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Kimball TR. Bench to Bedside…and Back Again. J Am Soc Echocardiogr 2024; 37:364-367. [PMID: 38181833 DOI: 10.1016/j.echo.2023.12.011] [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: 12/22/2023] [Revised: 12/23/2023] [Accepted: 12/23/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Thomas R Kimball
- Louisiana State University Health Sciences Center, New Orleans, Louisiana; Tulane University School of Medicine, New Orleans, Louisiana; Children's Hospital of New Orleans, New Orleans, Louisiana.
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2
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Liu Y, Chen Q, Yang JZ, Li XW, Chen LJ, Zhang KK, Liu JL, Li JH, Hsu C, Chen L, Zeng JH, Wang Q, Zhao D, Xu JT. Multi-Omics Analysis Reveals the Role of Sigma-1 Receptor in a Takotsubo-like Cardiomyopathy Model. Biomedicines 2023; 11:2766. [PMID: 37893138 PMCID: PMC10604683 DOI: 10.3390/biomedicines11102766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 10/29/2023] Open
Abstract
Takotsubo syndrome (TTS) is a stress-induced cardiomyopathy that presents with sudden onset of chest pain and dyspneic and cardiac dysfunction as a result of extreme physical or emotional stress. The sigma-1 receptor (Sigmar1) is a ligand-dependent molecular chaperone that is postulated to be involved in various processes related to cardiovascular disease. However, the role of Sigmar1 in TTS remains unresolved. In this study, we established a mouse model of TTS using wild-type and Sigmar1 knockout mice to investigate the involvement of Sigmar1 in TTS development. Our results revealed that Sigmar1 knockout exacerbated cardiac dysfunction, with a noticeable decrease in ejection fraction (EF) and fractional shortening (FS) compared to the wild-type model. In terms of the gut microbiome, we observed regulation of Firmicutes and Bacteroidetes ratios; suppression of probiotic Lactobacillus growth; and a rise in pathogenic bacterial species, such as Colidextribacter. Metabolomic and transcriptomic analyses further suggested that Sigmar1 plays a role in regulating tryptophan metabolism and several signaling pathways, including MAPK, HIF-1, calcium signaling, and apoptosis pathways, which may be crucial in TTS pathogenesis. These findings offer valuable insight into the function of Sigmar1 in TTS, and this receptor may represent a promising therapeutic target for TTS.
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Affiliation(s)
- Yi Liu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Qing Chen
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing 100088, China
- Beijing Municipal Public Security Judicial Appraisal Center, Beijing 100142, China
| | - Jian-Zheng Yang
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Xiu-Wen Li
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Li-Jian Chen
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Kai-Kai Zhang
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Jia-Li Liu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Jia-Hao Li
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Clare Hsu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Long Chen
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Jia-Hao Zeng
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Qi Wang
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
| | - Dong Zhao
- Key Laboratory of Evidence Science, China University of Political Science and Law, Ministry of Education, Beijing 100088, China
| | - Jing-Tao Xu
- Guangzhou Key Laboratory of Forensic Multi-Omics for Precision Identification, School of Forensic Medicine, Southern Medical University, Guangzhou 510515, China (Q.W.)
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Ralston K, Zaidel E, Acquatella H, Barbosa MM, Narula J, Nakagama Y, Molina GR, Sliwa K, Zamorano JL, Pinto FJ, Piñeiro DJ, Corneli M. WHF Recommendations for the Use of Echocardiography in Chagas Disease. Glob Heart 2023; 18:27. [PMID: 37305068 PMCID: PMC10253240 DOI: 10.5334/gh.1207] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 05/02/2023] [Indexed: 06/13/2023] Open
Abstract
Chagas disease (ChD) represents a significant health burden in endemic regions of Latin America and is increasingly being recognized as a global health issue. The cardiac involvement in ChD, known as Chagas cardiomyopathy (ChCM), is the most severe manifestation and a leading cause of heart failure and mortality in affected individuals. Echocardiography, a non-invasive imaging modality, plays a crucial role in the diagnosis, monitoring, and risk stratification of ChCM. This consensus recommendation aims to provide guidance on the appropriate use of echocardiography in ChD. An international panel of experts, including cardiologists, infectious disease specialists, and echocardiography specialists, convened to review the available evidence and provide practical recommendations based on their collective expertise. The consensus addresses key aspects related to echocardiography in ChD, including its role in the initial evaluation, serial monitoring, and risk assessment of patients. It emphasizes the importance of standardized echocardiographic protocols, including the assessment of left ventricular function, chamber dimensions, wall motion abnormalities, valvular involvement, and the presence of ventricular aneurysm. Additionally, the consensus discusses the utility of advanced echocardiographic techniques, such as strain imaging and 3D echocardiography, in assessing myocardial mechanics and ventricular remodeling.
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Affiliation(s)
| | - Ezequiel Zaidel
- Sanatorio Güemes, Buenos Aires, Argentina
- Pharmacology Department, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Harry Acquatella
- Faculty of Medicine Universidad Central de Venezuela, Hospital Universitario and Centro Medico, Caracas, Venezuela
| | | | - Jagat Narula
- Division of Cardiology, Mount Sinai St. Luke’s Hospital, New York, USA
| | - Yu Nakagama
- Dept of Parasitology, Osaka Metropolitan University, Japan
| | | | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Sciences, University of Cape Town, South Africa
| | | | - Fausto J. Pinto
- Cardiology Department, Centro Hospitalar Universitário Lisboa Norte, CAML, CCUL, Faculdade de Medicina, Universidade de Lisboa, Portugal
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4
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Tang S, Guan L, Tayier B, Mu Y. ECHO provides layer-specific insight of both myocardial deformation and microcirculation dysfunction in dilated cardiomyopathy patients: Clinical value of combined application of left ventricular layer-specific strain and myocardial contrast echocardiography. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:753-761. [PMID: 36578173 DOI: 10.1002/jcu.23419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 06/02/2023]
Abstract
AIM To investigate the pattern of left ventricular (LV) function and myocardial perfusion and their relationship in dilated cardiomyopathy (DCM) patients using layer-specific speckle tracking imaging (STI) and layer-specific myocardial contrast echocardiography (MCE). MATERIAL AND METHODS Thirty DCM patients and 30 controls were recruited and underwent STI and MCE examination. The peak values of longitudinal strain (LS), circumferential strain (CS) of each layer of LV were recorded and compared between groups. Additionally, cross-sectional area of a microvessel (A) and average myocardial microvascular lesion (β) of each layer were measured, myocardial blood flow (MBF) was estimated using A × β, above parameters were compared between two groups. RESULTS The LS of endo- (LSendo ), mid- (LSmid ) and epicardium (LSepi ), as well as CS of endo- (RSendo ), mid- (RSmid ), (LSepi ) epicardium and LS endo/epi, CS endo/epi were significantly decreased in DCM patients. More importantly, DCM patients demonstrated decreased A, β and A × β in all three myocardium layers and A endo/epi, β endo/epi, A × β endo/epi compared to the controls. The time to peak and the cardiac cycle required to reach the peak were prolonged in DCM patients (p < 0.05). Longitudinal strain parameters of each layer had a negative relationship with perfusion parameter A and this relationship was strongest between LSendo and Aendo (r = 0.690, p < 0.01). CONCLUSIONS The cardiac strain and, more importantly, coronary microcirculation perfusion was impaired in each layer in DCM patients. The longitudinal function of the LV myocardium was closely related to changes in myocardial microcirculation perfusion.
