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Wensel R, Opitz C. Novel interventions on the tricuspid valve: how to consider the pulmonary circulation? Curr Opin Pulm Med 2024; 30:444-450. [PMID: 39114937 DOI: 10.1097/mcp.0000000000001101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024]
Abstract
PURPOSE OF REVIEW This review addresses treatment options for moderate to severe tricuspid valve regurgitation and the importance of right ventricular function and the pulmonary circulation. RECENT FINDINGS Several interventional treatment options for severe tricuspid regurgitation have been developed including transcatheter edge-to-edge repair, annuloplasty and valve replacement. So far, transcatheter edge-to-edge repair is most frequently used with procedural success rates of more than 95% and improvements in functional and quality of life parameters for up to 2 years. Right ventricular function as well as pulmonary artery pressure and resistance levels are important outcome predictors. Mean pulmonary artery pressure more than 30 mmHg, transpulmonary gradient more than 17 mmHg and right ventricular to pulmonary artery coupling ratio less than 0.406 indicate poor outcome. SUMMARY Despite the remarkable safety of interventional treatment of severe tricuspid regurgitation right ventricular dysfunction and abnormal pulmonary hemodynamics are important determinants of procedural success and clinical outcome.Complete hemodynamic work-up should be an integral part of prerepair assessment although validated data predicting outcome are limited.
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Affiliation(s)
- Roland Wensel
- Klinik für Innere Medizin - Kardiologie, DRK Kliniken Berlin | Westend, Berlin, Germany
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Nishimura T, Hirata Y, Ise T, Iwano H, Izutani H, Kinugawa K, Kitai T, Ohno T, Ohtani T, Okumura T, Ono M, Satomi K, Shiose A, Toda K, Tsukamoto Y, Yamaguchi O, Fujino T, Hashimoto T, Higashi H, Higashino A, Kondo T, Kurobe H, Miyoshi T, Nakamoto K, Nakamura M, Saito T, Saku K, Shimada S, Sonoda H, Unai S, Ushijima T, Watanabe T, Yahagi K, Fukushima N, Inomata T, Kyo S, Minamino T, Minatoya K, Sakata Y, Sawa Y. JCS/JSCVS/JCC/CVIT 2023 guideline focused update on indication and operation of PCPS/ECMO/IMPELLA. J Cardiol 2024; 84:208-238. [PMID: 39098794 DOI: 10.1016/j.jjcc.2024.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/06/2024]
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3
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Murayama M, Kaga S, Onoda A, Nishino H, Yokoyama S, Goto M, Suzuki Y, Yanagi Y, Shimono Y, Nakamura K, Aoyagi H, Tamaki Y, Ishizaka S, Iwano H, Kamiya K, Nagai T, Anzai T. Head-to-Head Comparison of Hepatic Vein and Superior Vena Cava Flow Velocity Waveform Analyses for Predicting Elevated Right Atrial Pressure. ULTRASOUND IN MEDICINE & BIOLOGY 2024; 50:1352-1360. [PMID: 38834491 DOI: 10.1016/j.ultrasmedbio.2024.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Revised: 04/27/2024] [Accepted: 05/10/2024] [Indexed: 06/06/2024]
Abstract
OBJECTIVE Blood flow in the hepatic veins and superior vena cava (SVC) reflects right heart filling; however, their Doppler profiles are often not identical, and no studies have compared their diagnostic efficacies. We aimed to determine which venous Doppler profile is reliable for detecting elevated right atrial pressure (RAP). METHODS In 193 patients with cardiovascular diseases who underwent cardiac catheterization within 2 d of echocardiography, the hepatic vein systolic filling fraction (HV-SFF) and the ratio of the peak systolic to diastolic forward velocities of the SVC (SVC-S/D) were measured. HV-SFF < 55% and SVC-S/D < 1.9 were regarded as elevated RAP. We also calculated the fibrosis 4 index (FIB-4) as a serum liver fibrosis marker. RESULTS HV-SFF and SVC-S/D were feasible in 177 (92%) and 173 (90%) patients, respectively. In the 161 patients in whom both venous Doppler waveforms could be measured, HV-SFF and SVC-S/D were inversely correlated with RAP (r = -0.350, p < 0.001; r = -0.430, p < 0.001, respectively). SVC-S/D > 1.9 showed a significantly higher diagnostic accuracy of RAP elevation compared with HV-SFF < 55% (area under the curve, 0.842 vs. 0.614, p < 0.001). Multivariate analyses showed that both FIB-4 (β = -0.211, p = 0.013) and mean RAP (β = -0.319, p < 0.001) were independent determinants of HV-SFF. In contrast, not FIB-4 but mean RAP (β = -0.471, p < 0.001) was an independent determinant of SVC-S/D. The diagnostic accuracy remained unchanged when HV-SFF < 55% was considered in conjunction with the estimated RAP based on the inferior vena cava morphology. Conversely, SVC-S/D showed an incremental diagnostic value over the estimated RAP. CONCLUSIONS SVC-S/D enabled a more accurate diagnosis of RAP elevation than HV-SFF.
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Affiliation(s)
- Michito Murayama
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan; Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Sanae Kaga
- Department of Medical Laboratory Science, Faculty of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan; Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan.
| | - Airi Onoda
- Graduate School of Health Sciences, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hisao Nishino
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Shinobu Yokoyama
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Mana Goto
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yukino Suzuki
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yusuke Yanagi
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Yui Shimono
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Kosuke Nakamura
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroyuki Aoyagi
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Yoji Tamaki
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Suguru Ishizaka
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Hiroyuki Iwano
- Diagnostic Center for Sonography, Hokkaido University Hospital, Sapporo, Hokkaido, Japan; Division Cardiology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Kiwamu Kamiya
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshiyuki Nagai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Toshihisa Anzai
- Department of Cardiovascular Medicine, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
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Malakan Rad E, Elhamian R, Zanjani KS, Shabanian R, Moghadam EA, Majnoon MT, Zeinaloo A. Echocardiographic estimation of pulmonary arterial and right atrial pressures in children with congenital heart disease: a comprehensive prospective study and introduction of novel equations. J Cardiovasc Imaging 2024; 32:23. [PMID: 39113161 PMCID: PMC11308456 DOI: 10.1186/s44348-024-00023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 12/03/2023] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Pediatric pulmonary hypertension (PH) is characterized by a mean pulmonary arterial pressure exceeding 20 mmHg. There is limited research on the suitability of adult-based methods for estimating PH in pediatric populations. Using established formulas for adults, this study aimed to evaluate the correlation between echocardiographic estimates of systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures in children with congenital heart disease (CHD). METHODS A prospective study was conducted involving children with CHD undergoing cardiac catheterization without prior cardiac surgery. We used echocardiography to estimate pulmonary and right atrial pressures and compared these with invasively measured values. Four reliable regression equations were developed to estimate systolic, diastolic, and mean pulmonary arterial pressures, and mean right atrial pressures. Cutoff values were determined to predict the occurrence of PH. Linear regression, Bland-Altman analysis, and receiver operating characteristic curve analysis were performed to assess the accuracy of echocardiography and establish diagnostic thresholds for PH. RESULTS The study involved 55 children (23 with normal pulmonary arterial pressure and 32 with PH) with acyanotic CHD aged 1 to 192 months. Four equations were developed to detect high pulmonary arterial pressures, with cutoff values of 32.9 for systolic pulmonary arterial pressure, 14.95 for diastolic pulmonary arterial pressure, and 20.7 for mean pulmonary arterial pressure. The results showed high sensitivity and moderate specificity but a tendency to underestimate systolic and mean pulmonary arterial pressures at higher pressures. CONCLUSIONS The study provides valuable insights into the use of adult-based echocardiographic formulas for estimating PH in pediatric patients with acyanotic CHD.
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Affiliation(s)
- Elaheh Malakan Rad
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran.
| | - Reza Elhamian
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Keyhan Sayadpour Zanjani
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Shabanian
- Hakim Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Ehsan Aghaei Moghadam
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Mohamad Taghi Majnoon
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
| | - Aliakbar Zeinaloo
- Department of Pediatric Cardiology, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
- Fetal and Pediatric Cardiovascular Research Center, Children's Medical Center (Pediatric Center of Excellence), Tehran University of Medical Sciences, Tehran, Iran
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Moon I, Kwak S, Kim M, Lee SP, Kim HK, Kim YJ, Park JB. Assessment of right ventricular systolic function using speckle tracking strain imaging in patients with severe tricuspid regurgitation: a validation study with cardiac magnetic resonance. J Cardiovasc Imaging 2024; 32:22. [PMID: 39113162 PMCID: PMC11304584 DOI: 10.1186/s44348-024-00015-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/11/2024] [Indexed: 08/10/2024] Open
Abstract
BACKGROUND Right ventricular (RV) systolic dysfunction is an established prognostic factor in patients with severe tricuspid regurgitation (TR). However, accurate assessment of RV systolic function using conventional echocardiography remains challenging. We investigated the accuracy of strain measurement using speckle tracking echocardiography (STE) for evaluating RV systolic function in patients with severe TR. METHODS We included consecutive patients with severe TR who underwent echocardiography and cardiac magnetic resonance imaging (CMR) within 30 days between 2011 and 2023. Two-dimensional STE was used to measure RV free wall longitudinal strain (RVFWLS) and global longitudinal strain (RVGLS). These values were compared with the RV ejection fraction (RVEF) from CMR. RV systolic dysfunction was defined as a CMR-derived RVEF < 35%. RESULTS A total of 87 patients with severe TR were identified during the study period. Among echocardiographic RV strain measurements, RVFWLS was the best correlate of CMR-derived RVEF (r = -0.37, P < 0.001), followed by RVGLS (r = -0.27, P = 0.012). Receiver operating characteristic (ROC) curve analysis revealed that RVFWLS provided better discrimination of RV systolic dysfunction, yielding an area under the ROC curve (AUC) of 0.770 (95% confidence interval [CI], 0.696-0.800) than RV fractional area change (AUC, 0.615; 95% CI, 0.500-0.859). CONCLUSIONS In patients with severe TR, STE-derived RVFWLS showed the best correlation with RVEF on CMR and displayed superior discrimination of RV systolic dysfunction compared with the RV fractional area change. This study suggests the potential usefulness of STE in assessing RV systolic function in this population.
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Affiliation(s)
- Inki Moon
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Soongu Kwak
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - MinKwan Kim
- Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
| | - Seung-Pyo Lee
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jun-Bean Park
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
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Badagliacca R, Ghio S, D'Alto M, Ameri P, Correale M, Filomena D, Raineri C, Stolfo D, Naeije R, Vizza CD. Relevance of Echocardiography-derived Phenotyping in Patients with Pulmonary Arterial Hypertension Treated with Initial Oral Combination Therapy: An Italian Pulmonary Hypertension Network (iPHNET) Study. Am J Respir Crit Care Med 2024; 210:362-365. [PMID: 38820124 DOI: 10.1164/rccm.202402-0431le] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 05/28/2024] [Indexed: 06/02/2024] Open
Affiliation(s)
- Roberto Badagliacca
- Department of Clinical, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Stefano Ghio
- Fondazione IRCCS Policlinico S Matteo, Pavia, Italy
| | - Michele D'Alto
- Department of Cardiology, Monaldi Hospital, University "L. Vanvitelli", Naples, Italy
| | - Pietro Ameri
- Cardiac, Vascular, and Thoracic Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Michele Correale
- Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Domenico Filomena
- Department of Clinical, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Claudia Raineri
- Division of Cardiology, Department of Cardiovascular and Thoracic, Molinette Hospital, Città della Salute e della Scienza, Turin, Italy
- Unit of Cardiology, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Davide Stolfo
- Cardiovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy; and
| | - Robert Naeije
- Department of Pathophysiology, Free University of Brussels, Brussels, Belgium
| | - Carmine Dario Vizza
- Department of Clinical, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Dziewięcka E, Winiarczyk M, Banyś R, Urbańczyk-Zawadzka M, Krupiński M, Mielnik M, Wiśniowska-Śmiałek S, Karabinowska-Małocha A, Leśniak-Sobelga A, Holcman K, Kostkiewicz M, Hlawaty M, Podolec P, Robak J, Kaciczak M, Baranowski F, Rubiś P. Relation between cardiac magnetic resonance-assessed interstitial fibrosis and diastolic dysfunction in heart failure due to dilated cardiomyopathy. IJC HEART & VASCULATURE 2024; 53:101426. [PMID: 38946711 PMCID: PMC11214482 DOI: 10.1016/j.ijcha.2024.101426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 05/07/2024] [Accepted: 05/09/2024] [Indexed: 07/02/2024]
Abstract
Background Dilated cardiomyopathy (DCM) is distinguished by left ventricle (LV) dilation accompanied by systolic dysfunction. However, some studies suggested also a high prevalence of LV diastolic dysfunction (LVDD), similar to a general cohort of heart failure (HF) with reduced ejection fraction (LVEF). The bulk of evidence, mostly arising from basic studies, suggests a causative link between cardiac fibrosis (CF) and LVDD. However, still, there remains a scarcity of data on LVDD and CF. Therefore, the aim of the study was to investigate the association between CF and LVDD in DCM patients. Methods The study population was composed of 102 DCM patients. Replacement CF was evaluated qualitatively (late gadolinium enhancement - LGE) and quantitively (LGE extent); interstitial cardiac fibrosis was assessed via extracellular volume (ECV). Based on echocardiography patients were divided into normal and elevated left atrial pressure (nLAP, eLAP) groups. Results 42 % of patients had eLAP. They displayed higher troponin and NT-proBNP. Both groups did not differ in terms of LGE presence and extent; however, eLAP patients had larger ECV: 30.1 ± 5.6 % vs. 27.8 ± 3.9 %, p = 0.03. Moreover, ECV itself was found to be an independent predictor of LVDD (OR = 0.901; 95 %CI 0.810-0.999; p = 0.047; normalised for LVEF and RVOT diameter). Conclusions More than two-in-five DCM patients had at least moderate LVDD. The mere presence or extent of replacement cardiac fibrosis is similar in patients with nLAP and eLAP. On the other hand, interstitial cardiac fibrosis is more pronounced in those with a higher grade of LVDD. ECV was found to be an independent predictor of LVDD in DCM.
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Affiliation(s)
- Ewa Dziewięcka
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Mateusz Winiarczyk
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Robert Banyś
- Department of Radiology, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | | | - Maciej Krupiński
- Department of Radiology, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Małgorzata Mielnik
- Department of Radiology, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Sylwia Wiśniowska-Śmiałek
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
- Department of Cardiovascular Surgery and Transplant, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Aleksandra Karabinowska-Małocha
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Agata Leśniak-Sobelga
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Katarzyna Holcman
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Magdalena Kostkiewicz
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Marta Hlawaty
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Piotr Podolec
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
| | - Jan Robak
- Students’ Scientific Group at the Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, 31-008 Krakow, Poland
| | - Monika Kaciczak
- Students’ Scientific Group at the Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, 31-008 Krakow, Poland
| | - Filip Baranowski
- Students’ Scientific Group at the Department of Cardiac and Vascular Diseases, Jagiellonian University Collegium Medicum, John Paul II Hospital, Prądnicka Street 80, 31-008 Krakow, Poland
| | - Paweł Rubiś
- Clinical Department of Cardiac and Vascular Diseases, Institute of Cardiology, Jagiellonian University Collegium Medicum, Cracow, Swietej Anny Street 12, Cracow, Poland
- Department of Cardiac and Vascular Diseases, Saint John Paul II Hospital in Cracow, Prądnicka Street 80, 31-202 Cracow, Poland
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8
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Onishi H, Izumo M, Watanabe Y, Okutsu M, Hozawa K, Shoji T, Sato Y, Kuwata S, Akashi YJ. Prognostic value of extraaortic-valvular cardiac damage in patients with moderate aortic stenosis and reduced left ventricular ejection fraction. Echocardiography 2024; 41:e15892. [PMID: 39023286 DOI: 10.1111/echo.15892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 06/26/2024] [Accepted: 07/07/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE The extraaortic-valvular cardiac damage (EVCD) Stage has shown potential for risk stratification for patients with aortic stenosis (AS). This study aimed to examine the usefulness of the EVCD Stage in risk stratification of patients with moderate AS and reduced left ventricular ejection fraction (LVEF). METHODS Clinical data from patients with moderate AS (aortic valve area, .60-.85 cm2/m2; peak aortic valve velocity, 2.0-4.0 m/s) and reduced LVEF (LVEF 20%-50%) were analyzed during 2010-2019. Patients were categorized into three groups: EVCD Stages 1 (LV damage), 2 (left atrium and/or mitral valve damage), and 3/4 (pulmonary artery vasculature and/or tricuspid valve damage or right ventricular damage). The primary endpoint included a composite of cardiac death and heart failure hospitalization, with non-cardiac death as a competing risk. RESULTS The study included 130 patients (mean age 76.4 ± 6.8 years; 62.3% men). They were categorized into three groups: 26 (20.0%) in EVCD Stage 1, 66 (50.8%) in Stage 2, and 48 (29.2%) in Stage 3/4. The endpoint occurred in 54 (41.5%) patients during a median follow-up of 3.2 years (interquartile range, 1.4-5.1). Multivariate analysis indicated EVCD Stage 3/4 was significantly associated with the endpoint (hazard ratio 2.784; 95% confidence interval 1.197-6.476; P = .017) compared to Stage 1, while Stage 2 did not (hazard ratio 1.340; 95% confidence interval .577-3.115; P = .500). CONCLUSION The EVCD staging system may aid in the risk stratification of patients with moderate AS and reduced LVEF.
