormality in RA patients with preserved left ventricular (LV) ejection fraction. Methods We compared 38 female RA patients without clinical evidence of heart disease and 30 female controls without RA and clinical evidence of heart disease. Further, we compared RA patients receiving infliximab and increasing doses of prednisolone over a three-month period. At baseline and post treatment, this study assessed (1) LA and LV parameters using conventional and speckle tracking echocardiography (STE), and (2) electrocardiographic P-wave changes. Results The values of C-reactive protein (CRP), isovolumic relaxation time (IVRT), A wave, and deceleration time (DT) were significantly higher in RA patients compared to the control group (p < 0.05), whereas E/E′ and E/A values were found to be lower (p < 0.05) in RA patients. E/E′ values were lower in prednisolone- compared to infliximab-treated patients (p < 0.05). After three months of infliximab and prednisolone treatment, CRP and disease activity score (DAS 28) values decreased in both groups (p < 0.05), and Duke activity status index (DASI) increased (p < 0.05). Maximal left atrial volume index (LAVImax), pre-contraction left atrial volume index (LAVIpreA) and maximum P wave (Pmax) of the RA patients were higher compared to the control group (p < 0.05), whereas LA global strain was found to be lower (p < 0.05). There was no difference in Pmax values between groups before and after the treatment period. E/E′, LAVImax and LAVIpreA values of infliximab-treated patients decreased and LA global strain increased after three months of therapy compared to baseline (p < 0.05). At baseline in both treatment groups, E/E′ and LA global late diastolic strain rate were lower in prednisolone-compared to infliximab-treated patients (p < 0.05). Conclusion There was echocardiographic LA abnormality in these RA patients. In this patient group there was also a meaningful increase in maximum P wave assessed by electrocardiography. Infliximab therapy for a period of three months improved LA abnormality.
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Affiliation(s)
| | - Çetin Süha
- Department of Cardiology, 29 Mayis Hospital, Ankara, Turkey.
| | | | - Vural Mustafa Gökhan
- Department of Cardiology, Dişkapi Research and Education Hospital, Ankara, Turkey
| | | | - Keskin Göksal
- Department of Internal Medicine, Dişkapi Research and Education Hospital, Ankara, Turkey
| | | | - Yeter Ekrem
- Department of Cardiology, Dişkapi Research and Education Hospital, Ankara, Turkey
| | | | - Doğan Mehmet
- Department of Cardiology, Dişkapi Research and Education Hospital, Ankara, Turkey
| | - Mehmet Akif Öztürk
- Department of Rheumatology, School of Medicine, Gazi University, Ankara, Turkey
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Khangura KK, Eirin A, Kane GC, Misra S, Textor SC, Lerman A, Lerman LO. Cardiac function in renovascular hypertensive patients with and without renal dysfunction. Am J Hypertens 2014; 27:445-53. [PMID: 24162729 DOI: 10.1093/ajh/hpt203] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypertension impairs left ventricular (LV) diastolic and systolic function, which might be aggravated by inflammation or neurohumoral activation. We hypothesized that LV diastolic dysfunction is more common in patients with renovascular hypertension (RVHT) compared with essential hypertension (EHT). METHODS Hypertensive patients who underwent both renal imaging to exclude RVHT and cardiac echocardiography within a 3-year period were identified retrospectively. Patients with significant renovascular disease were included in the RVHT group (n = 75); those without significant renovascular disease were included in the EHT group (n = 69). Cardiac function and structure were compared. RESULTS Baseline renal function was preserved (serum creatinine ≤ 2mg/dl) in EHT patients and impaired (serum creatinine > 2mg/dl) in only 9 RVHT patients. RVHT patients had higher systolic blood pressure, E/e' ratio, and greater prevalence of concentric hypertrophy but lower estimated glomerular-filtration-rate (eGFR) compared with EHT patients. Increased prevalence of LV diastolic dysfunction remained statistically significant in patients with RVHT after multivariable adjustment for age, sex, blood pressure, eGFR, diabetes, smoking, and statin use, with a relative risk (95% CI) for abnormal E/e' of 1.70 (95% confidence interval = 1.05-2.90; P = 0.03) compared with EHT. RVHT patients with severe renal dysfunction showed greater impairments in cardiac systolic and diastolic function compared with those in EHT patients or preserved renal function RVHT patients. CONCLUSIONS Among hypertensive patients undergoing echocardiography, cardiac structure and diastolic function are impaired in RVHT patients compared with EHT patients and remain different after adjustment for multiple significant covariables. When associated with significant renal dysfunction, RVHT aggravates LV hypertrophy and both systolic and diastolic dysfunction. Hence, identification of RVHT and renal dysfunction warrants development of targeted management strategies.