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Affiliation(s)
- Sha Tang
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
| | - Lina Guan
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
| | - Baihetiya Tayier
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
| | - Yuming Mu
- Department of Echocardiography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
- Xinjiang Key Laboratory of Ultrasound Medicine, Urumqi, China
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Kotby AA, Ebrahim SOS, Al-Fahham MM. Reference centiles for left ventricular longitudinal global and regional systolic strain by automated functional imaging in healthy Egyptian children. Cardiol Young 2022; 33:1-9. [PMID: 35241202 DOI: 10.1017/s1047951122000129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Two-dimensional speckle tracking echocardiography-derived left ventricular longitudinal systolic strain is an important myocardial deformation parameter for assessing the systolic function of the left ventricle. Strain values differ according to the vendor machine and software. This study aimed to provide normal reference values for global and regional left ventricular longitudinal systolic strain in Egyptian children using automated functional imaging software integrated into the General Electric healthcare machine and to study the correlation between the global longitudinal left ventricular systolic strain and age, body size, vital data, and some echocardiographic parameters. METHODS Healthy children (250) aged from 1 to 16 years were included. Conventional echocardiography was done to measure the left ventricular dimensions and function. Automated functional imaging was performed to measure the global and regional peak longitudinal systolic strain. RESULTS The global longitudinal strain was -21.224 ± 1.862%. The regional strain was -20.68 ± 2.11%, -21.06 ± 1.84%, and -21.86 ± 2.71% at the basal, mid, and apical segments, respectively. The mean values of the systolic longitudinal strain become significantly more negative from base to apex. Age differences were found as regard to global and regional longitudinal strain parameters but no gender differences. The global peak longitudinal systolic strain correlated positively with age. No correlations were found with either the anthropometric parameters or the vital data. CONCLUSIONS Age-specific normal values for two-dimensional speckle tracking-derived left ventricular longitudinal regional and global systolic strain are established using automated functional imaging.
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Affiliation(s)
- Alyaa A Kotby
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
| | - Sahar O S Ebrahim
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
| | - Marwa M Al-Fahham
- Pediatric Department, Pediatric Cardiology Unit, Faculty of Medicine, Ain Shams University, Abbasia 11566, Cairo, Egypt
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6
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Benameur N, Arous Y, Ben Abdallah N, Kraiem T. Comparison Between 3D Echocardiography and Cardiac Magnetic Resonance Imaging (CMRI) in the Measurement of Left Ventricular Volumes and Ejection Fraction. Curr Med Imaging 2020; 15:654-660. [PMID: 32008513 DOI: 10.2174/1573405614666180815115756] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/17/2018] [Accepted: 07/30/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND Echocardiography and Cardiac Magnetic Resonance Imaging (CMRI) are two noninvasive techniques for the evaluation of cardiac function for patients with coronary artery diseases. Although echocardiography is the commonly used technique in clinical practice for the assessment of cardiac function, the measurement of LV volumes and left ventricular ejection fraction (LVEF) by the use of this technique is still influenced by several factors inherent to the protocol acquisition, which may affect the accuracy of echocardiography in the measurement of global LV parameters. OBJECTIVE The aim of this study is to compare the end systolic volume (ESV), the end diastolic volume (EDV), and the LVEF values obtained with three dimensional echocardiography (3D echo) with those obtained by CMRI (3 Tesla) in order to estimate the accuracy of 3D echo in the assessment of cardiac function. METHODS 20 subjects, (9 controls, 6 with myocardial infarction, and 5 with myocarditis) with age varying from 18 to 58, underwent 3D echo and CMRI. LV volumes and LVEF were computed from CMRI using a stack of cine MRI images in a short axis view. The same parameters were calculated using the 3D echo. A linear regression analysis and Bland Altman diagrams were performed to evaluate the correlation and the degree of agreement between the measurements obtained by the two methods. RESULTS The obtained results show a strong correlation between the 3D echo and CMR in the measurement of functional parameters (r = 0.96 for LVEF values, r = 0.99 for ESV and r= 0.98 for EDV, p < 0.01 for all) with a little lower values of LV volumes and higher values of LVEF by 3D echo compared to CMRI. According to statistical analysis, there is a slight discrepancy between the measurements obtained by the two methods. CONCLUSION 3D echo represents an accurate noninvasive tool for the assessment of cardiac function. However, other studies should be conducted on a larger population including some complicated diagnostic cases.
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Affiliation(s)
- Narjes Benameur
- Laboratory of Biophysics and Medical Technologies, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Younes Arous
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | | | - Tarek Kraiem
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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7
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Patel MD, Myers C, Negishi K, Singh GK, Anwar S. Two-Dimensional Strain is more Precise than Conventional Measures of Left Ventricular Systolic Function in Pediatric Patients. Pediatr Cardiol 2020; 41:186-193. [PMID: 31707490 DOI: 10.1007/s00246-019-02243-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/31/2019] [Indexed: 12/17/2022]
Abstract
Ejection fraction (EF) and fractional shortening (FS) are standard methods of quantifying left ventricular (LV) systolic function. 2D global longitudinal strain (2D GLS) is a well-established, but underutilized method for LV function quantification. The aim of this study was to assess precision of GLS compared to EF & FS in pediatrics. Echocardiograms were prospectively analyzed by 2 blinded observers. FS, EF, and GLS were calculated following standard methods. Bland-Altman was applied to assess agreement. Intraclass correlation coefficient (ICC) was used to measure reliability. Coefficient of variation was used to demonstrate relative variability between methods. 103 pediatric echos were evaluated for inter-observer reproducibility, and 15 patients for intra-observer reproducibility. GLS had higher inter-observer agreement and reliability (bias 7%, 95% LOA - 3.4 to + 3.5, ICC 0.86 CI 0.80-0.90) compared to EF (bias 27%, 95% LOA - 18.9 to + 19.5; ICC 0.25 CI 0.07-0.43) and FS (bias 12%, 95% LOA - 11.9 to + 12.2; ICC 0.53 CI 0.38-0.66). GLS also had higher intra-observer agreement (bias 4%, 95% LOA - 3.6 to + 3.7; ICC 0.87 CI 0.66-0.96) compared to EF (bias 11%, 95% LOA - 14.9 to + 15.1; ICC 0.26 CI - 0.28-0.67) and FS (bias 12%, 95% LOA - 12.2 to + 12.5; ICC 0.38 CI - 0.15-0.74). GLS is a more precise method for quantifying LV function in pediatrics, with lower variability compared to EF and FS. GLS provides a more reliable evaluation of LV systolic function and should be utilized more widely in pediatrics.