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Affiliation(s)
- Hirokazu Onishi
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Masaaki Okutsu
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Koji Hozawa
- Department of Cardiology, New Tokyo Hospital, Chiba, Japan
| | - Tatsuro Shoji
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yukio Sato
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Shingo Kuwata
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Yoshihiro J Akashi
- Department of Cardiology, St. Marianna University School of Medicine, Kanagawa, Japan
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9
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Maccallini M, Barge-Caballero G, Barge-Caballero E, López-Pérez M, Bilbao-Quesada R, González-Babarro E, Gómez-Otero I, López-López A, Gutiérrez-Feijoo M, Varela-Román A, García-Seara J, Bouzas-Mosquera A, Crespo-Leiro MG. Prognostic value of the tricuspid annular plane systolic excursion/systolic pulmonary artery pressure ratio in cardiac amyloidosis. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:634-644. [PMID: 38296161 DOI: 10.1016/j.rec.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/05/2024] [Indexed: 02/19/2024]
Abstract
INTRODUCTION AND OBJECTIVES The tricuspid annular plane systolic excursion/systolic pulmonary artery pressure (TAPSE/SPAP) ratio is a noninvasive surrogate of right ventricular to pulmonary circulation that has prognostic implications in patients with heart failure (HF) or pulmonary hypertension. Our purpose was to evaluate the prognostic value of the TAPSE/SPAP ratio in patients with cardiac amyloidosis. METHODS We used the database of the AMIGAL study, a prospective, observational registry of patients with cardiac amyloidosis recruited in 7 hospitals of the Autonomous Community of Galicia, Spain, from January 1, 2018 to October 31, 2022. We selected patients whose baseline TAPSE/SPAP ratio was calculated with transthoracic echocardiography. Long-term survival and survival free of HF hospitalization were assessed by means of 5 different multivariable Cox regression models. Median follow-up was 680 days. RESULTS We studied 233 patients with cardiac amyloidosis, among whom 209 (89.7%) had transthyretin type. The baseline TAPSE/SPAP ratio correlated significantly with clinical outcomes. Depending on the multivariable model considered, the adjusted hazard ratios estimated per 0.1mm/mmHg increase of baseline TAPSE/SPAP ratio ranged from 0.76 to 0.84 for all-cause mortality. Similarly, the ratios for all-cause mortality of HF hospitalization ranged from 0.79 to 0.84. The addition of the baseline TAPSE/SPAP ratio to the predictive model of the United Kingdom National Amyloidosis Centre resulted in an increase in Harrell's c-statistic from 0.662 to 0.705 for all-cause mortality and from 0.668 to 0.707 for all-cause mortality or HF hospitalization. CONCLUSIONS Reduced TAPSE/SPAP ratio is an independent adverse prognostic marker in patients with cardiac amyloidosis.
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Affiliation(s)
- Marta Maccallini
- Department of Internal Medicine, IRCCS Humanitas Research Hospital, Milan, Italy
| | - Gonzalo Barge-Caballero
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Eduardo Barge-Caballero
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Manuel López-Pérez
- Servicio de Cardiología, Complexo Hospitalario Universitario de Ferrol (CHUF), Servicio Galego de Saúde (SERGAS), Ferrol, A Coruña, Spain
| | - Raquel Bilbao-Quesada
- Servicio de Cardiología, Complexo Hospitalario Universitario de Vigo (CHUVI), Servicio Galego de Saúde (SERGAS), Vigo, Pontevedra, Spain
| | - Eva González-Babarro
- Servicio de Cardiología, Complexo Hospitalario Universitario de Pontevedra (CHOP), Servicio Galego de Saúde (SERGAS), Pontevedra, Spain
| | - Inés Gómez-Otero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Andrea López-López
- Servicio de Cardiología, Hospital Universitario Lucus Augusti (HULA), Servicio Galego de Saúde (SERGAS), Lugo, Spain
| | - Mario Gutiérrez-Feijoo
- Servicio de Cardiología, Complexo Hospitalario Universitario de Ourense (CHUOU), Servicio Galego de Saúde (SERGAS), Ourense, Spain
| | - Alfonso Varela-Román
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Javier García-Seara
- Servicio de Cardiología, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servicio Galego de Saúde (SERGAS), Santiago de Compostela, A Coruña, Spain
| | - Alberto Bouzas-Mosquera
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - María G Crespo-Leiro
- Servicio de Cardiología, Complexo Hospitalario Universitario A Coruña (CHUAC), Instituto de Investigación Biomédica de A Coruña (INIBIC), Servicio Galego de Saúde (SERGAS), A Coruña, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
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10
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Papolos AI, Kenigsberg BB, Austin DR, Barnett CF. Management of the peri-intubation period in patients with pulmonary arterial hypertension and respiratory failure. Curr Cardiol Rep 2024; 26:815-820. [PMID: 38913233 DOI: 10.1007/s11886-024-02081-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/25/2024]
Abstract
PURPOSE OF REVIEW The endotracheal intubation of patients with pulmonary arterial hypertension (PAH) in respiratory distress is a highly morbid procedure that can precipitate hemodynamic collapse. Here we review our strategy for confronting this difficult clinical situation. RECENT FINDINGS There are no clinical trials that explore best practices in the management of patients with PAH and respiratory failure. Here we provide a practical approach to respiratory support, inopressor and pulmonary vasodilator selection, hemodynamic considerations, point-of-care ultrasound monitoring, and endotracheal intubation in patients with PAH in respiratory failure.
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Affiliation(s)
- Alexander I Papolos
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC, USA.
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
| | - Benjamin B Kenigsberg
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC, USA
- Division of Cardiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Daniel R Austin
- Department of Critical Care, MedStar Washington Hospital Center, Washington, DC, USA
- Department of Anesthesiology, MedStar Washington Hospital Center, Washington, DC, USA
| | - Christopher F Barnett
- Division of Cardiology, University of California-San Francisco School of Medicine, San Francisco, CA, USA
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11
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Denault A, Couture EJ, Perry T, Saade E, Calderone A, Zeng YH, Scherb D, Moses K, Potes C, Hammoud A, Beaubien-Souligny W, Elmi-Sarabi M, Grønlykke L, Lamarche Y, Lebon JS, Rousseau-Saine N, Desjardins G, Rochon A. Continuous Right Ventricular Pressure Monitoring in Cardiac Surgery. J Cardiothorac Vasc Anesth 2024; 38:1673-1682. [PMID: 38862285 DOI: 10.1053/j.jvca.2024.04.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/10/2024] [Accepted: 04/19/2024] [Indexed: 06/13/2024]
Abstract
OBJECTIVE Right ventricular (RV) dysfunction in cardiac surgery can lead to RV failure, which is associated with increased morbidity and mortality. Abnormal RV function can be identified using RV pressure monitoring. The primary objective of the study is to determine the proportion of patients with abnormal RV early to end-diastole diastolic pressure gradient (RVDPG) and abnormal RV end-diastolic pressure (RVEDP) before initiation and after cardiopulmonary bypass (CPB) separation. The secondary objective is to evaluate if RVDPG before CPB initiation is associated with difficult and complex separation from CPB, RV dysfunction, and failure at the end of cardiac surgery. DESIGN Prospective study. SETTING Tertiary care cardiac institute. PARTICIPANTS Cardiac surgical patients. INTERVENTION Cardiac surgery. MEASUREMENTS AND MAIN RESULTS Automated electronic quantification of RVDPG and RVEDP were obtained. Hemodynamic measurements were correlated with cardiac and extracardiac parameters from transesophageal echocardiography and postoperative complications. Abnormal RVDPG was present in 80% of the patients (n = 105) at baseline, with a mean RVEDP of 14.2 ± 3.9 mmHg. Patients experienced an RVDPG > 4 mmHg for a median duration of 50.2% of the intraoperative period before CPB initiation and 60.6% after CPB separation. A total of 46 (43.8%) patients had difficult/complex separation from CPB, 18 (38.3%) patients had RV dysfunction, and 8 (17%) had RV failure. Abnormal RVDPG before CPB was not associated with postoperative outcome. CONCLUSION Elevated RVDPG and RVEDP are common in cardiac surgery. RVDPG and RVEDP before CPB initiation are not associated with RV dysfunction and failure but can be used to diagnose them.
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Affiliation(s)
- André Denault
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada.
| | - Etienne J Couture
- Department of Anesthesiology, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Quebec City, Quebec, Canada
| | - Tjorvi Perry
- Department of Anesthesiology, University of Minnesota, Minneapolis, MN, USA
| | - Elena Saade
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Alexander Calderone
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Yu Hao Zeng
- Departments of Medicine and of Family Medicine, Jewish General Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | | | | | - Ali Hammoud
- Division of Critical Care, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | | | - Mahsa Elmi-Sarabi
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Lars Grønlykke
- Department of Cardiothoracic Anaesthesiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Yoan Lamarche
- Department of Cardiothoracic Surgery, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Jean-Sébastien Lebon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Nicolas Rousseau-Saine
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Georges Desjardins
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
| | - Antoine Rochon
- Department of Anesthesiology, Montreal Heart Institute, Université de Montréal, Montreal, Quebec, Canada
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12
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Harada D, Noto T, Takagawa J. Multifaced risk factors and clinical impact of a deep Y descent in patients with heart failure irrespective of RV-PA coupling. IJC HEART & VASCULATURE 2024; 53:101439. [PMID: 38939016 PMCID: PMC11209010 DOI: 10.1016/j.ijcha.2024.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 05/21/2024] [Accepted: 06/01/2024] [Indexed: 06/29/2024]
Abstract
Background A deep Y descent in the jugular venous pulse (JVP) is associated with diseases such as a decrease in right ventricular (RV) preload reserve. The present study investigated the relationship between RV-pulmonary arterial (PA) coupling and a deep Y descent, examined risk factors for a deep Y descent and clarified whether a deep Y descent was an independent risk factor for cardiac events irrespective of RV-PA coupling in patients with heart failure (HF). Methods We enrolled 350 patients with HF who underwent echocardiography and JVP examination. A deep Y descent was identified by a deeper 'Y' descent than 'X' descent in the JVP waveform. We defined cardiac events of HF as follows: sudden death, death from HF, the emergent infusion of loop diuretics, or hospitalization for decompensated HF. Results and Conclusions A deep Y descent and cardiac events were observed in 129 and 83 patients, respectively. The prevalence of a deep Y descent increased with decreases in the tricuspid annular plane systolic excursion (TAPSE)/systolic pulmonary arterial pressure (SPAP) ratio. Not only the TAPSE/SPAP ratio (odds ratio,0.756 per0.1 mm/mmHg, 95 %confidence interval [CI], 0.660-0.866, p < 0.001), but also age, atrial fibrillation, and the use of beta-blockers were independent factors for a deep Y descent in multivariate logistic model. Multivariate Cox hazard model demonstrated that a deep Y descent was for cardiac events in patients with HF (Hazard ratio,2.682, 95 %CI, 1.599-4.497, p < 0.001) irrespective of the TAPSE/SPAP ratio. The development of therapeutic strategies based on central venous waveform may be needed for patients with HF.
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Affiliation(s)
- Daisuke Harada
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Takahisa Noto
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
| | - Junya Takagawa
- The Cardiology Division, Imizu Municipal Hospital, Toyama, Japan
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13
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Anwer S, Stollenwerk L, Winkler NE, Guastafierro F, Hebeisen M, Akdis D, Saguner AM, Brunckhorst C, Duru F, Tanner FC. Right heart strain in arrhythmogenic right ventricular cardiomyopathy: implications for cardiovascular outcome. Eur Heart J Cardiovasc Imaging 2024; 25:1061-1068. [PMID: 38683812 PMCID: PMC11288757 DOI: 10.1093/ehjci/jeae117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 03/29/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
AIMS Arrhythmogenic right ventricular cardiomyopathy (ARVC) is characterized by progressive myocardial dysfunction and associated with an increased risk of major cardiovascular (CV) events. To determine right heart strain (ventricular and atrial global longitudinal strain (RVGLS and RAGLS) in patients with definite ARVC and its association with adverse events during follow-up. METHODS AND RESULTS RVGLS and RAGLS were analysed in focused right heart apical views from 70 patients using TomTec ImageArena and association with a composite endpoint was determined (sustained ventricular arrhythmia and cardiovascular death). Over a median follow-up duration of 4.9 years, 26 (37%) patients met the endpoint. RVGLS was significantly impaired in the event group (-11.5 [-13.3 to -10.2] %) vs. the no-event group (-15.8 [-17.1 to -14.5] %, P < 0.001), and so was RAGLS (22.8 [21.4-27.4] % vs. 31.5 [25.1-39.6] %, respectively, P < 0.001). In Cox regression, RVGLS (HR 1.36, P < 0.001) and RAGLS (HR 0.92, P = 0.002) were associated with a higher risk of adverse events. In multivariable Cox regression models, RVGLS and RAGLS remained independent of and were incremental to age, gender, and conventional RV parameters, and model fitness was improved when RVGLS and RAGLS were applied together rather than alone. CONCLUSION RVGLS and RAGLS are more impaired in patients with adverse events and associated with adverse events independent of age, gender, and conventional RV parameters. When RVGLS and RAGLS are applied together, prediction models are improved suggesting that right heart strain may form part of the echocardiographic routine protocol in patients with ARVC.