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MESH Headings
- Aged
- Biomarkers/blood
- Chi-Square Distribution
- Creatinine/blood
- Diastole
- Female
- Glomerular Filtration Rate
- Humans
- Hypertension/complications
- Hypertension/diagnosis
- Hypertension/mortality
- Hypertension/physiopathology
- Hypertension, Renovascular/complications
- Hypertension, Renovascular/diagnosis
- Hypertension, Renovascular/mortality
- Hypertension, Renovascular/physiopathology
- Hypertrophy, Left Ventricular/diagnostic imaging
- Hypertrophy, Left Ventricular/etiology
- Hypertrophy, Left Ventricular/mortality
- Hypertrophy, Left Ventricular/physiopathology
- Hypertrophy, Right Ventricular/diagnostic imaging
- Hypertrophy, Right Ventricular/etiology
- Hypertrophy, Right Ventricular/mortality
- Hypertrophy, Right Ventricular/physiopathology
- Kaplan-Meier Estimate
- Kidney/physiopathology
- Male
- Middle Aged
- Minnesota/epidemiology
- Multivariate Analysis
- Prevalence
- Retrospective Studies
- Risk Factors
- Stroke Volume
- Systole
- Time Factors
- Ultrasonography
- Ventricular Dysfunction, Left/diagnostic imaging
- Ventricular Dysfunction, Left/etiology
- Ventricular Dysfunction, Left/mortality
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Function, Left
- Ventricular Remodeling
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Hagendorff A, Tiemann K, Simonis G, Campo dell‘ Orto M, von Bardeleben S. Empfehlungen zur Notfallechokardiographie. KARDIOLOGE 2013. [DOI: 10.1007/s12181-013-0531-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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21
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Evaluation of Ventricular Filling Pressures and Ventricular Function by Doppler Echocardiography in Patients with Functional Single Ventricle: Correlation with Simultaneous Cardiac Catheterization. J Am Soc Echocardiogr 2011; 24:1220-5. [DOI: 10.1016/j.echo.2011.08.011] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Indexed: 11/19/2022]
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22
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Matyal R, Skubas NJ, Shernan SK, Mahmood F. Perioperative assessment of diastolic dysfunction. Anesth Analg 2011; 113:449-72. [PMID: 21813627 DOI: 10.1213/ane.0b013e31822649ac] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Assessment of diastolic function should be a component of a comprehensive perioperative transesophageal echocardiographic examination. Abnormal diastolic function exists in >50% of patients presenting for cardiac and high-risk noncardiac surgery, and has been shown to be an independent predictor of adverse postoperative outcome. Normalcy of systolic function in 50% of patients with congestive heart failure implicates diastolic dysfunction as the probable etiology. Comprehensive evaluation of diastolic function requires the use of various, load-dependent Doppler techniques This is further complicated by the additional effects of dehydration and anesthetic drugs on myocardial relaxation and compliance as assessed by these Doppler measures. The availability of more sophisticated Doppler techniques, e.g., Doppler tissue imaging and flow propagation velocity, makes it possible to interrogate left ventricular diastolic function with greater precision, analyze specific stages of diastole, and to differentiate abnormalities of relaxation from compliance. Additionally, various Doppler-derived ratios can be used to estimate left ventricular filling pressures. The varying hemodynamic environment of the operating room mandates modification of the diagnostic algorithms used for ambulatory cardiac patients when left ventricular diastolic function is evaluated with transesophageal echocardiography in anesthetized surgical patients.
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Affiliation(s)
- Robina Matyal
- Department of Anesthesia and Critical Care Medicine, Beth Israel Deaconess Medical Center, CC-454, 1 Deaconess Rd., Boston, MA 02215, USA.