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Affiliation(s)
- Meghna D Patel
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA. .,Division of Pediatric Cardiology, Lucile Packard Children's Hospital, Stanford University, 750 Welch Road, Suite 321, Palo Alto, CA, 94304, USA.
| | - Craig Myers
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kazuaki Negishi
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - Gautam K Singh
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Shafkat Anwar
- Division of Cardiology, Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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8
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Demirtas D, Kucukosmanoglu M. In patients with diabetic foot, improved left ventricular functions are detected by strain echocardiography after the diabetic foot treatment: A cross-sectional study. Medicine (Baltimore) 2019; 98:e17217. [PMID: 31567978 PMCID: PMC6756686 DOI: 10.1097/md.0000000000017217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Diabetic foot is a macrovascular complication of diabetes mellitus (DM). In the literature, the relationship between diabetic foot and another macrovascular complication of DM is not clear. The aim of this study was to determine the current left ventricular (LV) systolic function in patients with diabetic foot and to investigate the effect of diabetic foot treatment on LV systolic functions.In this study, 54 patients with diabetic foot and 22 patients without diabetic foot were included. Routine anamnesis, physical examination, echocardiography, and laboratory examinations were performed. In addition, LV global longitudinal strain (LV-GLS) was measured by strain echocardiography technique. LV ejection fraction (LV-EF) and LV-GLS measurements were repeated with echocardiography at the 3rd month of diabetic foot treatment.The incidence of cardiovascular risk factors such as smoking, hypertension, and coronary artery disease was found to be higher in patients with diabetic foot. (P < .05 for each one). Similarly, in patients with diabetic foot, glucose, Hemoglobin A1c, neutrophil, sedimentation, urea, creatinine, potassium, uric acid, alanine aminotransferase, aspartate aminotransferase, C-reactive protein, and brain natriuretic protein were higher; high-density lipoprotein cholesterol level was found to be significantly lower. LV wall thicknesses and diameters were higher and LV-EF was lower in patients with diabetic foot (P < .05 each one). LV-GLS values were significantly lower in patients with diabetic foot (P < .05). Although no significant change was found in the LV-EF value at the 3rd-month follow-up echocardiography (48.6% ± 7.0% vs 48.5% ± 5.9% and P = .747), it was detected that LV-GLS values (17.3 ± 2.1 vs 18.4 ± 2.3) were significantly increased (P < .001).LV systolic function was significantly affected in patients with diabetic foot. This may be related to the increased frequency of cardiovascular risk factors in these patients. However, the significant improvement in LV-GLS values after the diabetic foot treatment showed that diabetic foot itself was an important cause of LV systolic dysfunction.
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Affiliation(s)
- Derya Demirtas
- Department of Internal Medicine, University of Health Sciences
| | - Mehmet Kucukosmanoglu
- Department of Cardiology, University of Health Sciences - Adana Health Practices and Research Center, Adana, Turkey
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9
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Wang W, Zhang L, Battiprolu PK, Fukushima A, Nguyen K, Milner K, Gupta A, Altamimi T, Byrne N, Mori J, Alrob OA, Wagg C, Fillmore N, Wang SH, Liu DM, Fu A, Lu JY, Chaves M, Motani A, Ussher JR, Reagan JD, Dyck JRB, Lopaschuk GD. Malonyl CoA Decarboxylase Inhibition Improves Cardiac Function Post-Myocardial Infarction. ACTA ACUST UNITED AC 2019; 4:385-400. [PMID: 31312761 PMCID: PMC6609914 DOI: 10.1016/j.jacbts.2019.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 02/04/2019] [Accepted: 02/11/2019] [Indexed: 01/03/2023]
Abstract
MCD inhibition decreases fatty acid oxidation via increasing malonyl coenzyme A levels to prevent fatty acid uptake into mitochondria in the failing hearts induced by coronary artery ligation. Downregulating fatty acid oxidation by MCD inhibition occurrs in conjuction with a decrease in glycolysis and in proton production while an increase in triacylglycerol biosynthesis. MCD inhibition enhances antioxidative capacity through increasing mitochondrial superoxide dismutase activity via reducing its acetylation.
Alterations in cardiac energy metabolism after a myocardial infarction contribute to the severity of heart failure (HF). Although fatty acid oxidation can be impaired in HF, it is unclear if stimulating fatty acid oxidation is a desirable approach to treat HF. Both immediate and chronic malonyl coenzyme A decarboxylase inhibition, which decreases fatty acid oxidation, improved cardiac function through enhancing cardiac efficiency in a post–myocardial infarction rat that underwent permanent left anterior descending coronary artery ligation. The beneficial effects of MCD inhibition were attributed to a decrease in proton production due to an improved coupling between glycolysis and glucose oxidation.
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Key Words
- ATGL, adipose triglyceride lipase
- CPT1, carnitine palmitoyltransferase 1
- EF, ejection fraction
- FOXO3, forkhead box O3
- MCD, malonyl coenzyme A decarboxylase
- MI, myocardial infarction
- SERCA2, sarco(endo)plasmic reticulum Ca2+-ATPase 2
- SOD, superoxide dismutase
- SPT, serine palmitoyltransferase
- TAG, triacylglycerol
- Trx, thioredoxin
- fatty acid oxidation
- glucose oxidation
- heart failure
- uncoupling of glycolysis
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Affiliation(s)
- Wei Wang
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.,Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Liyan Zhang
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Arata Fukushima
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Kenneth Milner
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Abhishek Gupta
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tariq Altamimi
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Nikole Byrne
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jun Mori
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Osama Abo Alrob
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Cory Wagg
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Natasha Fillmore
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Shao-Hua Wang
- Department of Cardiac Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | | | | | | | | | - John R Ussher
- Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada
| | | | - Jason R B Dyck
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Gary D Lopaschuk
- Cardiovascular Research Centre, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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10
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Hemu M, Zimmerman A, Kalra D, Okwuosa T. Pretransplant Cardiac Evaluation Using Novel Technology. J Clin Med 2019; 8:E690. [PMID: 31100854 PMCID: PMC6571765 DOI: 10.3390/jcm8050690] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/11/2019] [Accepted: 05/14/2019] [Indexed: 12/03/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is a complex procedure that has been increasingly successful in treating malignant and nonmalignant conditions. Despite its effectiveness, it can be associated with potentially life-threatening adverse effects. New onset heart failure, ischemic disease, and arrhythmias are among the most notable cardiovascular complications post-HSCT. As a result, appropriate cardiac risk stratification prior to transplant could result in decreased morbidity and mortality by identifying patients with a higher probability of tolerating possible toxicities associated with HSCT. In this review, we aim to discuss the utility of cardiac screening using novel modalities of imaging technology in the pre-HSCT phase.
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Affiliation(s)
- Mohamad Hemu
- Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Allison Zimmerman
- Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Dinesh Kalra
- Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
| | - Tochukwu Okwuosa
- Department of Medicine, Rush University Medical Center, Chicago, IL 60612, USA.
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11
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Siontis GC, Branca M, Serruys P, Silber S, Räber L, Pilgrim T, Valgimigli M, Heg D, Windecker S, Hunziker L. Impact of left ventricular function on clinical outcomes among patients with coronary artery disease. Eur J Prev Cardiol 2019; 26:1273-1284. [PMID: 30966820 DOI: 10.1177/2047487319841939] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
AIMS To investigate the clinical relevance of contemporary cut-offs of left ventricular ejection fraction (LVEF) including an intermediate phenotype with mid-range reduced ejection fraction among patients with coronary artery disease undergoing percutaneous coronary intervention. METHODS AND RESULTS Patient-level data were summarized from five randomized clinical trials in which 6198 patients underwent clinically indicated percutaneous coronary intervention in different clinical settings. We assessed all-cause mortality as primary endpoint at five-year follow-up. According to the proposed LVEF cut-offs, 3816 patients were included in the preserved LVEF group (LVEF ≥ 50%), 1793 in the mid-range reduced LVEF group (LVEF 40-49%) and 589 patients in the reduced LVEF group (LVEF < 40%). Patients in the reduced LVEF group were at increased risk for the primary outcome of all-cause mortality compared with both, preserved and mid-range LVEF throughout five years of follow-up (adjusted hazard ratio 2.39 (95% confidence interval 1.75-3.28, p < 0.001) and 1.68 (95% confidence interval 1.34-2.10, p < 0.001), respectively). The risk of cardiac death and the composite endpoint of cardiac death, myocardial infarction, or stroke were higher for patients in the reduced LVEF group compared with the preserved and mid-range reduced LVEF groups, but also for the mid-range LVEF compared with preserved LVEF group (adjusted p < 0.05 for all comparisons) throughout five years. Irrespective of clinical presentation at baseline (stable coronary artery disease or acute coronary syndrome), patients with reduced or mid-range LVEF were at increased risk of all-cause mortality and cardiac death up to five years compared with the other group (adjusted p < 0.05 for all comparisons). CONCLUSION Patients with reduced LVEF <40% or mid-range LVEF 40-49% in the context of coronary artery disease undergoing clinically indicated percutaneous coronary intervention are at increased risk of all-cause mortality, cardiac death and the composite of cardiac death, stroke and myocardial infarction throughout five years of follow-up. The recently proposed LVEF cut-offs contribute to the differentiation and risk stratification of patients with ischaemic heart disease.