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Affiliation(s)
- Shehab Anwer
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Lauren Stollenwerk
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Department of Cardiology, Bern University Hospital, Bern, Switzerland
| | - Neria E Winkler
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Francesca Guastafierro
- Humanitas Research Hospital, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | - Monika Hebeisen
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Deniz Akdis
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
- Division of Cardiology, GZO Zurich Regional Health Center Wetzikon, Wetzikon, Switzerland
| | - Ardan M Saguner
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Corinna Brunckhorst
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Firat Duru
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
| | - Felix C Tanner
- Department of Cardiology, University Heart Center, University Hospital Zürich and University of Zürich, Raemistrasse 100, 8091 Zürich, Switzerland
- Center for Translational and Experimental Cardiology (CTEC), University Hospital Zürich and University of Zürich, Wagistrasse 12, 8952 Schlieren, Zürich, Switzerland
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14
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Burgos LM, Vila RCB, Ballari FN, Goyeneche A, Costabel JP, Muñoz F, Spaccavento A, Fasan MA, Suárez LL, Vivas M, Riznyk L, Ghibaudo S, Trivi M, Ronderos R, Botto F, Diez M. Inferior vena CAVA and Lung UltraSound-guided therapy in Acute Heart Failure: a randomized pilot study (CAVAL US-AHF study). Am Heart J 2024:S0002-8703(24)00181-9. [PMID: 39094839 DOI: 10.1016/j.ahj.2024.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The optimal assessment of systemic and lung decongestion during acute heart failure is not clearly defined. We evaluated whether inferior vena cava (IVC) and pulmonary ultrasound (CAVAL US) guided therapy is superior to standard care in reducing subclinical congestion at discharge in patients with AHF. METHODS CAVAL US-AHF was an investigator-initiated, single-center, single-blind, randomized controlled trial. A daily quantitative ultrasound protocol using the 8-zone method was used and treatment was adjusted according to an algorithm. The primary endpoint was the presence of more than five B-lines and/or an increase in IVC diameter and collapsibility at discharge. And secondary endpoint exploratory outcome was the composite of readmission for HF, unplanned visit for worsening HF or death at 90 days RESULTS: Sixty patients were randomized to CAVAL US (n=30) or control (n=30). The primary endpoint was achieved in 4 patients (13.3%) in the CAVAL US group and 20 patients (66.6%) in the control group (p<0.001). A significant reduction in HF readmission, unplanned visit for worsening HF or death at 90 days was seen in the CAVAL US group (13.3% vs 36.7%; log rank p=0.038). Other endpoints such as NT-proBNP reduction at discharge showed a non-statistically significant reduction in the CAVAL US group (48% IQR 27-67 vs 37% -3-59;p=0.09). Safety outcomes were similar in both groups. CONCLUSION IVC and lung ultrasound-guided therapy in AHF patients significantly reduced subclinical congestion at discharge. CAVAL US-AHF provides preliminary evidence for the potential use of a simple technique to guide decongestive therapy during hospitalization for AHF, which may reduce the composite outcome at 90 days.
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Affiliation(s)
- Lucrecia María Burgos
- Heart failure, pulmonary hypertension and heart transplant division, Instituto Cardiovascular de Buenos Aires, Argentina.
| | - Rocio Consuelo Baro Vila
- Heart failure, pulmonary hypertension and heart transplant division, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Franco Nicolás Ballari
- Heart failure, pulmonary hypertension and heart transplant division, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Ailin Goyeneche
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Juan Pablo Costabel
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Florencia Muñoz
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Ana Spaccavento
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Martín Andrés Fasan
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | | | - Martin Vivas
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Laura Riznyk
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Sebastian Ghibaudo
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Marcelo Trivi
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Ricardo Ronderos
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Fernando Botto
- Clinical cardiology department, Instituto Cardiovascular de Buenos Aires, Argentina
| | - Mirta Diez
- Heart failure, pulmonary hypertension and heart transplant division, Instituto Cardiovascular de Buenos Aires, Argentina
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15
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Guler Y, Karagoz A, Inan D, Sonsoz MR, Bilen MN, Guler A, Kirma C. Quantitative Analysis of Right Atrial Functions by 2D-Speckle Tracking Echocardiography During Healthy Pregnancy. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2024. [PMID: 39078062 DOI: 10.1002/jum.16537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 06/26/2024] [Accepted: 07/14/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND The role of speckle tracking in the assessment of right atrial (RA) deformation parameters has not been investigated yet. The purpose of this article is to establish the effects of normal pregnancy on RA mechanical changes obtained by 2-dimensional speckle-tracking echocardiography. METHODOLOGY A total of 49 healthy pregnant women were included in the study. All participants were followed for each trimester and postpartum period, encompassing standard assessments of both RA and ventricular functions, as well as measurements of RA global peak atrial longitudinal strain (RA-Global-PALS) and RA global peak atrial contraction strain (RA-Global-PACS). Additionally, the RA segments were individually evaluated with respect to strain parameters. RESULTS During pregnancy, the increased volume load resulted in elevated RA reservoir function, as indicated by RA-Global-PALS, and increased contraction parameter, as indicated by RA-Global-PACS. These changes were within physiological limits and reversible. Segmental analysis of the right atrium showed similar findings for regional PACS and PALS parameters. CONCLUSION In this study, we established normal RA deformation parameters for healthy pregnancies. These data will aid in discerning various measures of RA phasic function in cardiovascular and systemic conditions among normal pregnant women. Moreover, they may offer insights into potential cardiac pathologies that may arise during the pregnancy.
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Affiliation(s)
- Yeliz Guler
- Department of Cardiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ali Karagoz
- Department of Cardiology, Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
| | - Duygu Inan
- Department of Cardiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet R Sonsoz
- Department of Cardiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Mehmet N Bilen
- Department of Cardiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Ahmet Guler
- Department of Cardiology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Cevat Kirma
- Department of Cardiology, Koşuyolu Heart Training and Research Hospital, Istanbul, Turkey
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16
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Egbe AC, Miranda WR, Jain CC, Burchill LJ, Young KA, Rose CH, Karnakoti S, Ahmed MH, Connolly HM. Cardiac remodelling during pregnancy in women with congenital heart disease and systemic left ventricle. Eur Heart J Cardiovasc Imaging 2024:jeae173. [PMID: 39073413 DOI: 10.1093/ehjci/jeae173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 07/30/2024] Open
Abstract
AIMS Women with congenital heart disease (CHD) are at risk of pregnancy-related adverse outcomes (PRAO). The purpose of this study was to assess temporal changes in cardiac structure and function (cardiac remodelling) during pregnancy, and the association with PRAO in women with CHD. METHODS AND RESULTS Retrospective study of pregnant women with CHD and serial echocardiograms (2003-2021). Cardiac structure and function were assessed at pre-specified time points: prepregnancy, early pregnancy, late pregnancy, and postnatal period. PRAO was defined as the composite of maternal cardiovascular, obstetric, and neonatal complications. The study comprised 81 women with CHD (age, 29 ± 5 years). Compared to the baseline echocardiogram, there was a relative increase in right ventricular systolic pressure (RVSP) (relative change 13 ± 5%, P < 0.001, in early pregnancy; and 18 ± 5%, P < 0.001, in late pregnancy). There was a relative decrease in right ventricle free wall strain (RVFWS) (relative change -11 ± 3%, P < 0.001, in late pregnancy; and -11 ± 4%, P = 0.003, in postnatal period), and a relative decrease in RVFWS/RVSP (relative change, -10 ± 5%, P = 0.02 in early pregnancy, -26 ± 7%, P < 0.001, in late pregnancy, and -14 ± 5%, P < 0.001, in postnatal period). Baseline right ventricular to pulmonary arterial (RV-PA) coupling, and temporal change in RV-PA coupling were associated with PRAO, after adjustment for maternal age and severity of cardiovascular disease. CONCLUSION Women with CHD had a temporal decrease in RV systolic function and RV-PA coupling, and these changes were associated with PRAO. Further studies are required to delineate the aetiology of deterioration in RV-PA coupling during pregnancy, and the long-term implications of right heart dysfunction observed in the postnatal period.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Luke J Burchill
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Kathleen A Young
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Carl H Rose
- Department of Obstetrics and Gynaecology, Mayo Clinic Rochester, Rochester, MN 55905, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Marwan H Ahmed
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Mayo Clinic and Foundation, 200 First Street SW, Rochester, MN 55905, USA
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17
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Torres Macho J, Duffot Falcó M. Ultrasound assessment of the inferior vena cava in heart failure. Med Clin (Barc) 2024; 163:78-80. [PMID: 38580571 DOI: 10.1016/j.medcli.2024.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/24/2024] [Accepted: 01/26/2024] [Indexed: 04/07/2024]
Affiliation(s)
- Juan Torres Macho
- Unidad de Ecografía Clínica, Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España.
| | - Mercedes Duffot Falcó
- Unidad de Ecografía Clínica, Servicio de Medicina Interna, Hospital Universitario Infanta Leonor-Virgen de La Torre, Madrid, España; Departamento de Medicina, Facultad de Medicina, Universidad Complutense, Madrid, España
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18
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Zhai Y, Li A, Tao X, Gao Q, Xie W, Zhang Y, Chen A, Wang C, Lei J, Ding S, Cai Y, Zhai Z. Predicting high-risk pre-capillary pulmonary hypertension: an echocardiographic multiparameter scoring index. BMC Cardiovasc Disord 2024; 24:384. [PMID: 39054410 PMCID: PMC11271058 DOI: 10.1186/s12872-024-04053-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2024] [Accepted: 07/16/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND The risk stratification of pulmonary arterial hypertension proposed by the European Society of Cardiology /European Respiratory Society guidelines in 2015 and 2022 included two to three echocardiographic indicators. However, the specific value of echocardiography in risk stratification of pre-capillary pulmonary hypertension (pcPH) has not been efficiently demonstrated. Given the complex geometry of the right ventricular (RV) and influencing factors of echocardiographic parameter, there is no single echocardiographic parameter that reliably informs about PH status. We hypothesize that a multi-parameter comprehensive index can more accurately evaluate the severity of the pcPH. The purpose of this study was to develop and validate an echocardiographic risk score model to better assist clinical identifying high risk of pcPH during initial diagnosis and follow-up. METHODS We studied 197 consecutive patients with pcPH. A multivariable echocardiographic model was constructed to predict the high risk of pcPH in the training set. Points were assigned to significant risk factors in the final model based on β-coefficients. We validated the model internally and externally. RESULTS The echocardiographic score was constructed by multivariable logistic regression, which showed that pericardial effusion, right atrial (RA) area, RV outflow tract proximal diameter (RVOT-Prox), the velocity time integral of the right ventricular outflow tract (TVIRVOT) and S' were predictors of high risk of pcPH. The area under curve (AUC) of the training set of the scoring model was 0.882 (95%CI: 0.809-0.956, p < 0.0001). External validation was tested in a test dataset of 77 patients. The AUC of the external validation set was 0.852. A 10-point score risk score was generated, with scores ranging from 0 to 10 in the training cohort. The estimate risk of high risk of pcPH ranged from 25.1 to 94.6%. CONCLUSIONS The echocardiographic risk score using five echocardiographic parameters could be comprehensive and useful to predict the high risk of pcPH for initial assessment and follow-up.
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Affiliation(s)
- Yanan Zhai
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
| | - Aili Li
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China.
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China.
- National Clinical Research Center for Respiratory Diseases, Beijing, China.
| | - Xincao Tao
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Qian Gao
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Wanmu Xie
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
| | - Yu Zhang
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Aihong Chen
- Department of Cardiology, China-Japan Friendship Hospital, No. 2, East Yinghua Road, Chaoyang District, Beijing, 100029, China
| | - Chi Wang
- Heart Health Research Center, Beijing, China
| | - Jieping Lei
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Data and Project Management Unit, Institute of Clinical Medical Sciences, China-Japan Friendship Hospital, Beijing, China
| | - Shangwei Ding
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Yantong Cai
- Department of Ultrasound, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
| | - Zhenguo Zhai
- Institute of Respiratory Medicine, Chinese Academy of Medical Sciences, Beijing, China
- National Clinical Research Center for Respiratory Diseases, Beijing, China
- Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China
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19
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Cacioli G, Ciabatti M, Cristiano E, Notari C, Papisca I, Distefano G, Menafra G, Monica PLD, Feccia MA, Pergolini A, Maestrini V, Sbaraglia F, Ranocchi F, Musumeci F. Myocardial Work by Speckle-Tracking Echocardiography in Heart Transplant Recipients: Association Between Global Work Efficiency and Coronary Allograft Vasculopathy. Am J Cardiol 2024:S0002-9149(24)00551-4. [PMID: 39053724 DOI: 10.1016/j.amjcard.2024.07.023] [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] [Received: 05/08/2024] [Revised: 06/15/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
Coronary allograft vasculopathy (CAV) is a leading cause of morbidity and mortality after heart transplantation. CAV is often diagnosed in later stages or during routine screening in asymptomatic subjects. Myocardial work (MW), calculated using left ventricular global longitudinal strain (LV-GLS) and systemic blood pressure, may be associated with the presence of CAV and outperform conventional echocardiographic parameters. In this retrospective observational study, heart transplant recipients who underwent regular follow-up at our institution between May 2022 and September 2023 were enrolled. All included patients underwent speckle-tracking echocardiography, including MW indexes. CAV was classified according to invasive coronary angiography or computed tomography performed within 12 months of index echocardiography. We collected all available clinical and echocardiographic parameters and evaluated the potential association with CAV. CAV was detected in 29 of 93 patients (31%) (CAV+). Of the MW indexes, the mean global work efficiency (GWE) was 90 ± 6% and was significantly lower in CAV+ than CAV- subjects (86 ± 7% vs 91 ± 4%, p <0.001). GWE (OR 0.86, CI 0.77 to 0.94, p = 0.002), E/e' ratio (OR 1.27, CI 1.08 to 1.52, p = 0.006), and left ventricular ejection fraction (OR 0.90; CI 0.81 to 0.98, p = 0.017) were independently associated with the presence of CAV. GWE (GWE vs LV-GLS, delta area under the curve 0.154, p = 0.047) and the proposed model (GWE+E/e' vs LV-GLS, delta area under the curve 0.198, p = 0.004) were significantly superior in stratifying the incremental risk for CAV compared with LV-GLS. In conclusion, GWE was observed to be independently associated with the presence of CAV. MW could represent a novel noninvasive screening method for CAV in heart transplant recipients. Larger and prospective studies are needed to confirm this hypothesis.
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Affiliation(s)
- Giulio Cacioli
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy.
| | | | - Ernesto Cristiano
- Department of Electrophysiology, Humanitas Gavazzeni, Bergamo, Italy
| | - Claudia Notari
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Ilaria Papisca
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Giada Distefano
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Giovanni Menafra
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Paola Lilla Della Monica
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Mariano Antonio Feccia
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Amedeo Pergolini
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Sbaraglia
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Federico Ranocchi
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
| | - Francesco Musumeci
- Cardiac Surgery and Heart Transplant Unit, Azienda Ospedaliera San Camillo Forlanini, Roma, Italy
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20
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Liang S, Chen S, Bai Y, Ma M, Shi F, Huang L, Wang H, Xia C, Diao K, He Y. Interventricular septum involvement is related to right ventricular dysfunction in anterior STEMI patients without right ventricular infarction: a cardiovascular magnetic resonance study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03166-z. [PMID: 39039380 DOI: 10.1007/s10554-024-03166-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 06/14/2024] [Indexed: 07/24/2024]
Abstract
The value of cardiovascular magnetic resonance (CMR) in assessing and predicting acute right ventricular (RV) dysfunction in patients with anterior ST-segment elevation myocardial infarction (STEMI) remains ascertained. Eighty eight patients with anterior STEMI were prospectively recruited and underwent CMR examinations within one week following the coronary intervention. Patients with RV ejection fraction (RVEF) less than 2 standard deviations below the average at the center (RVEF ≤ 45.0%) were defined as having RV dysfunction. The size of infarction, segmental wall motion, and T1 and T2 mapping values of global myocardium and the interventricular septum (IVS) were measured. Predictive performance was calculated using receiver-operating characteristic curve analysis and logistic regression test. Twenty two patients presented with RV dysfunction. The RV dysfunction group had a larger IVS infarct extent (54.28 ± 10.35 vs 33.95 ± 15.09%, P < 0.001) and lower left ventricle stroke volume index (33.93 ± 7.96 vs 42.46 ± 8.14 ml/m2, P < 0.001) compared to the non-RV dysfunction group. IVS infarct extent at 48.8% best predicted the presence of RV dysfunction with an area under the curve of 0.864. Left ventricular stroke volume index (LVSVI) and IVS infarct extent were selected by stepwise multivariable logistic regression analysis. Lower LVSVI (odds ratio [OR] 0.90; 95% confidence interval [CI], 0.79 to 0.99; P = 0.044) and higher IVS infarct extent (OR 1.16; 95% CI 1.05 to 1.33; P = 0.01) were found to be independent predictors for RV dysfunction. In patients with anterior STEMI, those with larger IVS infarct extent and worse LV function are more likely to be associated with RV dysfunction.