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Effect of Diastolic Dysfunction on Early Outcomes During Elective Off-Pump Coronary Artery Bypass Grafting: A Prospective Observational Study. Ann Thorac Surg 2011; 92:587-93. [DOI: 10.1016/j.athoracsur.2011.04.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2011] [Revised: 03/28/2011] [Accepted: 04/01/2011] [Indexed: 11/19/2022]
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24
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Shah SJ, Fonarow GC, Gheorghiade M, Lang RM. Phase II trials in heart failure: the role of cardiovascular imaging. Am Heart J 2011; 162:3-15.e3. [PMID: 21742085 DOI: 10.1016/j.ahj.2011.03.031] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 03/21/2011] [Indexed: 02/04/2023]
Abstract
The development of new therapies for heart failure (HF), especially acute HF, has proven to be quite challenging; and therapies evaluated in HF have greatly outnumbered treatments that are eventually successful in obtaining regulatory approval. Thus, the development of therapies for HF remains a vexing problem for pharmaceutical and device companies, clinical trialists, and health care professionals. Nowhere is this more apparent than in the phase II HF clinical trial, in which the goal is to determine whether an investigational agent should move forward to a phase III trial. Recent advancements in noninvasive cardiovascular imaging have allowed a new era of comprehensive phenotyping of cardiac structure and function in phase II HF trials. Besides using imaging parameters to predict success of subsequent phase III outcome studies, it is essential to also use imaging in phase II HF trials in a way that increases understanding of drug or device mechanism. Determination of the patients who would benefit most from a particular drug or device could decrease heterogeneity of phase III trial participants and lead to more successful HF clinical trials. In this review, we outline advantages and disadvantages of imaging various aspects of cardiac structure and function that are potential targets for therapy in HF, compare and contrast imaging modalities, provide practical advice for the use of cardiovascular imaging in drug development, and conclude with some novel uses of cardiac imaging in phase II HF trials.
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Affiliation(s)
- Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
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25
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Tsiachris D, Tsioufis C, Syrseloudis D, Thomopoulos C, Mpafakis I, Michaelides A, Redon J, Stefanadis C. Impaired exercise tolerance is associated with increased urine albumin excretion in the early stages of essential hypertension. Eur J Prev Cardiol 2011; 19:452-9. [PMID: 21450572 DOI: 10.1177/1741826711402739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Our aim was to investigate the relationship between impaired exercise capacity and albumin excretion level in the setting of never treated essential hypertension. DESIGN AND METHODS For this purpose, 338 consecutive essential hypertensives (52 ± 8.5 years, 227 males, office BP = 148.6/96.1 mmHg) performed a negative for myocardial ischemia, maximal treadmill exercise testing and were classified based on the gender specific median value of the amount of metabolic equivalents (METs) achieved (10.1 ml/kg/min for women and 11 ml/kg/min for men) as fit (n = 177) and unfit (n = 161). All the participants underwent 24-h ambulatory BP monitoring, complete echocardiographic study including left ventricular diastolic function evaluation and determination of albumin to creatinine ratio (ACR) on two non-consecutive morning spot urine samples. RESULTS Unfit hypertensives compared to the fit ones were older by 4.5 years (p < 0.001) and had greater waist circumference by 4.5 cm (p < 0.001), body mass index by 1.3 kg/m(2) (p = 0.001), 24-h pulse pressure by 3.0 mmHg (p = 0.005), ACR levels by 12.6% (p = 0.003) and prevalence of microalbuminuria (19.5% vs 10.3%, p = 0.007) while the differences in diastolic function indices lost significance after adjustment for confounders. By applying stepwise multivariate linear regression analysis in order to identify the predictors of METs, it was revealed that age (β = -0.338, p = 0.045), gender (β = 0.274, p = 0.045), body mass index (β = -0.230, p = 0.045) and logACR (β = -0.151, p = 0.004) were the only independent predictors of exercise capacity. CONCLUSIONS Increased ACR is associated with diminished exercise capacity in the early stages of essential hypertension independently from adverse cardiac adaptations, further elucidating the adverse prognostic role of albuminuria in this setting.
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Affiliation(s)
- Dimitris Tsiachris
- First Cardiology Clinic, University of Athens, Hippokration Hospital, Athens, Greece
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26
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Snopek G, Drewniak W, Borys M, Dabrowski M. Prognostic Value of Tissue Doppler Echocardiographic Imaging in Elderly Patients with Acute Myocardial Infarction. Echocardiography 2011; 28:298-302. [DOI: 10.1111/j.1540-8175.2010.01336.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bierig SM, Hill J. Echocardiographic Evaluation of Diastolic Function. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2011. [DOI: 10.1177/8756479311401914] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Left ventricular diastolic dysfunction is common in patients with heart failure. Echocardiographic evaluation of diastolic function provides the clinician with important information about ventricular relaxation and estimation of filling pressures. Optimal evaluation includes the integration of multiple echocardiographic parameters such as Doppler, M-mode, and volumes. This article aims to review the components of diastolic filling and ventricular performance, as well as discuss the techniques used for the assessment of left ventricular diastolic function.