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Affiliation(s)
- George Cm Siontis
- 1 Department of Cardiology, University Hospital of Bern, Inselspital, Switzerland
| | - Mattia Branca
- 2 Clinical Trials Unit, University of Bern, Switzerland
| | - Patrick Serruys
- 3 Imperial College of Science, Technology and Medicine, London, UK
| | - Sigmund Silber
- 4 Department of Cardiology, Heart Centre at the Isar, Munich, Germany
| | - Lorenz Räber
- 1 Department of Cardiology, University Hospital of Bern, Inselspital, Switzerland
| | - Thomas Pilgrim
- 1 Department of Cardiology, University Hospital of Bern, Inselspital, Switzerland
| | - Marco Valgimigli
- 1 Department of Cardiology, University Hospital of Bern, Inselspital, Switzerland
| | - Dik Heg
- 2 Clinical Trials Unit, University of Bern, Switzerland
| | - Stephan Windecker
- 1 Department of Cardiology, University Hospital of Bern, Inselspital, Switzerland
| | - Lukas Hunziker
- 1 Department of Cardiology, University Hospital of Bern, Inselspital, Switzerland
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12
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Bayram E, Gulcu O, Aksu U, Aksakal E, Birdal O, Kalkan K. Evaluating the Association Between the Three Different Ejection Fraction Measurement Techniques and Left Ventricle Global Strain. Eurasian J Med 2018; 50:173-177. [PMID: 30515038 DOI: 10.5152/eurasianjmed.2018.17409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Objective The prognosis of cardiovascular diseases (CVDs) is directly associated with systolic function based on the measurement of ejection fraction (EF), and many studies have indicated that the left ventricular global strain (LVGS) provides better predictivity than the EF measurement in the diagnosis, prognosis, survival, and CVD staging. However, these studies did not investigate the correlation between the EF measurement and the LVGS parameters, or which parameters are better correlated with LVGS, but we analyzed the association between three EF measurement methods and LVGS. Materials and Methods This study included 62 patients that applied to the clinic between October 2015 and March 2016. An echocardiography examination of these patients was performed. The exclusion criteria were atrial fibrillation and suboptimal image quality. Results Sixty-two patients (the average age 61.0±12.6 years; 56% male and 44% female) were enrolled in the study. A statistically significant association was found between the visual EF and Simpson EF measurements and the LVGS parameters (p<0.001). While the visual EF was moderately correlated with the LVGS parameters (r=0.44), there was a good correlation between the Simpson EF and the LVGS parameters (r=0.710). Conclusion In this study, we demonstrate that the Simpson's rule LVEF correlates better with LVGS than the Teicholtz method or visual EF and that it has a better area under the curve value for determining an abnormal LVGS. Therefore, we recommend the use of the Simpson EF for the EF measurement that has a better correlation with the LVGS values in the patients whose ventricle functions should be evaluated.
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Affiliation(s)
- Ednan Bayram
- Department of Cardiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Oktay Gulcu
- Clinic of Cardiology, Patnos State Hospital, Erzurum, Turkey
| | - Ugur Aksu
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
| | - Emrah Aksakal
- Department of Cardiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Oguzhan Birdal
- Department of Cardiology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Kamuran Kalkan
- Department of Cardiology, Erzurum Training and Research Hospital, Erzurum, Turkey
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13
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Heinen A, Raupach A, Behmenburg F, Hölscher N, Flögel U, Kelm M, Kaisers W, Nederlof R, Huhn R, Gödecke A. Echocardiographic Analysis of Cardiac Function after Infarction in Mice: Validation of Single-Plane Long-Axis View Measurements and the Bi-Plane Simpson Method. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1544-1555. [PMID: 29706407 DOI: 10.1016/j.ultrasmedbio.2018.03.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/19/2018] [Accepted: 03/22/2018] [Indexed: 06/08/2023]
Abstract
Although echocardiography is commonly used to analyze cardiac function in small animal models of cardiac remodeling after myocardial infarction, the different echocardiographic methods are validated poorly. End-diastolic volume, end-systolic volume and ejection fraction were analyzed using either standard single-plane analysis from parasternal long-axis B-mode views (PSLAX) or the bi-plane Simpson method (using PSLAX and three short-axis views) and validated using magnetic resonance imaging as standard. Ejection fraction measured by PSLAX was moderately correlated with a coefficient of R2 = 0.49. The standard deviation of residuals was 9.91. Simpson analysis revealed an improved correlation coefficient of R2 = 0.77 and a reduction in standard deviation of residuals by 45% (5.45 vs. 9.92, p = 0.014). Subgroup analysis revealed that the high variation in PSLAX is due to changes in ventricular geometry after myocardial infarction. Our results indicate that the bi-plane Simpson method is advantageous for the assessment of cardiac function after myocardial infarction.
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Affiliation(s)
- Andre Heinen
- Institute of Cardiovascular Physiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany.
| | - Annika Raupach
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | - Nina Hölscher
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Ulrich Flögel
- Department of Molecular Cardiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Wolfgang Kaisers
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Rianne Nederlof
- Institute of Cardiovascular Physiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
| | - Ragnar Huhn
- Department of Anesthesiology, University Hospital Düsseldorf, Düsseldorf, Germany
| | - Axel Gödecke
- Institute of Cardiovascular Physiology, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany
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14
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Panayiotou M, Housden RJ, Ishak A, Brost A, Rinaldi CA, Sieniewicz B, Behar JM, Kurzendorfer T, Rhode KS. LV function validation of computer-assisted interventional system for cardiac resyncronisation therapy. Int J Comput Assist Radiol Surg 2018; 13:777-786. [PMID: 29603064 PMCID: PMC5974009 DOI: 10.1007/s11548-018-1748-0] [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: 01/24/2018] [Accepted: 03/21/2018] [Indexed: 12/01/2022]
Abstract
PURPOSE Cardiac resynchronisation therapy (CRT) is an established treatment for symptomatic patients with heart failure, a prolonged QRS duration, and impaired left ventricular (LV) function; however, non-response rates remain high. Recently proposed computer-assisted interventional platforms for CRT provide new routes to improving outcomes. Interventional systems must process information in an accurate, fast and highly automated way that is easy for the interventional cardiologists to use. In this paper, an interventional CRT platform is validated against two offline diagnostic tools to demonstrate that accurate information processing is possible in the time critical interventional setting. METHODS The study consisted of 3 healthy volunteers and 16 patients with heart failure and conventional criteria for CRT. Data analysis included the calculation of end-diastolic volume, end-systolic volume, stroke volume and ejection fraction; computation of global volume over the cardiac cycle as well as time to maximal contraction expressed as a percentage of the total cardiac cycle. RESULTS The results showed excellent correlation ([Formula: see text] values of [Formula: see text] and Pearson correlation coefficient of [Formula: see text]) with comparable offline diagnostic tools. CONCLUSION Results confirm that our interventional system has good accuracy in everyday clinical practice and can be of clinical utility in identification of CRT responders and LV function assessment.