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Affiliation(s)
- Shichu Liang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Shi Chen
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Yanlin Bai
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Min Ma
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Fanfan Shi
- Department of Clinical Research and Management, Center of Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Litao Huang
- Department of Clinical Research and Management, Center of Biostatistics, Design, Measurement and Evaluation (CBDME), West China Hospital, Sichuan University, Chengdu, China
| | - Hua Wang
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Chunchao Xia
- Department of Radiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China
| | - Kaiyue Diao
- Department of Radiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China.
| | - Yong He
- Department of Cardiology, West China Hospital, Sichuan University, No.37 GuoXue Alley, Chengdu, 610041, China.
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21
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Anastasiou V, Peteinidou E, Tountas C, Daios S, Moysidis DV, Fardoulis E, Gogos C, Theodorakopoulou M, Iatridi F, Sarafidis P, Giannakoulas G, Karamitsos T, Delgado V, Ziakas A, Kamperidis V. Right Ventricular and Right Atrial Strain Are Associated with Kidney Dysfunction in Acute Heart Failure. Diagnostics (Basel) 2024; 14:1576. [PMID: 39061713 PMCID: PMC11275611 DOI: 10.3390/diagnostics14141576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2024] [Revised: 07/14/2024] [Accepted: 07/16/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND In acute heart failure (HF), low cardiac output and venous congestion are pathophysiological mechanisms that contribute to renal function impairment. This study investigated the association between advanced echocardiographic measures of right ventricular and atrial function and renal impairment in patients with acute HF. METHODS AND RESULTS A total of 377 patients hospitalized for acute HF were prospectively evaluated. Estimated glomerular filtration rate (eGFR) on admission was measured using the 2021 Chronic Kidney Disease Epidemiology Collaboration creatinine equation. Advanced echocardiographic assessment was performed on admission. Patients with eGFR < 45 mL/min/1.73 m2 were more likely to have chronic heart failure, chronic atrial fibrillation, and type 2 diabetes mellitus compared to patients with eGFR ≥ 45 mL/min/1.73 m2. Patients with lower eGFR had lower cardiac output, higher mean E/e' ratio, larger right ventricular (RV) size, worse RV free wall longitudinal strain, more impaired right atrial (RA) reservoir strain, and more frequent severe tricuspid regurgitation. RV free wall longitudinal strain and RA reservoir strain were the only independent echocardiographic associates of low eGFR, whereas cardiac output was not. CONCLUSIONS Impaired RV and RA longitudinal strain were independently associated with eGFR < 45 mL/min/1.73 m2 in acute HF, while reduced cardiac output was not. This suggests that RV and RA dysfunction underlying venous congestion and increased renal afterload are more important pathophysiological determinants of renal impairment in acute HF than reduced cardiac output.
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Affiliation(s)
- Vasileios Anastasiou
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Emmanouela Peteinidou
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Christos Tountas
- Cardiology Department, Sismanoglio Hospital, 151 26 Athens, Greece;
| | - Stylianos Daios
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | | | - Emmanouil Fardoulis
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Christos Gogos
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Marieta Theodorakopoulou
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 546 42 Thessaloniki, Greece; (M.T.); (F.I.); (P.S.)
| | - Fotini Iatridi
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 546 42 Thessaloniki, Greece; (M.T.); (F.I.); (P.S.)
| | - Pantelis Sarafidis
- Department of Nephrology, School of Medicine, Aristotle University of Thessaloniki, Hippokration Hospital, 546 42 Thessaloniki, Greece; (M.T.); (F.I.); (P.S.)
| | - George Giannakoulas
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Theodoros Karamitsos
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Victoria Delgado
- Department of Cardiology, Hospital University Germans Triasi Pujol, 08916 Barcelona, Spain;
| | - Antonios Ziakas
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
| | - Vasileios Kamperidis
- 1st Department of Cardiology, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, AHEPA Hospital, St. Kiriakidi 1, 546 36 Thessaloniki, Greece; (V.A.); (E.P.); (S.D.); (E.F.); (C.G.); (G.G.); (T.K.); (A.Z.)
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22
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Naddaf N, Dianati Maleki N, Goldschmidt ME, Kalogeropoulos AP. Point of Care Ultrasound (POCUS) in the Management of Heart Failure: A Narrative Review. J Pers Med 2024; 14:766. [PMID: 39064020 PMCID: PMC11277924 DOI: 10.3390/jpm14070766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 07/08/2024] [Accepted: 07/10/2024] [Indexed: 07/28/2024] Open
Abstract
Assessing for volume overload is a key component of both short and long-term management of heart failure patients. Physical examination findings are neither sensitive nor specific for detecting congestion, and subclinical congestion may not be evident at the time of examination. Point of care ultrasound (POCUS) is an efficient and non-invasive way to assess heart failure patients for volume overload. The aim of our narrative review is to summarize how each of the following ultrasound modalities can be used to assess for congestion in the heart failure population: 2D and Doppler echocardiography, lung ultrasound, inferior vena cava ultrasound, internal jugular vein ultrasound, and venous excess grading. While each of these modalities has their limitations, their use in the acute and outpatient space offers the potential to reduce heart failure readmissions and mortality.
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Affiliation(s)
| | | | | | - Andreas P. Kalogeropoulos
- Division of Cardiology, Department of Medicine, Stony Brook Renaissance School of Medicine, Stony Brook, NY 11794, USA; (N.N.); (N.D.M.); (M.E.G.)
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23
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Segev A, Avrahamy B, Fardman A, Matetzky S, Freimark D, Regev O, Kuperstein R, Grupper A. Heart failure with improved ejection fraction: patient characteristics, clinical outcomes and predictors for improvement. Front Cardiovasc Med 2024; 11:1378955. [PMID: 39087071 PMCID: PMC11288926 DOI: 10.3389/fcvm.2024.1378955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 07/02/2024] [Indexed: 08/02/2024] Open
Abstract
Background Heart failure with improved ejection fraction (HFimpEF) is a recently recognized entity presenting a diagnostic and therapeutic challenge. Our aim was to characterize the profile of HFimpEF patients and evaluate predictors for EF lack of improvement among heart failure with reduced ejection fraction (HFrEF) patients. Methods We included ambulatory HFrEF patients (EF≤40%) between January 1, 2015, and September 1, 2022, with two consecutive echocardiography exams at least 6 months apart. HFimpEF was defined as improved EF from ≤40%->40% and by ≥10%. Results A total of 567 HFrEF patients (72% male, 54.3 ± 14.4 years old) were analyzed. Patients without EF improvement were more likely to be male, had more comorbidities, ischemic cardiomyopathy (ICMP), markers of adverse cardiac remodeling (lower EF and higher left and right ventricular diameters) and presence of late gadolinium enhancement (LGE) in MRI (P < 0.05 for all). In a multivariate analysis, male sex, ICMP, lower EF, larger ventricular size and LGE remained independent predictors for lack of EF improvement. A prediction model for lack of EF improvement including LVEF, LV diameter, diastolic blood pressure and ischemic etiology exhibited an area under the ROC curve of 0.77 (95% CI 0.73-0.81; P < 0.001). HFimpEF patients had better prognosis with lower hospitalizations and mortality rates. Guideline directed medical therapy (GDMT) were associated with improved outcomes in both groups regardless of EF improvement. Conclusions Lack of improvement in EF among HFrEF patients may be predicted by HF etiology and imaging parameters of adverse cardiac remodeling, and is associated with worse prognosis. GDMT were associated with improved outcomes in both HFimpEF and HFrEF patients.
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Affiliation(s)
- Amitai Segev
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Benny Avrahamy
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Alexander Fardman
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Shlomi Matetzky
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Dov Freimark
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Ohad Regev
- Faculty of Health Sciences, Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Rafael Kuperstein
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Avishay Grupper
- Cardiovascular Division, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
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24
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Egbe AC, Jain CC, Abozied O, Burchill LJ, Younis A, Karnakoti S, Ahmed MH, Connolly HM. Differences in Right Heart Function After Pulmonary Valve Replacement in Patients With Pulmonary Valve Stenosis Versus Tetralogy of Fallot. J Am Heart Assoc 2024; 13:e034833. [PMID: 38958134 PMCID: PMC11292774 DOI: 10.1161/jaha.124.034833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/06/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND There are limited data about the impact of timing of pulmonary valve replacement (PVR) on right heart reverse remodeling in patients with pulmonary regurgitation following intervention for isolated pulmonary valve stenosis (PS). This study compared differences in postprocedural right heart reverse remodeling after early versus late PVR (defined as PVR before versus after attainment of the conservative consensus criteria proposed by Bokma et al, 2018) in patients with prior intervention for PS, using patients with tetralogy of Fallot as the reference group. METHOD AND RESULTS Right atrial reservoir strain and right ventricular free wall strain was measured at baseline, 1 and 3 years after PVR. There were 114 patients with PS (early PVR, 87 [76%]; late PVR, 27 [24%]) and 291 patients with tetralogy of Fallot (early PVR, 197 [67%]; late PVR, 96 [33%]). The PS group had greater improvement in right atrial reservoir strain at 1 year (12%±4% versus 8%±4%; P<0.001) and 3 years (15%±6% versus 9%±6%; P<0.001), and a greater improvement in right ventricular free wall strain at 1 year (12%±4% versus 7%±3%, P=0.008) and 3-years (16%±6% versus 12%±5%; P=0.01) after PVR compared with the tetralogy of Fallot group. There was no difference in right heart reverse remodeling between patients who underwent early versus later PVR within the PS group. In contrast, late PVR was associated with less right heart reverse remodeling within the tetralogy of Fallot group. CONCLUSIONS These data suggest that patients with palliated PS presenting pulmonary regurgitation have a more benign clinical course, and hence delaying PVR in this population may be appropriate.
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Affiliation(s)
- Alexander C. Egbe
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - C. Charles Jain
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Omar Abozied
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Luke J. Burchill
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Ahmed Younis
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Snigdha Karnakoti
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Marwan H. Ahmed
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
| | - Heidi M. Connolly
- Department of Cardiovascular MedicineMayo Clinic RochesterRochesterMNUSA
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Vontetsianos A, Chynkiamis N, Gounaridi MI, Anagnostopoulou C, Lekka C, Zaneli S, Anagnostopoulos N, Oikonomou E, Vavuranakis M, Rovina N, Papaioannou AI, Kaltsakas G, Koulouris N, Vogiatzis I. Exercise Intolerance Is Associated with Cardiovascular Dysfunction in Long COVID-19 Syndrome. J Clin Med 2024; 13:4144. [PMID: 39064183 PMCID: PMC11278210 DOI: 10.3390/jcm13144144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/03/2024] [Accepted: 07/11/2024] [Indexed: 07/28/2024] Open
Abstract
Background/Objectives: Cardiorespiratory complications are commonly reported among patients with long COVID-19 syndrome. However, their effects on exercise capacity remain inconclusive. We investigated the impact of long COVID-19 on exercise tolerance combining cardiopulmonary exercise testing (CPET) with resting echocardiographic data. Methods: Forty-two patients (55 ± 13 years), 149 ± 92 days post-hospital discharge, and ten healthy age-matched participants underwent resting echocardiography and an incremental CPET to the limit of tolerance. Left ventricular global longitudinal strain (LV-GLS) and the left ventricular ejection fraction (LVEF) were calculated to assess left ventricular systolic function. The E/e' ratio was estimated as a surrogate of left ventricular end-diastolic filling pressures. Tricuspid annular systolic velocity (SRV) was used to assess right ventricular systolic performance. Through tricuspid regurgitation velocity and inferior vena cava diameter, end-respiratory variations in systolic pulmonary artery pressure (PASP) were estimated. Peak work rate (WRpeak) and peak oxygen uptake (VO2peak) were measured via a ramp incremental symptom-limited CPET. Results: Compared to healthy participants, patients had a significantly (p < 0.05) lower LVEF (59 ± 4% versus 49 ± 5%) and greater left ventricular end-diastolic diameter (48 ± 2 versus 54 ± 5 cm). In patients, there was a significant association of E/e' with WRpeak (r = -0.325) and VO2peak (r = -0.341). SRV was significantly associated with WRpeak (r = 0.432) and VO2peak (r = 0.556). LV-GLS and PASP were significantly correlated with VO2peak (r = -0.358 and r = -0.345, respectively). Conclusions: In patients with long COVID-19 syndrome, exercise intolerance is associated with left ventricular diastolic performance, left ventricular end-diastolic pressure, PASP and SRV. These findings highlight the interrelationship of exercise intolerance with left and right ventricular performance in long COVID-19 syndrome.
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Affiliation(s)
- Angelos Vontetsianos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Nikolaos Chynkiamis
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
- Thorax Research Foundation, 11521 Athens, Greece
| | - Maria Ioanna Gounaridi
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.I.G.); (E.O.); (M.V.)
| | - Christina Anagnostopoulou
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Christiana Lekka
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Stavroula Zaneli
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Nektarios Anagnostopoulos
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Evangelos Oikonomou
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.I.G.); (E.O.); (M.V.)
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, Sotiria Chest Disease Hospital, Medical School, National and Kapodistrian University of Athens, 11527 Athens, Greece; (M.I.G.); (E.O.); (M.V.)
| | - Nikoletta Rovina
- 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece;
| | - Andriana I. Papaioannou
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Georgios Kaltsakas
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
- Lane Fox Respiratory Service, Guy’s and St Thomas’ NHS Foundation Trust, London SE1 7EH, UK
- Centre of Human and Applied Physiological Sciences, Faculty of Life Sciences and Medicine, King’s College London, London SE1 1UL, UK
| | - Nikolaos Koulouris
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
| | - Ioannis Vogiatzis
- Rehabilitation Unit, 1st Respiratory Medicine Department, “Sotiria” Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece; (A.V.); (C.A.); (C.L.); (S.Z.); (N.A.); (A.I.P.); (G.K.); (N.K.); (I.V.)
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University Newcastle, Newcastle upon Tyne NE1 8ST, UK
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Lillo R, Cangemi S, Graziani F, Locorotondo G, Pedicino D, Aurigemma C, Romagnoli E, Malara S, Meucci MC, Iannaccone G, Bianchini F, Nesta M, Bruno P, Lombardo A, Trani C, Burzotta F. Pulmonary congestion assessed by lung ultrasound in patients with severe aortic stenosis undergoing transcatheter aortic valve implantation: Prevalence and prognostic implications. Eur J Heart Fail 2024. [PMID: 39014551 DOI: 10.1002/ejhf.3365] [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] [Received: 01/21/2024] [Revised: 05/08/2024] [Accepted: 06/21/2024] [Indexed: 07/18/2024] Open
Abstract
AIMS Lung ultrasound (LUS) is a sensitive tool to assess pulmonary congestion (PC). Few data are available on LUS-PC evaluation in patients with severe aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI). The aim of this study was to assess the prevalence and prognostic impact of LUS-PC in patients with severe AS before and after TAVI. METHODS AND RESULTS We designed a single-centre prospective study in patients referred for TAVI for severe AS (ClinicalTrials.gov identification number: NCT05024942). All patients underwent echocardiography and LUS (according to a simplified 8-zone scanning protocol) the day before and within 72 h after the procedure. The primary endpoint was the composite of all-cause mortality, hospitalization for heart failure and urgent medical visits for worsening dyspnoea at 12-month follow-up. A total of 127 patients were enrolled (mean age 81.1 ± 5.8 years; 54.3% female). Pre-TAVI LUS-PC was documented in 65 patients (51%). After TAVI, the prevalence of LUS-PC significantly decreased as compared to pre-TAVI evaluation, being documented in only 28 patients (22% vs. 51%, p < 0.001) with a median B-lines score of 4 (interquartile range [IQR] 0-11) versus 11 (IQR 6-19) pre-TAVI (p < 0.001). During a median follow-up of 12 (12-17) months, 25 patients (19.6%) met the composite endpoint. On multivariable Cox regression analysis, pre-TAVI LUS-PC was independently associated with cardiovascular events (hazard ratio 2.764, 95% confidence interval 1.114-6.857; p = 0.028). CONCLUSIONS Lung ultrasonography reveals a high prevalence of PC in patients with severe AS undergoing TAVI, which is significantly reduced by the procedure. Pre-TAVI PC, measured by LUS, is an independent predictor of 1-year clinical outcome.