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Popescu WM, Bell R, Duffy AJ, Katz KH, Perrino AC. A pilot study of patients with clinically severe obesity undergoing laparoscopic surgery: evidence for impaired cardiac performance. J Cardiothorac Vasc Anesth 2011; 25:943-9. [PMID: 21232976 DOI: 10.1053/j.jvca.2010.11.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Given the propensity for heart disease in obese patients, the authors investigated the effects of pneumoperitoneum on cardiac performance. DESIGN A pilot observational intraoperative study. SETTING A single-center university hospital. PARTICIPANTS Patients undergoing laparoscopic gastric bypass surgery. INTERVENTIONS Abdominal insufflation. MEASUREMENTS AND RESULTS Hemodynamic, respiratory, and echocardiographic data were collected at 4 epochs: (1) baseline after the induction of anesthesia, (2) after abdominal insufflation in supine position, (3) after abdominal insufflation in the reverse Trendelenburg (RT) position, and (4) after desufflation in RT position. At epoch 1, 3 of 13 patients manifested systolic dysfunction (SD), 5 of 13 patients exhibited diastolic dysfunction (DD) according to transmitral flow (TMF) Doppler criteria, and 4 of 8 patients according to Doppler tissue imaging (DTI) criteria. With pneumoperitoneum, the total systemic resistance increased to values of 142% from baseline (p < 0.05). Compared with baseline, stroke volume decreased by 25%, cardiac output by 35%, and fractional area change by 13% (p < 0.05). Mean arterial blood pressure and heart rate remained stable. Additionally, new-onset DD manifested in 1 of 8 patients according to TMF criteria and in 3 of 4 patients according to DTI criteria. Desufflation of the abdomen reverted the diastolic function to baseline in all but 1 patient. CONCLUSION The study data revealed that surgical pneumoperitoneum used in patients with clinically severe obesity resulted in the deterioration of cardiac performance including the development of new-onset DD. These patients, despite their relative young age and without a history of heart failure or coronary artery disease, displayed a cardiovascular profile during laparoscopic surgery similar to that seen in patients with significant heart disease.
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Affiliation(s)
- Wanda M Popescu
- Department of Anesthesiology, Yale University School of Medicine, New Haven, CT 06520-8051, USA.
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Zuber M, Cuculi F, Attenhofer Jost CH, Kipfer P, Buser P, Seifert B, Erne P. Value of brain natriuretic peptides in primary care patients with the clinical diagnosis of chronic heart failure. SCAND CARDIOVASC J 2010; 43:324-9. [PMID: 19247872 DOI: 10.1080/14017430902769919] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Brain natriuretic peptide (BNP) and N-Terminal pro natriuretic peptide (NT-proBNP) are widely accepted to diagnose congestive heart failure (CHF) in the emergency room. The aim of this study was to evaluate the value of BNP and NT-proBNP to diagnose CHF in primary care. METHODS Clinical and Doppler-echocardiographic assessment of patients referred by their general practitioner (GP) with the diagnosis of CHF. Receiver operating curves were used to evaluate the accuracy of BNP and NT-proBNP for echocardiographically confirmed systolic and/or diastolic heart failure. RESULTS Three hundred and eighty four patients (mean age of 65) were included. One hundred and ninety three (50%) patients had systolic heart failure and 31 (8%) had isolated diastolic heart failure. Using currently recommended cut-off values of BNP (less than 100 pg/ml) and NT-proBNP (less than 125 pg/ml) for exclusion of CHF, BNP was false negative in 25% and NT-proBNP in 10% of the patients. The area under the curve was better for NT-proBNP than for BNP (0.742 vs. 0.691). CONCLUSION In this population with a high prevalence of CHF, BNP and NT-proBNP failed to adequately rule out CHF. GP's should be cautious when using BNP and NT-proBNP in primary care. An echocardiography remains compulsory in unexplained dyspnea.