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Affiliation(s)
- Maria Panayiotou
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK.
| | - R James Housden
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | - Athanasius Ishak
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
| | | | - Christopher A Rinaldi
- Department of Cardiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Benjamin Sieniewicz
- Department of Cardiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Jonathan M Behar
- Department of Cardiology, Guy's and St. Thomas' Hospitals NHS Foundation Trust, London, UK
| | | | - Kawal S Rhode
- Division of Imaging Sciences and Biomedical Engineering, King's College London, London, UK
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15
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Acquatella H, Asch FM, Barbosa MM, Barros M, Bern C, Cavalcante JL, Echeverria Correa LE, Lima J, Marcus R, Marin-Neto JA, Migliore R, Milei J, Morillo CA, Nunes MCP, Campos Vieira ML, Viotti R. Recommendations for Multimodality Cardiac Imaging in Patients with Chagas Disease: A Report from the American Society of Echocardiography in Collaboration With the InterAmerican Association of Echocardiography (ECOSIAC) and the Cardiovascular Imaging Department of the Brazilian Society of Cardiology (DIC-SBC). J Am Soc Echocardiogr 2018; 31:3-25. [DOI: 10.1016/j.echo.2017.10.019] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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16
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Barjaktarovic M, Korevaar TIM, Gaillard R, de Rijke YB, Visser TJ, Jaddoe VWV, Peeters RP. Childhood thyroid function, body composition and cardiovascular function. Eur J Endocrinol 2017; 177:319-327. [PMID: 28724570 DOI: 10.1530/eje-17-0369] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 06/27/2017] [Accepted: 07/19/2017] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The cardiovascular system is a known target for thyroid hormone. Early-life cardiovascular alterations may lead to a higher risk of cardiovascular disease in adulthood. Little is known about the effects of thyroid hormone on cardiovascular function during childhood, including the role of body composition in this association. DESIGN Population-based prospective cohort of children (n = 4251, median age 6 years, 95% range: 5.7-8.0 years). METHODS Thyroid-stimulating hormone (TSH) and free thyroxine (FT4) concentrations were measured to assess thyroid function. Left ventricular (LV) mass was assessed with echocardiography. Arterial stiffness was assessed with carotid-femoral pulse wave velocity (CFPWV). Systolic and diastolic blood pressure (BP) was measured. Body composition was assessed by dual-energy X-ray absorptiometry scan. RESULTS FT4 was inversely associated with LV mass (P = 0.002), and with lean body mass (P < 0.0001). The association of FT4 with LV mass was partially mediated through variability in lean body mass (55% mediated effect). TSH was inversely associated with LV mass (P = 0.010), predominantly in boys. TSH was positively associated with systolic and diastolic BP (both P < 0.001). FT4 was positively associated with CFPWV and diastolic BP (P < 0.0001, P = 0.008, respectively), and the latter association attenuated after adjustment for CFPWV. CONCLUSIONS At the age of 6 years, higher FT4 is associated with lower LV mass (partially through effects on lean body mass) and with higher arterial stiffness, which may lead to higher BP. Our data also suggest different mechanisms via which TSH and FT4 are associated with cardiovascular function during early childhood.
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Affiliation(s)
| | - Tim I M Korevaar
- The Generation R Study Group
- Department of Internal Medicine
- Rotterdam Thyroid Center
| | - Romy Gaillard
- The Generation R Study Group
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Theo J Visser
- Department of Internal Medicine
- Rotterdam Thyroid Center
| | - Vincent W V Jaddoe
- The Generation R Study Group
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Pediatrics, Erasmus Medical Center, Sophia Children's Hospital, Rotterdam, The Netherlands
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17
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Kang EJ, Lee KN, Choi WJ, Kim YD, Shin KM, Lim JK, Lee J. Left Ventricular Functional Parameters and Geometric Patterns in Korean Adults on Coronary CT Angiography with a 320-Detector-Row CT Scanner. Korean J Radiol 2017; 18:664-673. [PMID: 28670161 PMCID: PMC5447642 DOI: 10.3348/kjr.2017.18.4.664] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 01/29/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To assess the normal reference values of left ventricle (LV) functional parameters in Korean adults on coronary CT angiography (CCTA) with a 320-detector-row CT scanner, and to analyze sex-related differences and correlations with various clinical characteristics. MATERIALS AND METHODS This study retrospectively enrolled 172 subjects (107 men and 65 women; age, 58 ± 10.9 years; body surface area [BSA], 1.75 ± 0.2 m2) who underwent CCTA without any prior history of cardiac disease. The following parameters were measured by post-processing the CT data: LV volume, LV functional parameters (ejection fraction, stroke volume, cardiac output, etc.), LV myocardial mass, LV inner diameter, and LV myocardial thickness (including septal wall thickness [SWT], posterior wall thickness [PWT], and relative wall thickness [RWT = 2 × PWT / LV inner diameter]). All of the functional or volumetric parameters were normalized using the BSA. The general characteristics and co-morbidities for the enrolled subjects were recorded, and the correlations between these factors and the LV parameters were then evaluated. RESULTS The LV myocardial thickness (SWT, 1.08 ± 0.18 cm vs. 0.90 ± 0.17 cm, p < 0.001; PWT, 0.91 ± 0.15 cm vs. 0.78 ± 0.10 cm, p < 0.001; RWT, 0.38 ± 0.08 cm vs. 0.33 ± 0.05 cm, p < 0.001), LV volume (LV end-diastolic volume, 112.9 ± 26.1 mL vs. 98.2 ± 21.0 mL, p < 0.001; LV end-systolic volume, 41.7 ± 14.7 mL vs. 33.7 ± 12.2 mL, p = 0.001) and mass (145.0 ± 29.1 g vs. 107.9 ± 20.0 g, p < 0.001) were significantly greater in men than in women. However, these differences were not significant after normalization using BSA, except for the LV mass (LV mass index, 79.6 ± 14.0 g/m2 vs. 66.2 ± 11.0 g/m2, p < 0.001). The cardiac output and ejection fraction were not significantly different between the men and women (cardiac output, 4.3 ± 1.0 L/min vs. 4.2 ± 0.9 L/min, p = 0.452; ejection fraction, 63.4 ± 7.7% vs. 66.4 ± 7.6%, p = 0.079). Most of the LV parameters were positively correlated with BSA, body weight, and total Agatston score. CONCLUSION This study provides sex-related reference values and percentiles for LV on cardiac CT and should assist in interpreting results.