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Affiliation(s)
- Rosa Lillo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | | | - Francesca Graziani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gabriella Locorotondo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Daniela Pedicino
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Cristina Aurigemma
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Romagnoli
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Silvia Malara
- Catholic University of the Sacred Heart, Rome, Italy
| | - Maria Chiara Meucci
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giulia Iannaccone
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Bianchini
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Marialisa Nesta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Piergiorgio Bruno
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Antonella Lombardo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Carlo Trani
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University of the Sacred Heart, Rome, Italy
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Srdanović I, Stefanović M, Milovančev A, Vulin A, Pantić T, Dabović D, Tadić S, Ilić A, Stojšić Milosavljević A, Bjelobrk M, Miljković T, Velicki L. Relevance of the TAS'/PASP Ratio as a Predictor of Outcomes in Patients with Heart Failure with a Reduced Ejection Fraction. Life (Basel) 2024; 14:863. [PMID: 39063617 PMCID: PMC11277606 DOI: 10.3390/life14070863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND There is evidence that right ventricular (RV) contractile function, especially its coupling with the pulmonary circulation, has an important prognostic value in patients with left ventricular dysfunction. AIMS This study aimed to identify the best echocardiographic parameters of RV function and pulmonary artery systolic pressure (PASP) alone or in the form of the index of right ventricular-pulmonary artery coupling (RV-PA coupling) to determine the best predictor of 1-year major adverse cardiovascular events (MACE), which were defined as cardiovascular death and cardiac decompensation in heart failure patients with reduced ejection fraction (HFrEF). METHODS AND RESULTS The study enrolled 191 HFrEF patients (mean age 62.28 ± 12.79 years, 74% males, mean left ventricular ejection fraction (LVEF) 25.53 ± 6.87%). All patients underwent clinical, laboratory, and transthoracic echocardiographic (TTE) evaluation, focusing on assessing RV function and non-invasive parameters of RV-PA coupling. RV function was evaluated using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and peak tricuspid annular systolic velocity (TAS'). PASP was estimated by peak tricuspid regurgitation velocity (TRVmax) and corrected by assumed right atrial pressure relative to the dimension and collapsibility of the inferior vena cava. The TAPSE/PASP and TAS'/PASP ratios were taken as an index of RV-PA coupling. During the follow-up (mean period of 340 ± 84 days), 58.1% of patients met the composite endpoint. The independent predictors of one-year outcome were shown to be advanced age, atrial fibrillation, indexed left atrial systolic volume (LAVI), LVEF, TAPSE/PASP, and TAS'/PASP. TAS'/PASP emerged as the strongest independent predictor of prognosis, with a hazard ratio (HR) of 0.67 (0.531-0.840), p < 0.001. Reconstructing the ROC curve 0.8 (0.723-0.859), p < 0.001, we obtained a threshold value of TAS'/PASP ≤ 0.19 (cm/s/mm Hg) (sensitivity 74.0, specificity 75.2). Patients with TAS'/RVSP ≤ 0.19 have a worse prognosis (Log Rank p < 0.001). CONCLUSIONS This study confirmed previously known independent predictors of adverse outcomes in patients with HfrEF-advanced age, atrial fibrillation, LAVI, and LVEF-but non-invasive parameters of RV-PA coupling TAPSE/PASP and TAS'/PASP improved risk stratification in patients with HFrEF. Variable TAS'/PASP has been shown to be the most powerful, independent predictor of one-year outcome.
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Affiliation(s)
- Ilija Srdanović
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Maja Stefanović
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Aleksandra Milovančev
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Aleksandra Vulin
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Teodora Pantić
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Dragana Dabović
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Snežana Tadić
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Aleksandra Ilić
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Anastazija Stojšić Milosavljević
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Marija Bjelobrk
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Tatjana Miljković
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Lazar Velicki
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
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Badran HM, El Etriby A, Elfeky A, Naser G. Unified adult transthoracic echocardiographic report: an expert consensus document of the Egyptian Working Group of Echocardiography. Egypt Heart J 2024; 76:88. [PMID: 38976172 PMCID: PMC11231117 DOI: 10.1186/s43044-024-00519-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 07/01/2024] [Indexed: 07/09/2024] Open
Abstract
BACKGROUND Physicians face complexity in interpreting the results of echocardiography (ECHO) due to the variability across ECHO laboratories. Many international organizations published reports to reduce the inter-variability in ECHO reporting. However, with the evolution of imaging modalities, significant improvements in ECHO reporting are essential to eliminate any previous discrepancies. The Egyptian Working Group of Echocardiography (EEWG) aimed to prepare a standardized, updated, simple, and comprehensive ECHO reporting in Egypt to offer consistency, guarantee that all the crucial features are fulfilled, and ease practitioners' communication to maximize clinical decision-making. MAIN TEXT Relevant articles were retrieved and reviewed to explore the current state of TTE reporting practices, existing guidelines, and challenges faced by physicians in interpreting TTE results. Identified gaps and areas for improvement were then employed to establish the outline for the standardization approach. This report addresses crucial components such as demographic data, measurements, and interpretative summaries. It emphasizes left ventricle measurements and systolic function assessment, incorporating advanced techniques like speckle tracking and three-dimensional imaging. The significance of evaluating diastolic function, examining the right ventricle, and assessing valves, pericardium, and aorta are also discussed. CONCLUSION The current consensus goals to streamline communication among practitioners contribute to a more unified approach to interpreting ECHO results. Our initiative marks a significant step forward in enhancing the standardization and quality of ECHO reporting in Egypt. By introducing this report and encouraging continuous learning, the working group aims to raise the overall reporting quality and facilitate interpretation across diverse echocardiographic settings. This concerted effort improves patient care by ensuring consistency, accuracy, and relevance in interpreting echocardiographic findings.
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Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department, Menoufia University, 55-El Gish Street, P.O box: 31511, Tanta, Egypt.
| | - Adel El Etriby
- Cardiology Department, Ain Shams University, Cairo, Egypt
| | - Azza Elfeky
- Cardiology Department, Ain Shams University, Cairo, Egypt
| | - Gamela Naser
- Cardiology Department, Suez Canal University, Ismailia, Egypt
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Al-Abcha A, Abbasi M, El-Am E, Ghorbanzadeh A, Lee A, Scott CG, Thaden JJ, Eleid M, Rihal C, Oh J, Pellikka PA, Guerrero ME. Staging Extramitral Cardiac Damage in Mitral Annular Calcification With Mitral Valve Dysfunction. JACC Cardiovasc Interv 2024; 17:1577-1590. [PMID: 38986657 DOI: 10.1016/j.jcin.2024.05.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Mitral annular calcification (MAC) is a progressive degenerative process associated with comorbidities and increased mortality. A staging system that considers extramitral cardiac damage in MAC may help improve patient selection for mitral valve interventions. OBJECTIVES This study sought to develop a transthoracic echocardiogram (TTE)-based cardiac staging system in patients with MAC and significant mitral valve dysfunction and assess its prognostic utility. METHODS We retrospectively evaluated all adults who underwent TTE over 1 year at Mayo Clinic with MAC and significant mitral valve dysfunction defined as mitral stenosis and/or at least moderate mitral regurgitation. Patients were categorized into 5 stages according to extramitral cardiac damage by TTE. All-cause mortality and heart failure hospitalization were assessed. RESULTS For the 953 included patients, the mean age was 76.2 ± 10.7 years, and 54.0% were women. Twenty-eight (2.9%) patients were classified in stages 0 to 1, 499 (52.4%) in stage 2, 115 (12.1%) in stage 3, and 311 (32.6%) in stage 4. At the 3.8-year follow-up, mortality was significantly higher in patients in stages 2 to 4 compared to stages 0 to 1 and increased with each stage. Survival differences were maintained after adjustment for age, diabetes mellitus, and glomerular filtration rate. The rate of heart failure hospitalization was significantly higher in stages 3 and 4 compared to stages 0 to 1. Similar results were observed in subgroup analysis in patients with moderate or severe MAC, predominant mitral stenosis, or predominant mitral regurgitation. CONCLUSIONS Using the proposed extramitral cardiac damage staging system in patients with MAC and significant mitral valve dysfunction, more advanced stages are associated with higher mortality.
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Affiliation(s)
- Abdullah Al-Abcha
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Muhannad Abbasi
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward El-Am
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Atefeh Ghorbanzadeh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Alexander Lee
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Christopher G Scott
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeremy J Thaden
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mackram Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Charanjit Rihal
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jae Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Mayra E Guerrero
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Maleki F, Mehrabani J. Right ventricular remodeling induced by prolonged excessive endurance exercise is mediated by upregulating Wnt/β-catenin signaling in rats. Int J Cardiol 2024; 413:132316. [PMID: 38977222 DOI: 10.1016/j.ijcard.2024.132316] [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] [Received: 02/07/2024] [Revised: 05/26/2024] [Accepted: 07/01/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND The aim of this study was to develop an animal model to investigate whether prolonged intensive endurance exercise induces RV remodeling, taking into account the involvement of Wnt/β-catenin signaling. METHODS Four-week-old male Wistar rats (100 to 125 g) were assigned to four groups (n = 8/group): 1) sixteen weeks of intensive (36 m/min) exercise (INT), 2) twelve weeks of the intensive exercise followed by four weeks of moderate intensity (18 m/min) exercise (INT + MOD), 3) twelve weeks of the intensive exercise followed by four weeks of detraining (INT + DT), and 4) sedentary rats (SED). The exercise protocols were performed five days a week for one h/day. Echocardiography, real-time PCR, western blotting, and histological staining were performed at the end of week sixteen. RESULTS INT rats developed concentric hypertrophy without diastolic dysfunction compared to SED (p = 0.006) and INT + DT (p = 0.035). Wnt1, β-catenin and CyclinD1 proteins in the training groups were significantly higher than SED rats (p < 0.001). Interestingly, INT rats had higher protein levels than INT + DT and INT + MOD (p < 0.001), with higher gene expression compared to SED rats (p < 0.05). There was also a significant increase in collagen deposition in INT rats compared to SED (p = 0.046) and INT + DT (p = 0.034). Furthermore, INT + MOD and INT + DT rats did not show any adverse structural, functional, or histological changes. CONCLUSIONS Long-term intensive endurance training seems to be associated with increased collagen deposition and wall thickness in the RV through Wnt/β-catenin signaling (which is concentration dependent), without changes in diastolic function. CLINICAL PERSPECTIVE Over the past decades, there has been an ongoing debate about whether the structural and functional adaptations of the cardiovascular system in trained endurance athletes are benign physiological responses to training or potentially pathological changes related to disease. While the adaptations of the left heart are well-documented, the remodeling of the right heart remains a subject of discussion. To gain insights into the ability of sustained high-intensity exercise to cause adverse right ventricular (RV) remodeling, we conducted an experimental study in which male rats were trained to run vigorously for 1 h daily over a 16-week period and compared them to a parallel group of sedentary control rats. Our findings revealed that intense long-term exercise induced morphological changes along with fibrosis affecting the RV. These fibrotic changes were a result of the 16-week vigorous exercise training regimen. If these results are confirmed in humans, they suggest that prolonged high-intensity endurance exercise training may lead to adverse cardiac remodeling. Our findings have important potential implications for the assessment of cardiac remodeling in individuals engaged in high-level exercise training.
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Affiliation(s)
- Farzaneh Maleki
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran.
| | - Javad Mehrabani
- Department of Exercise Physiology, Faculty of Sport Sciences, University of Guilan, Rasht 4199843653, Iran.
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Anastasiou V, Daios S, Moysidis DV, Liatsos AC, Papazoglou AS, Didagelos M, Savopoulos C, Bax JJ, Ziakas A, Kamperidis V. Right ventricular-pulmonary arterial coupling in patients with first acute myocardial infarction: an emerging post-revascularization triage tool. Hellenic J Cardiol 2024:S1109-9666(24)00139-8. [PMID: 38977061 DOI: 10.1016/j.hjc.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 06/09/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND The tricuspid annular plane systolic excursion/pulmonary artery systolic pressure (TAPSE/PASP) ratio is a non-invasive surrogate for right ventricular-pulmonary arterial (RV-PA) coupling, studied in chronic RV pressure overload syndromes. However, its prognostic utility in patients with acute myocardial infarction (AMI), which may cause acute RV pressure overload, remains unexplored. OBJECTIVE This study aimed to determine predictors of RV-PA uncoupling in patients with first AMI and examine whether it could improve risk stratification for cardiovascular in-hospital mortality after revascularization. METHODS Three-hundred consecutive patients with first AMI were prospectively studied (age 61.2 ± 11.8, 24% females). Echocardiography was performed 24 h after successful revascularization, and TAPSE/PASP was evaluated. Cardiovascular in-hospital mortality was recorded. RESULTS The optimal cutoff value of TAPSE/PASP to determine cardiovascular in-hospital mortality was 0.49 mm/mmHg. RV-PA uncoupling was considered for patients with TAPSE/PASP ≤0.49 mm/mmHg. Left ventricular ejection fraction (LVEF) was independently associated with RV-PA uncoupling. A total of 23 (7.7%) patients died in hospital despite successful revascularization. TAPSE/PASP was independently associated with in-hospital mortality after adjustment for Global Registry of Acute Coronary Events (GRACE) risk score and LVEF (odds ratio 0.14 [95% confidence interval 0.03-0.56], P = 0.007). The prognostic value of a baseline model including the GRACE risk score and NT-pro-BNP (χ2 26.55) was significantly improved by adding LVEF ≤40% (χ2 44.71, P < 0.001), TAPSE ≤ 17 mm (χ2 75.42, P < 0.001) and TAPSE/PASP ≤ 0.49 mm/mmHg (χ2 101.74, P < 0.001) for predicting cardiovascular in-hospital mortality. CONCLUSION RV-PA uncoupling, assessed by echocardiographic TAPSE/PASP ≤ 0.49 mm/mmHg 24 h after revascularization, may improve risk stratification for cardiovascular in-hospital mortality after first AMI.
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Affiliation(s)
- Vasileios Anastasiou
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Stylianos Daios
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Dimitrios V Moysidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Alexandros C Liatsos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Andreas S Papazoglou
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Matthaios Didagelos
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Leiden, the Netherlands
| | - Antonios Ziakas
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
| | - Vasileios Kamperidis
- First Department of Cardiology, AHEPA Hospital, Aristotle University of Thessaloniki, Greece.