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Affiliation(s)
- Michel Zuber
- Department of Cardiology, Kantonsspital Luzern, Luzern, Switzerland
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30
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Choi JO, Choi JH, Lee HJ, Noh HJ, Huh J, Kang IS, Lee HJ, Lee SC, Kim DK, Park SW. Dual pulsed-wave Doppler tracing of right ventricular inflow and outflow: single cardiac cycle right ventricular tei index and evaluation of right ventricular function. Korean Circ J 2010; 40:391-8. [PMID: 20830253 PMCID: PMC2933464 DOI: 10.4070/kcj.2010.40.8.391] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 02/19/2010] [Accepted: 03/10/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The reliability and usefulness of the right ventricular (RV) Tei index (RTX) remains controversial because it has not been possible to simultaneously measure RV inflow and outflow. However, dual pulsed-wave Doppler (DPD) enables flow velocities to be obtained at different sampling sites simultaneously. In this study we evaluated the feasibility and reliability of RTX values obtained by DPD (RTX(DPD)). SUBJECTS AND METHODS Forty-one patients who underwent cardiac catheterization and echocardiography for RV volume or pressure overloading conditions were evaluated. Symptom-limited exercise treadmill testing with expired gas analysis was performed and maximal exercise capacity was measured. RESULTS RTX by conventional flow Doppler (RTX(CFD), 0.262±0.164) was similar to RTX(DPD) (0.253±0.117, p=NS), whereas RTX by tissue Doppler echocardiography (RTX(TDE), 0.447±0.125) was significantly larger than RTX(DPD) (p<0.001). Based on multiple regression analysis, maximal exercise capacity was independently related to RTX(DPD) (β=-0.60, p<0.001), mid-RV dimension (β=-0.26, p=0.012), left ventricular ejection fraction (β=0.22, p=0.023), and early diastolic tricuspid annular velocity (β=0.21, p=0.048). CONCLUSION It is feasible and reliable to evaluate RV function using RTX(DPD) values. However, to evaluate the clinical usefulness of RTX(DPD), additional studies are required with a large number of patients and long-term follow-up.
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Affiliation(s)
- Jin-Oh Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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31
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Kane GC, Xu N, Mistrik E, Roubicek T, Stanson AW, Garovic VD. Renal artery revascularization improves heart failure control in patients with atherosclerotic renal artery stenosis. Nephrol Dial Transplant 2010; 25:813-820. [DOI: 10.1093/ndt/gfp393] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Menon SC, Eidem BW, Dearani JA, Ommen SR, Ackerman MJ, Miller D. Diastolic dysfunction and its histopathological correlation in obstructive hypertrophic cardiomyopathy in children and adolescents. J Am Soc Echocardiogr 2009; 22:1327-34. [PMID: 19815379 DOI: 10.1016/j.echo.2009.08.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND Histopathologic hallmarks of hypertrophic cardiomyopathy (HCM) include myocyte hypertrophy and disarray as well as interstitial and endocardial fibrosis. Published correlations between echocardiographic parameters and histopathologic findings are scarce. METHODS All patients aged <20 years (n = 45; 15 female patients; median age, 14 years) with obstructive HCM undergoing septal myectomy at the Mayo Clinic from 2003 to 2007 were identified. A retrospective review of echocardiographic data was performed, and these data were compared with the histologic findings from the myectomy specimens. RESULTS Histopathologic analysis of myectomy specimens revealed significant myocyte hypertrophy (100%), myocyte disarray (98%), interstitial fibrosis (95%), and subendocardial fibrosis (97%). On multivariate regression analysis, there was a significant relationship between the degree of myocyte disarray and echocardiographic markers of left ventricular diastolic dysfunction. CONCLUSION The results of this study suggest that myocyte disarray is a key factor responsible for diastolic dysfunction in pediatric patients with obstructive HCM. These findings provide novel insights into the mechanism of diastolic dysfunction in HCM that warrant further study.
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Affiliation(s)
- Shaji C Menon
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, Minnesota, USA.