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Affiliation(s)
- Eun-Ju Kang
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Ki-Nam Lee
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Won Jin Choi
- Department of Radiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Young-Dae Kim
- Department of Cardiology, College of Medicine, Dong-A University, Busan 49201, Korea
| | - Kyung Min Shin
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
| | - Jae-Kwang Lim
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
| | - Jongmin Lee
- Department of Radiology, Kyungpook National University, Daegu 41944, Korea
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18
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Ballo H, Tarkia M, Haavisto M, Stark C, Strandberg M, Vähäsilta T, Saunavaara V, Tolvanen T, Teräs M, Hynninen VV, Savunen T, Roivainen A, Knuuti J, Saraste A. Accuracy of echocardiographic area-length method in chronic myocardial infarction: comparison with cardiac CT in pigs. Cardiovasc Ultrasound 2017; 15:1. [PMID: 28069008 PMCID: PMC5223339 DOI: 10.1186/s12947-016-0093-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Accepted: 12/19/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We evaluated echocardiographic area-length methods to measure left ventricle (LV) volumes and ejection fraction (EF) in parasternal short axis views in comparison with cardiac computed tomography (CT) in pigs with chronic myocardial infarction (MI). METHODS Male farm pigs with surgical occlusion of the left anterior descending coronary artery (n = 9) or sham operation (n = 5) had transthoracic echocardiography and cardiac-CT 3 months after surgery. We measured length of the LV in parasternal long axis view, and both systolic and diastolic LV areas in parasternal short axis views at the level of mitral valve, papillary muscles and apex. Volumes and EF of the LV were calculated using Simpson's method of discs (tri-plane area) or Cylinder-hemiellipsoid method (single plane area). RESULTS The pigs with coronary occlusion had anterior MI scars and reduced EF (average EF 42 ± 10%) by CT. Measurements of LV volumes and EF were reproducible by echocardiography. Compared with CT, end-diastolic volume (EDV) measured by echocardiography showed good correlation and agreement using either Simpson's method (r = 0.90; mean difference -2, 95% CI -47 to 43 mL) or Cylinder-hemiellipsoid method (r = 0.94; mean difference 3, 95% CI -44 to 49 mL). Furthermore, End-systolic volume (ESV) measured by echocardiography showed also good correlation and agreement using either Simpson's method (r = 0.94; mean difference 12 ml, 95% CI: -16 to 40) or Cylinder-hemiellipsoid method (r = 0.97; mean difference:13 ml, 95% CI: -8 to 33). EF was underestimated using either Simpson's method (r = 0.78; mean difference -6, 95% CI -11 to 1%) or Cylinder-hemiellipsoid method (r = 0.74; mean difference -4, 95% CI-10 to 2%). CONCLUSION Our results indicate that measurement of LV volumes may be accurate, but EF is underestimated using either three or single parasternal short axis planes by echocardiography in a large animal model of chronic MI.
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Affiliation(s)
- Haitham Ballo
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland. .,Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
| | - Miikka Tarkia
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Matti Haavisto
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Christoffer Stark
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Marjatta Strandberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tommi Vähäsilta
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Tuula Tolvanen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Mika Teräs
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Ville-Veikko Hynninen
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Timo Savunen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland.,Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku and Turku University Hospital, Kiinamyllynkatu 4-8, Turku, 20520, Finland.,Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Institute of Clinical Medicine, University of Turku, Turku, Finland
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19
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Spitzer E, Ren B, Zijlstra F, Mieghem NMV, Geleijnse ML. The Role of Automated 3D Echocardiography for Left Ventricular Ejection Fraction Assessment. Card Fail Rev 2017; 3:97-101. [PMID: 29387460 DOI: 10.15420/cfr.2017:14.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Ejection fraction is one of the most powerful determinants of prognosis and is a crucial parameter for the determination of cardiovascular therapies in conditions such as heart failure, valvular conditions and ischaemic heart disease. Among echocardiographic methods, 3D echocardiography has been attributed as the preferred one for its assessment, given an increased accuracy and reproducibility. Full-volume multi-beat acquisitions are prone to stitching artefacts due to arrhythmias and require prolonged breath holds. Single-beat acquisitions exhibit a lower temporal resolution, but address the limitations of multi-beat acquisitions. If not fully automated, 3D echocardiography remains time-consuming and resource-intensive, with suboptimal observer variability, preventing its implementation in routine practice. Further developments in hardware and software, including fully automated knowledge-based algorithms for left ventricular quantification, may bring 3D echocardiography to a definite turning point.
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Affiliation(s)
- Ernest Spitzer
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management & Core Laboratories,Rotterdam, the Netherlands
| | - Ben Ren
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands.,Cardialysis, Clinical Trial Management & Core Laboratories,Rotterdam, the Netherlands
| | - Felix Zijlstra
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands
| | - Marcel L Geleijnse
- Cardiology, Thoraxcenter, Erasmus University Medical Center,Rotterdam, the Netherlands
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20
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Three-dimensional echocardiography in various types of heart disease: a comparison study of magnetic resonance imaging and 64-slice computed tomography in a real-world population. J Echocardiogr 2016; 15:18-26. [PMID: 27589871 DOI: 10.1007/s12574-016-0315-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 08/04/2016] [Accepted: 08/14/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Accurate quantification of left ventricular (LV) volumes [end-diastolic volume (EDV) and end-systolic volume (ESV)] and ejection fraction (EF) is of critical importance. The development of real-time three-dimensional echocardiography (RT3DE) has shown better correlation than two-dimensional (2D) echocardiography with magnetic resonance imaging (MRI) measurements. The aim of our study was to assess the accuracy of RT3DE and 64-slice computed tomography (CT) in the evaluation of LV volumes and function using MRI as the reference standard in a real-world population with various types of heart disease with different chamber geometry. METHODS The study population consisted of 66 patients referred for cardiac MRI for various pathologies. All patients underwent cardiac MRI, and RT3DE and 64 slices CT were then performed on a subsequent day. The study population was then divided into 5 clinical groups depending on the underlying heart disease. RESULTS RT3DE volumes correlated well with MRI values (R 2 values: 0.90 for EDV and 0.94 for ESV). RT3DE measurements of EF correlated well with MRI values (R 2 = 0.86). RT3DE measurements resulted in slightly underestimated values of both EDV and ESV, as reflected by biases of -9.18 and -4.50 mL, respectively. Comparison of RT3DE and MRI in various types of cardiomyopathies showed no statistical difference between different LV geometrical patterns. CONCLUSION These results confirm that RT3DE has good accuracy in everyday clinical practice and can be of clinical utility in all types of cardiomyopathy independently of LV geometric pattern, LV diameter or wall thickness, taking into account a slight underestimation of LV volumes and EF compared to MRI.