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Astengo M, Bobbio E, Polte CL, Täll E, Bollano E, Bech-Hanssen O. Multiparametric right ventricular assessment improves risk stratification in patients with new-onset acute heart failure. ESC Heart Fail 2024. [PMID: 38967241 DOI: 10.1002/ehf2.14954] [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: 10/10/2023] [Revised: 05/20/2024] [Accepted: 06/23/2024] [Indexed: 07/06/2024] Open
Abstract
AIMS Risk stratification of patients with new-onset acute heart failure (AHF) is important but remains challenging. In the present study, we evaluated the prognostic value of a new multiparameter right ventricular dysfunction (RVD) score. METHODS AND RESULTS Patients (n = 210) hospitalized due to new-onset AHF between 2015 and 2018 were retrospectively included. Mean age was 56 ± 10 years, 24% were female and median left ventricular ejection fraction was 28% (interquartile range 20; 34%). The RVD score, tricuspid annular plane systolic excursion (TAPSE), and fractional area change (FAC) were determined at index hospitalization and after therapy titration. The 4-point RVD score included reduced TAPSE, right ventricular enlargement, moderate or severe tricuspid regurgitation and increased central venous pressure. The study endpoint was a composite of all-cause mortality, left ventricular assist device implantation, and heart transplantation. After 60 months median follow-up time, 53 (25%) patients met the endpoint. At index hospitalization, there were no significant differences in any echocardiographic parameter between patients with and without the endpoint. After therapy titration, there were differences in TAPSE (16 vs. 19 mm, P = 0.001), FAC (33 vs. 40%, P < 0.001) and the proportion of patients with RVD score ≥2 (36 vs. 4%, P < 0.001). The presence of RVD despite therapy titration had different impact on survival depending on the parameter considered: the proportion of patients free from events after 1 year was 87% in patients with TAPSE <17 mm, 89% in patients with FAC <35% and 65% in patients with RVD score ≥2. In a multivariable analysis, RVD score ≥2 after therapy titration, but not TAPSE <17 mm or FAC < 35%, remained associated with a higher risk of the composite endpoint (hazard ratio 3.11, 95% confidence interval 1.44-6.74). CONCLUSIONS A novel multiparametric RVD score might improve prognostic stratification in patients with new-onset AHF. RVD after therapy titration, but not at index hospitalization is associated with a higher risk of the composite endpoint.
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Affiliation(s)
- Marco Astengo
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Emanuele Bobbio
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Lars Polte
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Eric Täll
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Entela Bollano
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
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Myagmardorj R, Fortuni F, Galloo X, Nabeta T, Meucci MC, Butcher SC, van der Kley F, Bax JJ, Ajmone Marsan N. Changes in Global Longitudinal Strain after TAVI: Additional Prognostic Value over Cardiac Damage in Patients with Severe Aortic Stenosis. J Clin Med 2024; 13:3945. [PMID: 38999514 PMCID: PMC11242647 DOI: 10.3390/jcm13133945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 06/27/2024] [Accepted: 07/02/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Previous studies demonstrated the prognostic value of baseline cardiac damage staging as well as left ventricular global longitudinal strain (LVGLS) in patients undergoing transcatheter aortic valve implantation (TAVI). The aim of the present study was to evaluate the changes in cardiac damage stage and LVGLS after TAVI and to investigate their prognostic values when integrated into the follow-up assessment. Methods: Patients with severe aortic stenosis undergoing TAVI were hierarchically classified into cardiac damage stages based on echocardiographic criteria before TAVI and at a 6-month follow-up. At the same time, LVGLS was measured. The staging system included stage 0 = no signs of cardiac damage; stage 1 = LV damage; stage 2 = mitral or left atrial damage; stage 3 = pulmonary vasculature or tricuspid damage; and stage 4 = right ventricular damage. The primary endpoint was all-cause mortality. Results: A total of 620 patients were included. At follow-up, LVGLS significantly improved, and the improvement was similar among each baseline cardiac damage stage. Follow-up LVGLS values were divided into quintiles, and each quintile was integrated into the cardiac damage staging, leading to a reclassification of 308 (50%) patients. At the time of a median follow-up at 48 (IQR 31-71) months starting from the 6-month follow-up after TAVI, 262 (38%) patients had died. A multivariable Cox regression model showed that LVGLS-integrated cardiac damage staging at follow-up had an incremental prognostic value over the baseline assessment (HR per 1-stage increase 1.384; 95% CI 1.152-1.663; p < 0.001). Conclusions: The integration of LVGLS with conventional echocardiographic parameters of cardiac damage at a 6-month follow-up after TAVI can improve patient risk-stratification.
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Affiliation(s)
- Rinchyenkhand Myagmardorj
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Federico Fortuni
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
- Department of Cardiology, San Giovanni Battista Hospital, 06034 Foligno, Italy
| | - Xavier Galloo
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Takeru Nabeta
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Maria Chiara Meucci
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Steele C. Butcher
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Frank van der Kley
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
| | - Jeroen J. Bax
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
- Heart Center, University of Turku and Turku University Hospital, 20520 Turku, Finland
| | - Nina Ajmone Marsan
- Department of Cardiology, Heart Lung Centre, Leiden University Medical Centre (LUMC), 2333 ZC Leiden, The Netherlands; (F.F.); (X.G.); (T.N.); (M.C.M.); (S.C.B.); (F.v.d.K.); (J.J.B.); (N.A.M.)
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Follis M, Lorusso R. Editorial: Right ventricular failure: current strategies and future development. Front Cardiovasc Med 2024; 11:1388501. [PMID: 39036506 PMCID: PMC11258031 DOI: 10.3389/fcvm.2024.1388501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 06/20/2024] [Indexed: 07/23/2024] Open
Affiliation(s)
- Marco Follis
- Department of Cardio-Thoracic and Vascular Surgery, Klinikum Braunschweig, Braunschweig, Germany
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht (CARIM), Maastricht, Netherlands
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Watanabe R, Hori K, Ishihara K, Tsujikawa S, Hino H, Matsuura T, Takahashi Y, Shibata T, Mori T. Possible role of QRS duration in the right ventricle as a perioperative monitoring parameter for right ventricular function: a prospective cohort analysis in robotic mitral valve surgery. Front Cardiovasc Med 2024; 11:1418251. [PMID: 39027000 PMCID: PMC11254697 DOI: 10.3389/fcvm.2024.1418251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 06/24/2024] [Indexed: 07/20/2024] Open
Abstract
Background The clinical importance of the right ventricle (RV) has recently been recognized; however, assessing its function during cardiac surgery remains challenging owing to its complex anatomy. A temporary transvenous pacing catheter is a useful tool in the small surgical field of minimally invasive cardiac surgery, and an electrocardiogram recorded through the catheter is composed of the direct electrophysiological activity of the RV. Therefore, we hypothesized that QRS duration in the RV (QRSRV) could be a useful monitoring parameter for perioperative RV function. Methods We conducted a prospective cohort analysis involving adult patients undergoing robotic mitral valve repair. A bipolar pacing catheter was inserted using x-ray fluoroscopy, and the QRSRV duration was assessed at four time points: preoperative baseline, during one-lung ventilation, after weaning from cardiopulmonary bypass, and before the end of surgery. At the same time points, right ventricular fractional area change (RVFAC) measured by transesophageal echocardiography and QRS duration at V5 lead of the body surface electrocardiogram (QRSV5) were also evaluated. Results In the 94 patients analyzed, QRSRV duration was significantly prolonged during robotic mitral valve repair (p = 0.0009), whereas no significant intraoperative changes in RVFAC were observed (p = 0.2). By contrast, QRSV5 duration was significantly shortened during surgery (p < 0.00001). Multilinear regression showed a significant correlation of QRSRV duration with RVFAC (p = 0.00006), but not with central venous pressure (p = 0.9), or left ventricular ejection fraction (p = 0.3). When patients were divided into two groups by postoperative QRSRV > 100 or ≤100 ms, 25 patients (26.6%) exhibited the prolonged QRSRV duration, and the mean increase in the postoperative QRSRV from preoperative baseline was 12 ms (p = 0.001), which was only 0.6 ms in patients with QRSRV ≤ 100 ms (p = 0.6). Cox regression analysis showed that prolonged postoperative QRSRV duration was the only significant parameter associated with a longer ICU stay after surgery (p = 0.02; hazard ratio, 0.55). Conclusion Our data suggest that QRSRV duration is a useful parameter for monitoring the RV during cardiac surgery, possibly better than a commonly used echocardiographic parameter, RVFAC. An electrophysiological assessment by QRSRV duration could be a practical tool for the complex anatomy of the RV, especially with limited modalities in perioperative settings.
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Affiliation(s)
- Ryota Watanabe
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Kotaro Hori
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Keisuke Ishihara
- Department of Anesthesiology, Osaka City General Hospital, Osaka, Japan
| | - Shogo Tsujikawa
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Hideki Hino
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Matsuura
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Yosuke Takahashi
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
| | - Takashi Mori
- Department of Anesthesiology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan
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Nemes A. Myocardial, Valvular and Vascular Abnormalities in Repaired Tetralogy of Fallot. Life (Basel) 2024; 14:843. [PMID: 39063597 PMCID: PMC11277634 DOI: 10.3390/life14070843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/07/2024] [Accepted: 06/19/2024] [Indexed: 07/28/2024] Open
Abstract
Tetralogy of Fallot is the most common heart defect associated with cyanosis characterized by the co-occurrence of pulmonary stenosis, right ventricular hypertrophy, and ventricular septal defect with over-riding of the aorta. The present review purposed to summarize myocardial, valvular and vascular abnormalities, which were described in a series of patients following repair of tetralogy of Fallot. It was also aimed to describe potential differences in these parameter using different surgical strategies.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
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Colak A, Kumral Z, Sezgin D, Simsek GO, Yildirim TD, Kis M, Ozpelit E, Akdeniz B. The prognostic value of right ventricular outflow tract velocity time integral in patients with pulmonary hypertension. ESC Heart Fail 2024. [PMID: 38961603 DOI: 10.1002/ehf2.14934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 05/04/2024] [Accepted: 06/18/2024] [Indexed: 07/05/2024] Open
Abstract
AIMS Right ventricular (RV) failure is one of the leading causes of death in patients with pulmonary hypertension (PH). Conventional echocardiographic parameters are not included in risk stratification and follow-up for prognostic assessment due to PH's diverse nature and the RV's complex geometry. RV outflow tract velocity time integral (RVOT VTI) is a simple, non-invasive estimate of pulmonary flow and an echocardiographic surrogate of RV stroke volume. In this study, we aimed to define the prognostic value of RVOT VTI in PH patients. METHODS Sixty-three subjects with idiopathic PAH (IPAH) (n = 23), connective tissue disease-associated PAH (CTD-associated PAH) (n = 19) and chronic thromboembolic pulmonary hypertension (CTEPH) (n = 21) were retrospectively included. A comprehensive two-dimensional echocardiographic evaluation, including RVOT-VTI measurement, was performed during the follow-up and the New York Heart Association functional class (NYHA FC), 6 min walk distance (6MWD) and brain natriuretic peptide (BNP) levels were recorded. RESULTS The median age of the whole cohort was 63 years (52-68), and 47 (74.6%) of the patients were women. The median follow-up period was 20 months (11-33), and 20 (31.7%) patients died in this period. BNP values were higher [317 (210-641) vs 161 (47-466), P = 0.02], and 6MWD values were lower [197.5 ± 89.5 vs 339 ± 146.3, P < 0.0001] in the non-survivor group, and the non-survivor group had a worse NYHA-FC (P = 0.02). Among echocardiographic data, tricuspid annular plane systolic excursion (TAPSE) (15.4 ± 4.8 vs 18.6 ± 4.2, P = 0.01) and RVOT VTI (11.9 ± 4.1 vs 17.2 ± 4.3, P < 0.0001) values were lower whereas right atrial area (RAA) (26.9 ± 10.1 vs 22.2 ± 7.1, P = 0.04) values were higher in the non-survivor group. The area under curve of the RVOT VTI for predicting mortality was 0.82 [95% confidence interval (CI) 0.715-0.940, P < 0.0001], and the best cut-off value was 14.7 cm with a sensitivity of 80% and specificity of 77%. Survival was significantly lower in subjects with RVOT VTI ≤ 14.7 cm (log-rank P < 0.0001). Survival rates for patients with RVOT VTI ≤ 14.7 cm were 70% at 1 year, 50% at 2 years, %29 at 3 years and 21% at 5 years. The univariate determinants of all-cause mortality were BNP [hazard ratio (HR) 1.001 (1.001-1.002), P = 0.001], 6MWD [HR 0.994 (0.990-0.999), P = 0.012] and NYHA-FC III-IV [HR 3.335 (1.103-10.083), P = 0.03], TAPSE [HR 0.838 (0.775-0.929), P = 0.001], RAA [HR 1.072 (1.013-1.135), P = 0.016] and RVOT VTI [HR 0.819 (0.740-0.906), P < 0.0001]. RVOT VTI was found to be the only independent determinant of mortality [HR 0.857 (0.766-0.960), P = 0.008]. CONCLUSIONS The decreased RVOT VTI predicts mortality in patients with PH and each 1 mm decrease in RVOT VTI increases the risk of mortality by 14.3%. This parameter might serve as an additional parameter in the follow-up of these patients especially when 6MWD and NYHA-FC could not be determined.
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Affiliation(s)
- Ayse Colak
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Zeynep Kumral
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Dilek Sezgin
- Dokuz Eylul University Faculty of Nursing, Izmir, Turkey
| | | | - Tuba Demirci Yildirim
- Department of Rheumatology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Mehmet Kis
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ebru Ozpelit
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Bahri Akdeniz
- Department of Cardiology, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
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Nemes A, Rácz G, Kormányos Á, Gyenes N, Ambrus N, Lengyel C, Valkusz Z. Three-Dimensional Speckle-Tracking Echocardiography-Derived Tricuspid Annular Properties in Acromegaly-Results from the MAGYAR-Path Study. Biomedicines 2024; 12:1464. [PMID: 39062037 PMCID: PMC11274697 DOI: 10.3390/biomedicines12071464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 06/24/2024] [Accepted: 06/27/2024] [Indexed: 07/28/2024] Open
Abstract
INTRODUCTION Acromegaly is an endocrine pathology characterized by the overproduction of human growth hormone. The present study aimed to analyze three-dimensional speckle-tracking echocardiography (3DSTE)-derived tricuspid annular (TA) properties in detail in patients with acromegaly and to compare the findings to those of matched healthy controls. METHODS The present study consisted of 29 patients with acromegaly (mean age: 55.9 ± 14.5 years, 21 males), of which 13 had an active disease. The control population comprised 57 healthy subjects (mean age: 53.2 ± 8.4 years, 38 males). RESULTS In the presence of acromegaly, left atrial and end-diastolic left ventricular (LV) sizes were dilated, and LV ejection fraction was increased, which was accompanied by thickened interventricular septum and LV posterior wall as compared with matched healthy controls. The presence of grade 1 mitral (MR) and tricuspid (TR) regurgitations were more frequent in acromegaly than in controls, regardless of disease activity. Higher than grade 1 MR/TR was uncommon in acromegaly. The 3DSTE-derived all end-diastolic (2.47 ± 0.27 cm vs. 2.23 ± 0.27 cm; 8.73 ± 1.77 cm2 vs. 6.67 ± 1.40 cm2; 11.56 ± 1.34 cm vs. 10.20 ± 1.10 cm, p < 0.001 for all) and end-systolic (1.97 ± 0.27 cm vs. 1.77 ± 0.28 cm; 6.24 ± 1.61 cm2 vs. 5.01 ± 1.42 cm2; 9.80 ± 1.35 cm vs. 8.72 ± 1.10 cm, p < 0.001 for all) TA diameters, areas, and perimeters proved to be dilated, while TA functional parameters including TA fractional area change (28.77 ± 9.80% vs. 27.64 ± 15.34%, p = 0.720) and fractional shortening (20.60 ± 9.08% vs. 20.51 ± 8.81%, p = 0.822) were normal in acromegaly regardless of whether acromegaly was active or not. RA volumes respecting the cardiac cycle were dilated in acromegaly as compared with those of healthy controls regardless of disease activity and were associated with respective changes in TA dimensions. CONCLUSIONS In the presented acromegaly patients, significant TA dilation with preserved function could be detected regardless of disease activity. RA volumes and TA dimensions are correlated in acromegaly.