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Diastolic function in healthy humans: non-invasive assessment and the impact of acute and chronic exercise. Eur J Appl Physiol 2009; 108:1-14. [DOI: 10.1007/s00421-009-1233-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2009] [Indexed: 01/27/2023]
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Choi JO, Han H, Cho SJ, Yang JH, Song BG, Lee SY, Kim JH, Lee SC, On YK, Kim JS, Park SW. Reduced Peak Atrial Systolic Mitral Annular Velocity Predicts the Development of Nonvalvular Atrial Fibrillation. Echocardiography 2009; 26:645-50. [DOI: 10.1111/j.1540-8175.2008.00858.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Abstract
CONTEXT Limited information exists regarding the role of left ventricular function in predicting exercise capacity and impact on age- and sex-related differences. OBJECTIVES To determine the impact of measures of cardiac function assessed by echocardiography on exercise capacity and to determine if these associations are modified by sex or advancing age. DESIGN Cross-sectional study of patients undergoing exercise echocardiography with routine measurements of left ventricular systolic and diastolic function by 2-dimensional and Doppler techniques. Analyses were conducted to determine the strongest correlates of exercise capacity and the age and sex interactions of these variables with exercise capacity. SETTING Large tertiary referral center in Rochester, Minnesota, in 2006. PARTICIPANTS Patients undergoing exercise echocardiography using the Bruce protocol (N = 2867). Patients with echocardiographic evidence of exercise-induced ischemia, ejection fractions lower than 50%, or significant valvular heart disease were excluded. MAIN OUTCOME MEASURE Exercise capacity in metabolic equivalents (METs). RESULTS Diastolic dysfunction was strongly and inversely associated with exercise capacity. Compared with normal function, after multivariate adjustment, those with moderate/severe resting diastolic dysfunction (-1.30 METs; 95% confidence interval [CI], -1.52 to -0.99; P < .001) and mild resting diastolic dysfunction (-0.70 METs; 95% CI, -0.88 to -0.46; P < .001) had substantially lower exercise capacity. Variation of left ventricular systolic function within the normal range was not associated with exercise capacity. Left ventricular filling pressures measured by resting E/e' of 15 or greater (-0.41 METs; 95% CI, -0.70 to -0.11; P = .007) or postexercise E/e' of 15 or greater (-0.41 METs; 95% CI, -0.71 to -0.11; P = .007) were similarly associated with a reduction in exercise capacity, each in separate multivariate analyses. Individuals with impaired relaxation (mild dysfunction) or resting E/e' of 15 or greater had a progressive increase in the magnitude of reduction in exercise capacity with advancing age (P < .001 and P = .02, respectively). Other independent correlates of exercise capacity were age (unstandardized beta coefficient, -0.85 METs; 95% CI, -0.92 to -0.77, per 10-year increment; P < .001), female sex (-1.98 METs; 95% CI, -2.15 to -1.84; P < .001), and body mass index greater than 30 (-1.24 METs; 95% CI, -1.41 to -1.10; P < .001). CONCLUSION In this large cross-sectional study of those referred for exercise echocardiography and not limited by ischemia, abnormalities of left ventricular diastolic function were independently associated with exercise capacity.
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Affiliation(s)
- Jasmine Grewal
- Division of Cardiovascular Diseases Mayo Clinic Rochester, Minnesota
| | - Robert B. McCully
- Division of Cardiovascular Diseases Mayo Clinic Rochester, Minnesota
| | - Garvan Kane
- Division of Cardiovascular Diseases Mayo Clinic Rochester, Minnesota
| | - Carolyn Lam
- Division of Cardiovascular Diseases Mayo Clinic Rochester, Minnesota
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Lenci I, Alvior A, Manzia TM, Toti L, Neuberger J, Steeds R. Saline contrast echocardiography in patients with hepatopulmonary syndrome awaiting liver transplantation. J Am Soc Echocardiogr 2009; 22:89-94. [PMID: 19022621 DOI: 10.1016/j.echo.2008.09.020] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Indexed: 02/08/2023]
Abstract
BACKGROUND Patients with hepatopulmonary syndrome (HPS) with end-stage liver disease (ESLD) have higher cardiorespiratory mortality than those without. The aims of this study were to determine whether echocardiography could distinguish patients with ESLD with and without HPS and whether the diagnosis of HPS by contrast echocardiography (CE) was altered by the performance of the test in a supine or standing position. METHODS Subjects were recruited prospectively from patients with end-stage liver disease undergoing assessment for liver transplantation. Hepatopulmonary syndrome was diagnosed on the basis of arterial blood gas analysis, lung function testing and agitated saline contrast echocardiography in the absence of primary cardiac or pulmonary disease. Bubble contrast injections were performed supine or standing in a randomised order and read by a blinded observer. RESULTS CE showed late right-to-left shunting in 13 of 50 consecutive patients with cirrhosis (26%). Eight patients (16%) had definite diagnoses of HPS. CE in the standing position consistently increased both the number and the size of shunts compared with supine injection. CE detected intrapulmonary shunting before a change in arterial blood gases. Standard echocardiographic parameters did not distinguish between those with and without HPS. CONCLUSION This study suggests that screening for HPS in patients with advanced cirrhosis should be done using CE with patients in the upright position.