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21
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Guidelines for the Appropriate Use of Bedside General and Cardiac Ultrasonography in the Evaluation of Critically Ill Patients—Part II. Crit Care Med 2016; 44:1206-27. [DOI: 10.1097/ccm.0000000000001847] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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22
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Bencardino G, Di Monaco A, Russo E, Colizzi C, Perna F, Pelargonio G, Narducci ML, Gabrielli FA, Lanza GA, Rebuzzi AG, Crea F. Outcome of Patients Treated by Cardiac Resynchronization Therapy Using a Quadripolar Left Ventricular Lead. Circ J 2016; 80:613-8. [DOI: 10.1253/circj.cj-15-0932] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Antonio Di Monaco
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Eleonora Russo
- Cardiac Arrhythmia Research Centre, Centro Cardiologico Monzino, IRCCS
| | - Cristian Colizzi
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Francesco Perna
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | - Gemma Pelargonio
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
| | | | | | | | | | - Filippo Crea
- Department of Cardiovascular Medicine, Catholic University of the Sacred Heart
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23
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Nazer B, Salgaonkar V, Diederich CJ, Jones PD, Duggirala S, Tanaka Y, Ng B, Sievers R, Gerstenfeld EP. Epicardial Catheter Ablation Using High-Intensity Ultrasound: Validation in a Swine Model. Circ Arrhythm Electrophysiol 2015; 8:1491-7. [PMID: 26546345 DOI: 10.1161/circep.115.003547] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Epicardial radiofrequency catheter ablation of ventricular tachycardia remains challenging because of the presence of deep myocardial scar and adjacent cardiac structures, such as the coronary arteries, phrenic nerve, and epicardial fat that limit delivery of radiofrequency energy. High-intensity ultrasound (HIU) is an acoustic energy source able to deliver deep lesions through fat, while sparing superficial structures. We developed and tested an epicardial HIU ablation catheter in a closed chest, in vivo swine model. METHODS AND RESULTS The HIU catheter is an internally cooled, 14-French, side-facing catheter, integrated with A-mode ultrasound guidance. Swine underwent percutaneous subxyphoid epicardial access and ablation with HIU (n=10 swine) at 15, 20, and 30 W. Compared with irrigated radiofrequency lesions in control swine (n = 5), HIU demonstrated increased lesion depth (HIU 11.6±3.2 mm versus radiofrequency 4.7±1.6 mm; mean±SD) and epicardial sparing (HIU 2.9±2.1 mm versus radiofrequency 0.1±0.2 mm) at all HIU powers, and increased lesion volume at HIU 20 and 30 W (P<0.0001 for all comparisons). HIU ablation over coronary arteries and surrounding epicardial fat resulted in deep lesions with normal angiographic flow. Histological disruption of coronary adventitia, but not media or intima, was noted in 44% of lesions. CONCLUSIONS Compared with radiofrequency, HIU ablation in vivo demonstrates significantly deeper and larger lesions with greater epicardial sparing in a dose-dependent manner. Further development of this catheter may lead to a promising alternative to epicardial radiofrequency ablation.
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Affiliation(s)
- Babak Nazer
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Vasant Salgaonkar
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Chris J Diederich
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Peter D Jones
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Srikant Duggirala
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Yasuaki Tanaka
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Bennett Ng
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Richard Sievers
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco
| | - Edward P Gerstenfeld
- From the Electrophysiology Section, Division of Cardiology, Department of Medicine (B.N., S.D., Y.T., R.S., E.P.G.), and Thermal Therapy Research Group, Department of Radiation Oncology (V.S., C.J.D., P.D.J., B.N.), University of California San Francisco.
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Bhan A, Sirker A, Zhang J, Protti A, Catibog N, Driver W, Botnar R, Monaghan MJ, Shah AM. High-frequency speckle tracking echocardiography in the assessment of left ventricular function and remodeling after murine myocardial infarction. Am J Physiol Heart Circ Physiol 2014; 306:H1371-83. [PMID: 24531814 DOI: 10.1152/ajpheart.00553.2013] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objectives of this study were to assess the feasibility and accuracy of high-frequency speckle tracking echocardiography (STE) in a murine model of myocardial infarction (MI). STE is used clinically to quantify global and regional cardiac function, but its application in mice is challenging because of the small cardiac size and rapid heart rates. A high-frequency micro-ultrasound system with STE (Visualsonics Vevo 2100) was compared against magnetic resonance imaging (MRI) for the assessment of global left ventricular (LV) size and function after murine MI. Animals subjected to coronary ligation (n = 46) or sham ligation (n = 27) were studied 4 wk postoperatively. Regional and global deformation were also assessed. STE-derived LV ejection fraction (EF) and mass correlated well with MRI indexes (r = 0.93, 0.77, respectively; P < 0.001), as did STE-derived mass with postmortem values (r = 0.80, P < 0.001). Higher STE-derived volumes correlated positively with MRI-derived infarct size (P < 0.01). Global strain parameters were significantly reduced after MI (all P < 0.001) and strongly correlated with LV mass and MRI-derived infarct size as promising surrogates for the extent of remodeling and infarction, respectively (both P < 0.05). Regional strain analyses showed that radial strain and strain rate were relatively preserved in anterior basal segments after MI compared with more apical segments (P < 0.001); however, longitudinal strain and strain rate were significantly impaired both basally and distally (P < 0.001). Strain-derived parameters of dyssynchrony were significantly increased in the MI group (P < 0.01). Analysis time for STE was 210 ± 45 s with acceptable inter- and intraobserver variability. In conclusion, high-frequency STE enables quantitative assessment of regional and global function in the remodeling murine LV after MI.
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Affiliation(s)
- Amit Bhan
- Cardiovascular Division, King's College London British Heart Foundation Centre, King's College London, London, United Kingdom; and
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25
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Arias T, Chen J, Fayad ZA, Fuster V, Hajjar RJ, Chemaly ER. Comparison of echocardiographic measurements of left ventricular volumes to full volume magnetic resonance imaging in normal and diseased rats. J Am Soc Echocardiogr 2013; 26:910-8. [PMID: 23706342 PMCID: PMC3725209 DOI: 10.1016/j.echo.2013.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Clinical two-dimensional (2D) and clinical three-dimensional echocardiography are validated against cardiac magnetic resonance imaging (CMR), the gold standard for left ventricular (LV) volume measurement. In rodents, there is no widely accepted echocardiographic measure of whole LV volumes, and CMR measurements vary among studies. The aim of this study was to compare LV volumes by 2D echocardiography (using a hemisphere-cylinder [HC] model) with HC and full-volume (FV) CMR in normal and diseased rats to measure the impact of geometric models and imaging modalities. METHODS Rats (n = 27) underwent ascending aortic banding, myocardial infarction induction by either permanent left anterior descending coronary artery ligation or ischemia-reperfusion, and sham thoracotomy. Subsequently, end-diastolic volume, end-systolic volume, and ejection fraction were measured using an HC 2D echocardiographic model combining parasternal short-axis and long-axis measurements, and these were compared with HC and FV CMR. RESULTS Diseased groups showed LV dilatation and dysfunction. HC echocardiographic and FV CMR measures of end-diastolic volume, end-systolic volume, and ejection fraction were correlated. On Bland-Altman plots, end-diastolic volumes were concordant between both methods, while HC echocardiography underestimated end-systolic volumes, resulting in a modest overestimation of ejection fractions compared with FV CMR. Other 2D echocardiographic geometric models offered less concordance with FV CMR than HC. HC CMR overestimated LV volumes compared with FV CMR, while HC echocardiography underestimated HC CMR volumes. Echocardiography underestimated corresponding LV dimensions by CMR, particularly short axis. CONCLUSIONS Concordant measures of LV volume and function were obtained using (1) a relatively simple HC model of the left ventricle inclusive of two orthogonal 2D echocardiographic planes and (2) FV CMR in normal and diseased rats. The HC model appeared to compensate for the underestimation of LV dimensions by echocardiography.