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Affiliation(s)
- Attila Nemes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Gergely Rácz
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Árpád Kormányos
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Nándor Gyenes
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Nóra Ambrus
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Csaba Lengyel
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
| | - Zsuzsanna Valkusz
- Department of Medicine, Albert Szent-Györgyi Medical School, University of Szeged, Semmelweis Street 8, P.O. Box 427, H-6725 Szeged, Hungary
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Guler GB, Guler A, Tanboga IH, Turkmen I, Atmaca S, Sahin H, Tekin M, Karakurt ST, Erin F, Inan D, Cinli TA, Akkas BE, Cansever AT, Erturk M. Ongoing assertion of two-dimensional measurements on differentiation type of left ventricular hypertrophy: Focus on inferior vena cava. Echocardiography 2024; 41:e15880. [PMID: 38979714 DOI: 10.1111/echo.15880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2024] [Revised: 06/11/2024] [Accepted: 06/16/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND Left ventricular hypertrophy (LVH), including hypertensive LVH, hypertrophic cardiomyopathy (HCM) and cardiac amyloidosis (CA), is a commonly encountered condition in cardiology practice, presenting challenges in differential diagnosis. In this study, we aimed to investigate the importance of echocardiographic evaluation of the inferior vena cava (IVC) in distinguishing LVH subtypes including hypertensive LVH, HCM, and CA. METHODS In this retrospective study, patients with common causes of LVH including hypertensive LVH, HCM, and CA were included. The role of echocardiographic evaluation of IVC diameter and collapsibility in distinguishing these causes of LVH was assessed in conjunction with other echocardiographic, clinical, and imaging methods. RESULTS A total of 211 patients (45% HCM, 43% hypertensive heart disease, and 12% CA) were included in our study. Their mean age was 56.6 years and 62% of them were male. While mean IVC diameter was significantly dilated in CA patients (13.4 mm in hypertensive LVH, 16.0 mm in HCM, and 21.1 mm in CA, p < .001), its collapsibility was reduced (IVC collapsible in 95% of hypertensive patients, 72% of HCM patients, and 12% of CA patients, p < .001). In the analysis of diagnostic probabilities, the presence of both hypovoltage and IVC dilation is significant for CA patients. Although it is not statistically significant, the presence of IVC dilation along with atrial fibrillation supports the diagnosis of HCM. CONCLUSION In conclusion, although advances in imaging techniques facilitate the diagnosis of LVH, simple echocardiographic methods should never be overlooked. Our study supports the notion that IVC assessment could play an important role in the differential diagnosis of LVH.
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Affiliation(s)
- Gamze Babur Guler
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Arda Guler
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Ibrahim Halil Tanboga
- Department of Cardiology & Biostatistics, Istanbul Nisantasi University Medical School, Istanbul, Turkey
| | - Irem Turkmen
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Sezgin Atmaca
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Hasan Sahin
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Meltem Tekin
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Seda Tukenmez Karakurt
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Faruk Erin
- Bahcesehir University Faculty of Medicine, Istanbul, Turkey
| | - Duygu Inan
- Department of Cardiology, University of Health Sciences, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
| | - Tahir Alper Cinli
- Department of Hematology, University of Health Sciences, Van Training and Research Hospital, Van, Turkey
| | - Burcu Esen Akkas
- Department of Nuclear Medicine, University of Health Sciences, Basaksehir Cam Sakura City Hospital, Istanbul, Turkey
| | - Aysel Turkvatan Cansever
- Department of Radiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Mehmet Erturk
- Department of Cardiology, University of Health Sciences, Mehmet Akif Ersoy Thoracic Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
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40
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Russo A, Bergamini Viola E, Gambaro A, Di Gennaro G, Fanti D, Devigili A, Ceola Graziadei M, Brognoli G, Corubolo L, Rama J, Zanin A, Schweiger V, Donadello K, Polati E, Gottin L. Preoperative right ventricular strain as an early predictor of perioperative cardiac failure in patients undergoing mitral surgery: An exploratory study. Health Sci Rep 2024; 7:e2172. [PMID: 39050905 PMCID: PMC11265990 DOI: 10.1002/hsr2.2172] [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: 11/22/2023] [Revised: 05/14/2024] [Accepted: 05/22/2024] [Indexed: 07/27/2024] Open
Abstract
Objectives This study's primary purpose was to demonstrate the correlation of preoperative right ventricular free-wall longitudinal strain (RVFWLS) and pre-/postsurgical variation in strain (delta strain) with the clinical and echocardiographic diagnosis of right ventricular dysfunction. Its secondary purpose was to determine the correlation of RVFWLS and delta strain with length of stay (LOS) in the intensive care unit (ICU), ventilation days, trend of natriuretic peptide test. (NT-proBNP) and lactate in the first 48 h, incidence of acute renal failure, and 28-day mortality. Design Prospective observational study. Setting Cardio-thoracic and Vascular Anaesthesia Department and ICU of the University Hospital Integrated Trust of Verona. Participants Patients scheduled for mitral surgery. Interventions None. Measurements and Main Results All clinical and transoesophageal echocardiographic (TEE) parameters were collected at baseline, before surgery (T1) and at admission in the ICU postsurgery (T2). During the postoperative period, the clinical and echocardiographic diagnoses of right, left, or biventricular dysfunction were evaluated. TEE parameters were evaluated by a cardiologist offline. The patients were divided into two subgroups according to the development of any type of ventricular dysfunction. No statistically significant differences emerged between the two groups. According to a logistic regression model, a T1-RVFWLS value of -15% appeared to predict biventricular dysfunction (sensitivity: 100%; specificity: 91.3%). No correlation between T1- or T2-RVFWLS and creatinine, hours of ventilation or ICU LOS was found. Conclusions Our study introduces a new parameter that could be used in perioperative evaluations to identify patients at risk of postoperative biventricular dysfunction.
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Affiliation(s)
- Alessandro Russo
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Elisa Bergamini Viola
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Alessia Gambaro
- Department of Medicine, Cardiology Division, University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Gianfranco Di Gennaro
- Department of Health Sciences, Medical StatisticsUniversity of Magna GraeciaCatanzaroItaly
| | - Diego Fanti
- Department of Medicine, Cardiology Division, University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Alessandro Devigili
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Marcello Ceola Graziadei
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Gabriele Brognoli
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Luisa Corubolo
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Jacopo Rama
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Anita Zanin
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
| | - Vittorio Schweiger
- Anaesthesia and Intensive Care B Unit, AOUI‑University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Katia Donadello
- Anaesthesia and Intensive Care B Unit, AOUI‑University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Enrico Polati
- Anaesthesia and Intensive Care B Unit, AOUI‑University Hospital Integrated Trust of VeronaUniversity of VeronaVeronaItaly
| | - Leonardo Gottin
- Cardio‑thoracic Anaesthesia and Intensive Care UnitUniversity of Verona, AOUI‑University Hospital Integrated Trust of VeronaVeronaItaly
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41
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Gutor SS, Richmond BW, Agrawal V, Brittain EL, Shaver CM, Wu P, Boyle TK, Mallugari RR, Douglas K, Piana RN, Johnson JE, Miller RF, Newman JH, Blackwell TS, Polosukhin VV. Pulmonary vascular disease in Veterans with post-deployment respiratory syndrome. Cardiovasc Pathol 2024; 71:107640. [PMID: 38604505 DOI: 10.1016/j.carpath.2024.107640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/05/2024] [Accepted: 04/06/2024] [Indexed: 04/13/2024] Open
Abstract
Exertional dyspnea has been documented in US military personnel after deployment to Iraq and Afghanistan. We studied whether continued exertional dyspnea in this patient population is associated with pulmonary vascular disease (PVD). We performed detailed histomorphometry of pulmonary vasculature in 52 Veterans with biopsy-proven post-deployment respiratory syndrome (PDRS) and then recruited five of these same Veterans with continued exertional dyspnea to undergo a follow-up clinical evaluation, including symptom questionnaire, pulmonary function testing, surface echocardiography, and right heart catheterization (RHC). Morphometric evaluation of pulmonary arteries showed significantly increased intima and media thicknesses, along with collagen deposition (fibrosis), in Veterans with PDRS compared to non-diseased (ND) controls. In addition, pulmonary veins in PDRS showed increased intima and adventitia thicknesses with prominent collagen deposition compared to controls. Of the five Veterans involved in our clinical follow-up study, three had borderline or overt right ventricle (RV) enlargement by echocardiography and evidence of pulmonary hypertension (PH) on RHC. Together, our studies suggest that PVD with predominant venular fibrosis is common in PDRS and development of PH may explain exertional dyspnea and exercise limitation in some Veterans with PDRS.
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Affiliation(s)
- Sergey S Gutor
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Bradley W Richmond
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Veterans Affairs, Nashville VA, Nashville, TN; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN
| | - Vineet Agrawal
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Evan L Brittain
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ciara M Shaver
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Pingsheng Wu
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN
| | - Taryn K Boyle
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Ravinder R Mallugari
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Katrina Douglas
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Robert N Piana
- Division of Cardiovascular Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Joyce E Johnson
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, TN
| | - Robert F Miller
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - John H Newman
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Timothy S Blackwell
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN; Department of Veterans Affairs, Nashville VA, Nashville, TN; Department of Cell and Developmental Biology, Vanderbilt University, Nashville, TN
| | - Vasiliy V Polosukhin
- Division of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, TN.
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Lara-Breitinger KM, Miranda WR, Eleid MF, Smith TJ, Thomas JD, Nishimura RA. Critical Appraisal of Pulmonary Artery Systolic Pressure by Doppler Echocardiography in Patients With Severe Tricuspid Regurgitation. J Am Soc Echocardiogr 2024; 37:708-711. [PMID: 38734155 DOI: 10.1016/j.echo.2024.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 04/25/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024]
Affiliation(s)
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Mackram F Eleid
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Tyler J Smith
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James D Thomas
- Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Rick A Nishimura
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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43
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Gao H, Wang K, Wang X, Zeng D, Chen Z. Integration of two-dimensional echocardiography: A novel risk indicator for ST-segment elevation myocardial infarction. ESC Heart Fail 2024. [PMID: 38946662 DOI: 10.1002/ehf2.14939] [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: 12/11/2023] [Revised: 05/04/2024] [Accepted: 06/18/2024] [Indexed: 07/02/2024] Open
Abstract
AIMS We aim to integrate the parameters of two-dimensional (2D) echocardiography and identify the high-risk population for all-cause mortality in patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). METHODS The study involved a retrospective cohort population with STEMI who were admitted to Yongchuan Hospital of Chongqing Medical University between January 2016 and January 2019. Baseline data were collected, including 2D echocardiography parameters and left ventricular ejection fraction (LVEF). The parameters of 2D echocardiography were subjected to cluster analysis. Logistic regression models were employed to assess univariate and multivariate adjusted odds ratios (ORs) of cluster information in relation to all-cause mortality. Four logistic regression models were generated, utilizing cluster information, clinical variables, clinical variables in conjunction with LVEF, and clinical variables in conjunction with LVEF and cluster information as predictive variables, respectively. The area under the curve (AUC) were utilized to evaluate the incremental risk stratification value of cluster information. RESULTS The study included 633 participants with 28.8% female, a mean age of 65.68 ± 11.98 years. Over the course of a 3-year follow-up period, 108 (17.1%) patients experienced all-cause mortality. Utilizing cluster analysis of 2D echocardiography parameters, the patients were categorized into two distinct clusters, with statistically significant differences observed in most clinical variables, echocardiography, and survival outcomes between the clusters. Multivariate regression analysis revealed that cluster information was independently associated with the risk of all-cause mortality with adjusted OR 7.33 (95% confidence interval [CI] 3.99-14.06, P < 0.001). The inclusion of LVEF enhanced the predictive capacity of the model utilized with clinical variables with AUC 0.848 (95% CI 0.809-0.888) versus AUC 0.872 (95% CI 0.836-0.908) (P < 0.001), and the addition of cluster information further improved its predictive performance with AUC 0.906 (95% CI 0.878-0.934, P < 0.001). This cluster analysis was translated into a free available online calculator (https://app-for-mortality-prediction-cluster.streamlit.app/). CONCLUSIONS The 2D echocardiographic diagnostic information based on cluster analysis had good prognostic value for STEMI population, which was helpful for risk stratification and individualized intervention.
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Affiliation(s)
- Hongli Gao
- Department of Cardiology, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Kai Wang
- Department of Cardiology, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xinyi Wang
- Department of Cardiology, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Deli Zeng
- Department of Cardiology, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Zijun Chen
- Department of Cardiology, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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44
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Levy D, Saura O, Lucenteforte M, Collado Lledó E, Demondion P, Hammoudi N, Assouline B, Petit M, Gautier M, Le Fevre L, Pineton de Chambrun M, Coutance G, Berg E, Chommeloux J, Schmidt M, Luyt CE, Lebreton G, Leprince P, Hékimian G, Combes A. Isoproterenol improves hemodynamics and right ventricle-pulmonary artery coupling after heart transplantation. Am J Physiol Heart Circ Physiol 2024; 327:H131-H137. [PMID: 38700470 DOI: 10.1152/ajpheart.00200.2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 05/02/2024] [Accepted: 05/02/2024] [Indexed: 05/05/2024]
Abstract
Right ventricular failure (RVF) is a major cause of early mortality after heart transplantation (HT). Isoproterenol (Iso) has chronotropic, inotropic, and vasodilatory properties, which might improve right ventricle function in this setting. We aimed to investigate the hemodynamic effects of isoproterenol on patients with post-HT RVF. We conducted a 1-yr retrospective observational study including patients receiving isoproterenol (Iso) and dobutamine for early RVF after HT. A comprehensive multiparametric hemodynamic evaluation was performed successively three times: no isoproterenol, low doses: 0.025 µg/kg/min, and high doses: 0.05 µg/kg/min (henceforth, respectively, called no Iso, low Iso, and high Iso). From June 2022 to June 2023, 25 patients, median [interquartile range (IQR) 25-75] age 54 [38-61] yr, were included. Before isoproterenol was introduced, all patients received dobutamine, and 15 (60%) were on venoarterial extracorporeal membrane oxygenation (VA-ECMO). Isoproterenol significantly increased heart rate from 84 [77-99] (no Iso) to 91 [88-106] (low Iso) and 102 [90-122] beats/min (high Iso, P < 0.001). Similarly, cardiac index rose from 2.3 [1.4-3.1] to 2.7 [1.8-3.4] and 3 [1.9-3.7] L/min/m2 (P < 0.001) with a concomitant increase in indexed stroke volume (28 [17-34] to 31 [20-34] and 33 [23-35] mL/m2, P < 0.05). Effective pulmonary arterial elastance and pressures were not modified by isoproterenol. Pulmonary vascular resistance (PVR) tended to decrease from 2.9 [1.4-3.6] to 2.3 [1.3-3.5] wood units (WU), P = 0.06. Right ventricular ejection fraction/systolic pulmonary artery pressure (sPAP) evaluating right ventricle-pulmonary artery (RV-PA) coupling increased after isoproterenol from 0.8 to 0.9 and 1%·mmHg-1 (P = 0.001). In conclusion, in post-HT RVF, isoproterenol exhibits chronotropic and inotropic effects, thereby improving RV-PA coupling and resulting in a clinically relevant increase in the cardiac index.NEW & NOTEWORTHY This study offers a detailed and comprehensive hemodynamic investigation at the bedside, illustrating the favorable impact of isoproterenol on right ventricular-pulmonary arterial coupling and global hemodynamics. It elucidates the physiological effects of an underused inotropic strategy in a critical clinical scenario. By enhancing cardiac hemodynamics, isoproterenol has the potential to expedite right ventricular recovery and mitigate primary graft dysfunction, thereby reducing the duration of mechanical support and intensive care unit stay posttransplantation.