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Affiliation(s)
- Ilaria Lenci
- Liver Unit, Queen Elizabeth University Hospital, Birmingham, UK
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Edwards NC, Hirth A, Ferro CJ, Townend JN, Steeds RP. Subclinical Abnormalities of Left Ventricular Myocardial Deformation in Early-Stage Chronic Kidney Disease: The Precursor of Uremic Cardiomyopathy? J Am Soc Echocardiogr 2008; 21:1293-8. [DOI: 10.1016/j.echo.2008.09.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2008] [Indexed: 10/21/2022]
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Choi JO, Shin DH, Cho SW, Song YB, Kim JH, Kim YG, Lee SC, Park SW. Effect of Preload on Left Ventricular Longitudinal Strain by 2D Speckle Tracking. Echocardiography 2008; 25:873-9. [DOI: 10.1111/j.1540-8175.2008.00707.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Choi JO, Park SW, Shin DH, Han H, Cho S, Kim JH, Song YB, Lee SC. Simultaneous Doppler tracing of the mitral inflow and annular motion provides a useful means of evaluating left ventricular diastolic function. Clin Cardiol 2008; 31:360-7. [PMID: 18727000 DOI: 10.1002/clc.20241] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND In this study, we evaluated the feasibility and clinical usefulness of TS(E-E(') ), the time interval between the onsets of early diastolic mitral inflow velocity (E) and mitral annular velocity (E'), obtained by simultaneously tracing E and E', in terms of evaluating diastolic function. METHODS By the diastolic functional status, 105 patients were allocated to abnormal relaxation, pseudonormal filling (PN), or normal diastolic function groups (n = 30, 43, and 32, respectively). The TS(E-E(') ) was measured in the same cardiac cycle by the pulsed-wave Doppler (PWD) tracing of mitral inflow near the septal annulus with appropriate filter and gain settings. RESULTS TS(E-E(') ) was prolonged in the PN group versus the normal group (34.1 +/- 12.2 msec versus 12.1 +/- 8.5 msec, p< or =0.001). The area under the receiver operating characteristic curve of TS(E-E(') ) for the detection of PN was 0.91 (95% confidence interval [CI]; 0.85 approximately 0.97, p<0.001), and 24.0 msec was determined to be the optimal cut-off value (specificity 83.7%, sensitivity 90.3%). CONCLUSION Simultaneous measurement of TS(E-E(') ) is feasible and clinically applicable for the grading of diastolic dysfunction (DD).
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Affiliation(s)
- Jin-Oh Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Meimoun P, Malaquin D, Benali T, Boulanger J, Zemir H, Tribouilloy C. Transient impairment of coronary flow reserve in tako-tsubo cardiomyopathy is related to left ventricular systolic parameters. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2008; 10:265-70. [PMID: 18755700 DOI: 10.1093/ejechocard/jen222] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
AIMS Recent studies suggest that coronary flow reserve (CFR) is transiently impaired in tako-tsubo cardiomyopathy (TTC). Mechanisms by which such impairment occurs are still unknown. To assess the relationship between CFR obtained by transthoracic Doppler echocardiography (TDE) and parameters of left ventricular (LV) performance in patients with TTC. METHODS AND RESULTS A total of 20 consecutive patients in sinus rhythm, with TTC (mean age 70+/-9 years, 19 women) underwent serial evaluation of TDE-CFR, in the distal part of the left anterior descending coronary artery (LAD), at the acute phase and after recovery using intravenous adenosine infusion (140 microg/kg/min over 2 min). CFR was calculated as hyperaemic to basal mean diastolic coronary flow velocity (CFV). Average of the septal and lateral mitral annulus early diastolic (Ea) and systolic (Sa) tissue velocity, early (E) and late (A) diastolic transmitral velocity, the ratio E/Ea, wall motion score (WMS, 16 segment model), LV end-systolic volume index (ESV/m(2)) and LV end-diastolic volume index (EDV/m(2), biplane-Simpson method) were serially measured by TDE. Basal CFV, LV mass index and haemodynamics parameters did not differ between acute phase and recovery, whereas hyperaemic CFV increased significantly after recovery (P<0.01) leading to a greater CFR (2.9+/-0.3 vs. 2.1+/-0.4, P<0.0001). At the acute phase, hyperaemic CFV was significantly correlated to WMS, ESV/m(2), but not to E/Ea, whereas at recovery, hyperaemic CFV was not correlated to LV parameters. The improvement of CFR was closely correlated to the decrease of ESV/m(2), of WMS, but not to diastolic parameters. No significant correlation was found between CFR and E/Ea or LV mass index at each stage. CONCLUSION There is a transient impairment of CFR at the acute phase of TTC, which is due to a reduced vasodilating capacity. This impairment is closely correlated to LV systolic parameters. Diastolic compressive forces to the coronary microcirculation do not appear to play a critical role.