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Affiliation(s)
- Teresa Arias
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández
Almagro, 3, Madrid, 28029, Spain
| | - Jiqiu Chen
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Zahi A. Fayad
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Valentin Fuster
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Melchor Fernández
Almagro, 3, Madrid, 28029, Spain
| | - Roger J. Hajjar
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
| | - Elie R. Chemaly
- Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at
Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY, 10029, USA
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Perez VADJ, Haddad F, Zamanian RT. Diagnosis and management of pulmonary hypertension associated with left ventricular diastolic dysfunction. Pulm Circ 2012; 2:163-9. [PMID: 22837857 PMCID: PMC3401870 DOI: 10.4103/2045-8932.97598] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is commonly seen in patients who present with left ventricular diastolic dysfunction (LVDD) and is considered a marker of poor prognosis. While PH in this setting is thought to result from pulmonary venous congestion, there is a subset of patients in which pulmonary pressures fail to improve with appropriate management of diastolic heart failure and go on to develop a clinical picture similar to that of patients with pulmonary arterial hypertension (PAH). Despite the utility of Doppler echocardiography and exercise testing in the initial evaluation of patients with suspected PH-LVDD, the diagnosis can only be confirmed using right heart catheterization. Management of PH-LVDD centers on both optimizing fluid management and afterload reduction to reducing left ventricular diastolic pressures and also increase pulmonary venous return. To date, there is no clear evidence that addition of PH-specific drugs can improve clinical outcomes, and their use should only be considered in the setting of clinical trials. In conclusion, PH-LVDD remains a challenging clinical entity that complicates the management of left ventricular dysfunction and significantly contributes to its morbidity and mortality. Determination of the optimal diagnostic and treatment strategies for this form of PH should be the goal of future studies.
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Affiliation(s)
- Vinicio A de Jesus Perez
- Division of Pulmonary and Critical Care Medicine, Stanford University Medical Center, Stanford, California, 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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Nakano EM, Shigueoka DC, Szarf G, Pinetti RZ, Santos JEM, Szejnfeld D, Barbieri A. Avaliação da função ventricular esquerda pela sequência de ressonância magnética sem apneia e com múltiplas excitações. Radiol Bras 2009. [DOI: 10.1590/s0100-39842009000500006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Avaliar a eficácia da sequência de ressonância magnética com três excitações, para obtenção de volumes e massas ventriculares, em indivíduos com respiração livre, sem apneia. MATERIAIS E MÉTODOS: Em 32 voluntários sadios, foram comparados os volumes e massas do ventrículo esquerdo, obtidos por meio de duas sequências de ressonância magnética em modo cine. A primeira, tradicionalmente utilizada e considerada padrão, em apneia e com excitação única, e a segunda, em respiração livre e com três excitações. Três leitores, com diferentes níveis de experiência, testaram a concordância e a reprodutibilidade. Para a análise estatística foram utilizados o coeficiente de correlação intraclasse, o teste t-pareado, os gráficos de Bland-Altman e o teste do sinal. RESULTADOS: Para os dois observadores mais experientes, os coeficientes de correlação intraclasse foram superiores a 0,913, assim como os níveis descritivos do teste t-pareado acima de 0,05, os gráficos de Bland-Altman com as diferenças distribuídas aleatoriamente em torno do zero e o teste do sinal com seu nível descritivo superior a 0,05. CONCLUSÃO: A sequência testada apresenta ótima concordância e reprodutibilidade em relação à sequência padrão, podendo ser aplicada em indivíduos com limitações respiratórias.
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Affiliation(s)
| | | | | | - Rogério Zaia Pinetti
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Universidade Federal de São Paulo, Brasil
| | | | - Denis Szejnfeld
- Colégio Brasileiro de Radiologia e Diagnóstico por Imagem; Universidade Federal de São Paulo, Brasil
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Cardiac image modeling tool for quantitative analysis of global and regional cardiac wall motion. Invest Radiol 2009; 44:271-8. [PMID: 19346964 DOI: 10.1097/rli.0b013e31819c96e3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the Cardiac Image Modeling (CIM 4.6; University of Auckland, Auckland, New Zealand) tool's ability to assess cardiac function via quantitative calculations of global and regional ejection fraction (EF) from magnetic resonance imaging in comparison with a current method of global analysis with Argus (Siemens Medical Solutions) and regional analysis with visual analysis. BACKGROUND Global cardiac function is commonly assessed quantitatively by post processing tools that calculate global EF. Currently, regional cardiac function is assessed by subjective visual analysis of wall motion, which can have significant interobserver variability. CIM is a tool that may reduce variability by generating a semi-automated 3-dimensional heart model to calculate quantitative global and regional EF. MATERIALS AND METHODS Thirty-one patients (22 men, 9 women; mean age 55.1 +/- 17.5 years) were selected based on global EFs calculated at the time of the clinical visit with the Argus postprocessing tool (Siemens Medical Solutions). Patients were then placed into 2 predetermined categories of normal: EF >or=50% and abnormal: EF <50%. Regional EF was calculated for each segment of a 16-segment cardiac model. Three blinded reviewers used the standard of care assessment of regional function, which was a qualitative grading of the 16 segments into categories of normal or abnormal regional wall motion by visual analysis. CIM quantitatively analyzed global EF and regional EF for each segment. These segments were then sorted into the predetermined categories of normal (EF >or=50%) and abnormal (EF <50%). Level of agreement was conducted via Pearson correlation coefficient and Bland-Altman analysis for global EF analysis and observed proportion of agreement (p(a)), sensitivity, and specificity for regional EF analysis. RESULTS Global EF analysis showed a high correlation (r2 = 0.85; y = 0.94x + 4.85, P < 0.001) between the Argus and CIM analyses. Sixteen-segment regional EF analysis showed p(a) averages >0.60. Regional wall motion by short axis slices showed pa averages >0.75, and combined analyses of all 3 reviewers' 16-segment regional data showed an overall total p(a) = 0.79 (sensitivity = 72%, specificity = 88%). Interobserver and intraobserver variability were low (p(a) > 0.65) in this study. CONCLUSIONS Global EF analysis of cardiac magnetic resonance imaging by CIM showed high agreement with the commonly used Argus postprocessing tool. Furthermore, CIM is capable of evaluating regional EF with good agreement in comparison with the current visual method. In addition to determining abnormal versus normal cardiac wall motion, CIM is able to add to the analysis a quantitative regional EF for each given segment. As a semi-automated tool, CIM has the potential to reduce reviewer variability and decrease the time required for analysis. In the future, CIM can potentially quantitatively track global and regional changes in patients with heart disease and aid the clinical management throughout the course of the disease.
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Marcucci C, Lauer R, Mahajan A. New Echocardiographic Techniques for Evaluating Left Ventricular Myocardial Function. Semin Cardiothorac Vasc Anesth 2008; 12:228-47. [DOI: 10.1177/1089253208328581] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Ultrasound imaging of the heart continues to play an important role in diagnosis and management of patients with cardiovascular diseases. Recent advances in ultrasound technology and introduction of newer imaging modalities have enabled improved assessment of left ventricular myocardial function. Tissue Doppler imaging and 2-dimensional speckle tracking allow more objective quantification of myocardial function in the form of tissue velocities, displacement, strain, and strain rate. Similarly, contrast-enhanced echocardiography and 3-dimensional echocardiography have provided a unique insight into left ventricular form and function that was not possible by unenhanced 2-dimensional echocardiography. In this review, the authors discuss the clinical application of these new imaging techniques in the assessment of left ventricular myocardial function.
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Affiliation(s)
- Carlo Marcucci
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Ryan Lauer
- Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
| | - Aman Mahajan
- Department of Anesthesiology, David Geffen School of Medicine at UCLA, Los Angeles, California,
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