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Affiliation(s)
- David Levy
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Ouriel Saura
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Manuela Lucenteforte
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Department of Health Sciences, University of Milan, Milano, Italy
| | - Elena Collado Lledó
- Acute Cardiovascular Care Unit, Department of Cardiology, Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Pierre Demondion
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Nadjib Hammoudi
- Sorbonne Université, ACTION Study Group, INSERM UMR_S 1166 and Hôpital Pitié-Salpêtrière (Assistance Publique-Hôpitaux de Paris), Boulevard de l'hôpital, Paris, France
| | - Benjamin Assouline
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Intensive Care Medicine Unit, Division of Intensive Care, Department of Acute Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Matthieu Petit
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Melchior Gautier
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Lucie Le Fevre
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Marc Pineton de Chambrun
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
- Service de Médecine Interne 2, Centre de Référence Lupus Systémique, SAPL et Autres Maladies Auto-immunes et Systémiques Rares, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Guillaume Coutance
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Elodie Berg
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Juliette Chommeloux
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Matthieu Schmidt
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Charles-Edouard Luyt
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Lebreton
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Pascal Leprince
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Chirurgie Cardiaque et Thoracique, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Guillaume Hékimian
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
| | - Alain Combes
- Institute of Cardiometabolism and Nutrition, Sorbonne Université, INSERM, UMRS_1166-ICAN, Paris, France
- Service de Médecine Intensive-Réanimation, Institut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Sorbonne Université, Hôpital Pitié-Salpêtrière, Paris, France
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Bevanda L, Mok V, Lin K, Assayag D, Fisher JH, Johannson KA, Khalil N, Kolb M, Manganas H, Marcoux V, Sadatsafavi M, Wong AW, Ryerson CJ. Validation of a Dyspnea Visual Analog Scale in Fibrotic Interstitial Lung Disease. Ann Am Thorac Soc 2024; 21:1007-1014. [PMID: 38315632 DOI: 10.1513/annalsats.202307-658oc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 02/05/2024] [Indexed: 02/07/2024] Open
Abstract
Rationale: A visual analog scale (VAS) is a simple and easily administered tool for measuring the impact of disease; however, little is known about the use of a dyspnea VAS in interstitial lung disease (ILD). Objectives: To validate the use of a dyspnea VAS in a large and heterogeneous cohort of patients with fibrotic ILD, including its minimal clinically important difference (MCID), responsiveness to change, and prognostic significance. Methods: Patients with fibrotic ILD were identified from a large prospective registry. The validity of a 100-mm dyspnea VAS was assessed by testing its correlation in change score with other measures of ILD severity, including the University of California San Diego Shortness of Breath Questionnaire, the King's Brief Interstitial Lung Disease quality of life questionnaire Breathlessness and Activities Domain, the European Quality of Life VAS, forced vital capacity, and diffusing capacity of the lung for carbon monoxide. The responsiveness of the dyspnea VAS was qualitatively confirmed on the basis of there being an observable difference in the change in dyspnea VAS across tertiles of change in anchor variables. The MCID in dyspnea VAS was calculated using both anchor (linear regression) and distribution (one-half standard deviation) approaches, with anchors including the above variables that had a correlation with dyspnea VAS (|r| ≥ 0.30). The association of dyspnea VAS with time to death or transplant was determined. Results: The cohort included 826 patients with fibrotic ILD, including 127 patients with follow-up measurements at 6 months. The mean baseline dyspnea VAS was 53 ± 24 mm. Dyspnea VAS change scores were moderately correlated with the University of California San Diego Shortness of Breath Questionnaire (|r| = 0.55) and the King's Brief Interstitial Lung Disease quality of life questionnaire Breathlessness and Activities Domain (|r| = 0.44) and weakly correlated with the European Quality of Life VAS (|r| = 0.19), forced vital capacity percent predicted (|r| = 0.21), and diffusing capacity of the lung for carbon monoxide percent predicted (|r| = 0.05). The MCID was 2.7 to 4.5 using the more reliable anchor-based methods and 12.0 based on distribution-based methods. Dyspnea VAS was associated with time to death or transplant in unadjusted models and after adjustment for age and sex (hazard ratios, 1.16 and 1.15, respectively; P < 0.05 for both). Conclusions: This study provides support for the use of the dyspnea VAS in patients with fibrotic ILD, with an estimated anchor-based MCID of 5 mm.
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Affiliation(s)
| | | | | | - Deborah Assayag
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Jolene H Fisher
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Kerri A Johannson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Martin Kolb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Helene Manganas
- Département de Médecine, Centre Hospitalier de L'Université de Montréal, Montreal, Quebec, Canada
| | - Veronica Marcoux
- Department of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; and
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alyson W Wong
- Department of Medicine and
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Christopher J Ryerson
- Department of Medicine and
- Centre for Heart Lung Innovation, St. Paul's Hospital, Vancouver, British Columbia, Canada
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Nabeta T, Galloo X, Tops L, Stassen J, Marsan NA, van der Bijl P, Bax JJ. Significant Mitral Regurgitation After Permanent Right Ventricular Pacemaker Implantation: Prognostic Implications. Am J Cardiol 2024; 222:78-86. [PMID: 38723856 DOI: 10.1016/j.amjcard.2024.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/23/2024]
Abstract
The underlying mechanisms leading to the development of mitral regurgitation (MR) after right ventricular (RV) pacemaker (PM) implantation and its prognostic value have yet to be fully understood. The purpose of this study was to evaluate the prevalence and clinical variables associated with the development of MR after RV pacing and its association with outcomes. A total of 451 patients (mean age 69 ± 15 years, 61% male) who underwent de novo RV PM implantation were included. The development of significant MR, defined as ≥moderate from mild or none/trace at baseline, occurred in 131 (29%) patients at a median of 2.4 years (interquartile range: 1.0 to 3.8 years) after PM implantation. Multivariate logistic regression analysis demonstrated that implantation of a single-chamber PM, left ventricular end-systolic volume index, and the presence of mild MR (vs no MR) at baseline were independently associated with the development of significant MR post-implant. Cardiac events, defined as the composite of all-cause mortality or heart failure hospitalization, occurred in 143 patients (31.7%) during a median follow-up of 5.4 years (interquartile range: 3.0 to 8.1 years). Multivariate Cox regression analysis demonstrated that the development of significant MR was independently related to the occurrence of cardiac events. In conclusion, the development of significant MR after PM implantation is seen in about one-third of recipients and is independently associated with adverse cardiac events.
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Affiliation(s)
- Takeru Nabeta
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Xavier Galloo
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Laurens Tops
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jan Stassen
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Department of Cardiology, Jessa Hospital, Hasselt, Belgium
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Pieter van der Bijl
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands; Heart Centre, University of Turku and Turku University Hospital, Turku, Finland
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47
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Wang J, Li X, Jiang J, Luo Z, Tan X, Ren R, Fujita T, Kashima Y, Tanimura TL, Wang M, Zhang C. Right Ventricular-Pulmonary Arterial Coupling and Outcome in Heart Failure With Preserved Ejection Fraction. Clin Cardiol 2024; 47:e24308. [PMID: 39011838 PMCID: PMC11249816 DOI: 10.1002/clc.24308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 06/02/2024] [Accepted: 06/05/2024] [Indexed: 07/17/2024] Open
Abstract
BACKGROUND Right ventricular-pulmonary artery coupling (RVPAC) refers to the relationship between right ventricular systolic force and afterload. The ratio of echocardiograph-derived tricuspid annular plane systolic excursion (TAPSE) to pulmonary artery systolic pressure (PASP) has been proposed as a noninvasive measurement of RVPAC and reported as an independent prognostic parameter of heart failure. However, it has not been adequately in detail evaluated in heart failure with preserved ejection fraction (HFpEF). We hypothesized that RVPAC may be used and proposed as an expression of key risk factors in patients with HFpEF. METHODS We retrospectively analyzed TAPSE/PASP of 648 HFpEF patients hospitalized in Chongqing Hospital of Traditional Chinese Medicine from January 1, 2016 to January 1, 2017. All eligible patients were followed up for 5 years. The correlation between TAPSE/SPAP index and clinical indicators and outcomes was evaluated. RESULTS The final analysis included 414 patients. Nonsurvivors had significantly lower TAPSE, TAPSE/PASP and higher PASP compared with survivors (p < 0.0001). ROC curve analysis showed that the optimal cutoff of TAPSE, PASP, and RVPAC to predict all-cause death were 16.5 mm, 37.5 mmHg, and 0.45 mm/mmHg, respectively. In multivariate Cox regression analyses adjusted for gender showed a significant, independent association of the RVPAC with the composite endpoint of all-cause death or HF-related recurrent hospitalization (HR: 0.006; 95% CI 0.001-0.057, p < 0.001). CONCLUSIONS RVPAC, defined by the ratio of TAPSE to PASP, is the expression of a key risk factor in HFpEF patients, which is independently associated with the composite endpoint of all-cause death or HF-related recurrent hospitalization.
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Affiliation(s)
- Jia Wang
- Emergency DepartmentWangjing Hospital of China Academy of Chinese Medical SciencesBeijingChina
| | - Xiang Li
- Department of CardiologyChongqing Hospital of Traditional Chinese MedicineChongqingChina
| | - Jiahui Jiang
- Department of CardiologyChongqing Hospital of Traditional Chinese MedicineChongqingChina
| | | | - Xilun Tan
- College of Traditional Chinese MedicineChongqing Medical UniversityChongqingChina
| | - Ruhua Ren
- Emergency DepartmentWangjing Hospital of China Academy of Chinese Medical SciencesBeijingChina
| | - Tsutomu Fujita
- Department of CardiologySapporo Cardio Vascular ClinicSapporoJapan
| | | | | | - Ming Wang
- Department of CardiologyChongqing Hospital of Traditional Chinese MedicineChongqingChina
- College of Traditional Chinese MedicineChongqing Medical UniversityChongqingChina
| | - Chenhao Zhang
- Emergency DepartmentWangjing Hospital of China Academy of Chinese Medical SciencesBeijingChina
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48
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Agricola E, Fiore G. Right ventricular function profits from tricuspid regurgitation reduction following tricuspid transcatheter edge-to-edge repair: When is it never too late? Eur J Heart Fail 2024; 26:1628-1630. [PMID: 38837860 DOI: 10.1002/ejhf.3332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Revised: 05/07/2024] [Accepted: 05/27/2024] [Indexed: 06/07/2024] Open
Affiliation(s)
- Eustachio Agricola
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Vita Salute University San Raffaele, Milan, Italy
| | - Giorgio Fiore
- Cardiovascular Imaging Unit, Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
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49
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Tolvaj M, Kovács A, Radu N, Cascella A, Muraru D, Lakatos B, Fábián A, Tokodi M, Tomaselli M, Gavazzoni M, Perelli F, Merkely B, Badano LP, Surkova E. Significant Disagreement Between Conventional Parameters and 3D Echocardiography-Derived Ejection Fraction in the Detection of Right Ventricular Systolic Dysfunction and Its Association With Outcomes. J Am Soc Echocardiogr 2024; 37:677-686. [PMID: 38641069 DOI: 10.1016/j.echo.2024.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 03/19/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
AIMS Conventional echocardiographic parameters such as tricuspid annular plane systolic excursion (TAPSE), fractional area change (FAC), and free-wall longitudinal strain (FWLS) offer limited insights into the complexity of right ventricular (RV) systolic function, while 3D echocardiography-derived RV ejection fraction (RVEF) enables a comprehensive assessment. We investigated the discordance between TAPSE, FAC, FWLS, and RVEF in RV systolic function grading and associated outcomes. METHODS We analyzed two- and three-dimensional echocardiography data from 2 centers including 750 patients followed up for all-cause mortality. Right ventricular dysfunction was defined as RVEF <45%, with guideline-recommended thresholds (TAPSE <17 mm, FAC <35%, FWLS >-20%) considered. RESULTS Among patients with normal RVEF, significant proportions exhibited impaired TAPSE (21%), FAC (33%), or FWLS (8%). Conversely, numerous patients with reduced RVEF had normal TAPSE (46%), FAC (26%), or FWLS (41%). Using receiver-operating characteristic analysis, FWLS exhibited the highest area under the curve of discrimination for RV dysfunction (RVEF <45%) with 59% sensitivity and 92% specificity. Over a median 3.7-year follow-up, 15% of patients died. Univariable Cox regression identified TAPSE, FAC, FWLS, and RVEF as significant mortality predictors. Combining impaired conventional parameters showed that outcomes are the worst if at least 2 parameters are impaired and gradually better if only one or none of them are impaired (log-rank P < .005). CONCLUSION Guideline-recommended cutoff values of conventional echocardiographic parameters of RV systolic function are only modestly associated with RVEF-based assessment. Impaired values of FWLS showed the closest association with the RVEF cutoff. Our results emphasize a multiparametric approach in the assessment of RV function, especially if 3D echocardiography is not available.
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Affiliation(s)
- Máté Tolvaj
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary; Department of Experimental Cardiology and Surgical Techniques, Semmelweis University, Budapest, Hungary.
| | - Noela Radu
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Carol Davila University of Medicine and Pharmacy, Prof. Dr. C. C. Iliescu Institute, Bucharest, Romania
| | - Andrea Cascella
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Denisa Muraru
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Bálint Lakatos
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Márton Tokodi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Michele Tomaselli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Mara Gavazzoni
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Francesco Perelli
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Luigi P Badano
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy; Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy
| | - Elena Surkova
- Royal Brompton and Harefield Hospitals, Part of Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; National Heart and Lung Institute, Imperial College London, London, United Kingdom
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50
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Tsolaki V, Parisi K, Zakynthinos GE, Gerovasileiou E, Karavidas N, Vazgiourakis V, Zakynthinos E, Makris D. Septic cardiomyopathy phenotype in the critically ill may depend on antimicrobial resistance. JOURNAL OF INTENSIVE MEDICINE 2024; 4:355-361. [PMID: 39035619 PMCID: PMC11258503 DOI: 10.1016/j.jointm.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 11/23/2023] [Accepted: 11/24/2023] [Indexed: 07/23/2024]
Abstract
Background Sepsis is a life-threatening organ dysfunction, and septic cardiomyopathy (SCM) may complicate the course of the disease. Infection with multidrug-resistant (MDR) pathogens has been linked with worse outcomes. This study aims to evaluate SCM in patients with infections caused by different antimicrobial-resistant phenotypes. Method This retrospective study included patients with sepsis/septic shock, hospitalized, and intubated in the intensive care unit of the University Hospital of Larissa between January 2022 and September 2023 with echocardiographic data during the first two days after infection onset. The patients were divided into two groups: non-MDR-SCM group and MDR-SCM group. The cardiac function was compared between the two groups. Result A total of 62 patients were included in the study. Forty-four patients comprised the MDR-SCM and 18 the non-MDR-SCM group. Twenty-six patients (41.9%) presented with left ventricular (LV) systolic dysfunction, and ≤35% right ventricular fractional area change (RVFAC) was present in 56.4%. LV systolic function was more severely impaired in the non-MDR-SCM group (left ventricular ejection fraction, 35.8% ±4.9% vs. 45.6%±2.4%, P=0.049; LV outflow tract velocity time integral, [10.1±1.4] cm vs. [15.3±0.74] cm, P=0.001; LV-Strain, -9.02%±0.9% vs. -14.02%±0.7%, P=0.001). The MDR-SCM group presented with more severe right ventricular (RV) dilatation (right ventricular end-diastolic area/left ventricular end-diastolic area, 0.81±0.03 vs. 0.7±0.05, P=0.042) and worse RV systolic function (RVFAC, 32.3%±1.9% vs. 39.6%±2.7%, P=0.035; tricuspid annular plane systolic excursion, [15.9±0.9] mm vs. [18.1±0.9] mm, P=0.165; systolic tissue Doppler velocity measured at the lateral tricuspid annulus, [9.9±0.5] cm/s vs. [13.1±0.8] cm/s, P=0.002; RV-strain, -11.1%±0.7% vs. -15.1%±0.9%, P=0.002). Conclusion SCM related to MDR infection presents with RV systolic dysfunction predominance, while non-MDR-SCM is mainly depicted with LV systolic dysfunction impairment.
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Affiliation(s)
- Vasiliki Tsolaki
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Kyriaki Parisi
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece
| | | | - Efrosini Gerovasileiou
- Respiratory Department, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Nikitas Karavidas
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Vassileios Vazgiourakis
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Epaminondas Zakynthinos
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece
| | - Demosthenes Makris
- Intensive Care Unit, University Hospital of Larissa, University of Thessaly Faculty of Medicine, Larissa, Greece
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