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Affiliation(s)
- Patrick Meimoun
- Department of Cardiology and Intensive Care Unit, Compiègne Hospital, 8 rue Henri Adnot, 60200 Compiègne, France.
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Al-Omari MA, Finstuen J, Appleton CP, Barnes ME, Tsang TS. Echocardiographic assessment of left ventricular diastolic function and filling pressure in atrial fibrillation. Am J Cardiol 2008; 101:1759-65. [PMID: 18549855 DOI: 10.1016/j.amjcard.2008.02.067] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 02/13/2008] [Accepted: 02/13/2008] [Indexed: 10/22/2022]
Abstract
Diastolic dysfunction has been linked to 2 epidemics: atrial fibrillation (AF) and heart failure. The presence and severity of diastolic dysfunction are associated with an increased risk for first AF and first heart failure in patients with sinus rhythm. Furthermore, the risk for heart failure is markedly increased once AF develops. The evaluation of diastolic function once AF has developed remains a clinical challenge. The conventional use of Doppler echocardiography for the assessment and grading of diastolic dysfunction relies heavily on evaluating the relation of ventricular and atrial flow characteristics. The mechanical impairment of the left atrium and the variable cycle lengths in AF render the evaluation of diastolic function difficult. A few Doppler echocardiographic methods have been proved clinically useful for the estimation of diastolic left ventricular filling pressures in AF, but these appear to be underutilized. Several innovative methods are emerging that promise to provide greater precision in diastolic function assessment, but their clinical utility in AF remains to be established. In conclusion, this review provides an up-to-date discussion of the evaluation of diastolic function assessment in AF and how it may be important in the clinical management of patients with AF.
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Ouzounian M, Lee DS, Liu PP. Diastolic heart failure: mechanisms and controversies. ACTA ACUST UNITED AC 2008; 5:375-86. [PMID: 18542106 DOI: 10.1038/ncpcardio1245] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 03/13/2008] [Indexed: 12/20/2022]
Abstract
Epidemiological and experimental studies have documented both the rising burden of diastolic heart failure (DHF) and several mechanisms that distinguish this disease from systolic heart failure (SHF). Controversies continue to surround the term 'DHF' as well as its existence as a pathophysiological entity distinct from SHF. Approximately half of all patients who present with heart failure have near-normal systolic function and predominately abnormal diastolic function. Recent reports counter the commonly held belief that survival of patients with DHF is better than that of patients with SHF. The challenges associated with managing the DHF phenotype arise from the heterogeneous etiologies of the condition that include aging, diabetes mellitus, hypertension and ischemia. Lack of diastolic distensibility in DHF has been attributed primarily to hypertrophy and fibrosis. Extracellular matrix and cytoskeletal components including matrix metalloproteinases, titin isoforms, and the quality and quantity of collagen are implicated in DHF development. Impaired active relaxation of the contractile apparatus also contributes to DHF. Novel therapeutic targets that address the pathophysiology of this disease are being actively explored, although as yet there are no proven therapies for DHF. New epidemiologic and mechanistic data regarding DHF highlight the urgency with which the scientific community must address this important public health problem.
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Affiliation(s)
- Maral Ouzounian
- Institute of Circulatory and Respiratory Health, CIHR, NCSB 11-1266, Toronto General Hospital, 200 Elizabeth Street, Toronto, ON M5G 2C4, Canada
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