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Bansal PB, Zaidi AN, Bansal N, Stern KWD, Mahgerefteh J. Impact of Obesity on Ventriculo-Arterial Interaction in Patients After Coarctation of Aorta repair. Pediatr Cardiol 2024; 45:1301-1307. [PMID: 36690764 DOI: 10.1007/s00246-023-03104-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 01/13/2023] [Indexed: 01/25/2023]
Abstract
Survival of patients after repair of coarctation of Aorta (CoA) has improved significantly over the decades, but patients have decreased life expectancy as compared to the general population. This has been attributed to increased hypertension, cerebrovascular disease, and coronary artery disease. There has also been an increasing concern of overweight and obesity in patients with adult congenital heart disease. While there have been studies looking at the impact of long-term hypertension on myocardial performance and outcomes in this population, this study aims to assess the impact of obesity in these patients on their myocardial performance. Ventriculo-arterial coupling is used as a measure of myocardial performance which reflects the interaction between cardiac contractility and arterial elastance. Patients after CoA repair are known to have hypertension affecting the arterial elastance. Obesity affects cardiac contractility as well. This study demonstrated that in a group of young patients after CoA repair, body mass index (BMI) has a relationship with left ventricular (LV) contractility and myocardial performance. This relationship was independent of blood pressure. BMI itself was not seen to affect the determinants of diastolic function in this study, suggesting that LV contractility may be affected before one can notice a change in the diastolic function secondary to BMI.
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Affiliation(s)
| | - Ali N Zaidi
- Icahn School of Medicine at Mount Sinai, New York, USA
| | - Neha Bansal
- Icahn School of Medicine at Mount Sinai, New York, USA
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2
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You JY, Sato R, Chawla S, Kapoor A, Wang X, Collier P, Auzinger G, Duggal A, Dugar S. Hemodynamic profile of cirrhotic patients with sepsis and septic shock: A propensity score matched case-control study. J Crit Care 2024; 81:154532. [PMID: 38330737 DOI: 10.1016/j.jcrc.2024.154532] [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: 09/26/2023] [Revised: 01/15/2024] [Accepted: 02/01/2024] [Indexed: 02/10/2024]
Abstract
PURPOSE Our understanding of hemodynamics in cirrhotic patients with sepsis remains limited. Our study aims to investigate differences in hemodynamic profiles using echocardiography between septic patients with and without cirrhosis. MATERIALS AND METHODS This is a single-center, retrospective study of septic patients with echocardiogram within 3 days of ICU admission. We compared baseline characteristics, echocardiographic markers of LV systolic function arterial load between patients with and without cirrhosis. A propensity score-matched case-control model was developed to describe the differences in those echocardiography derived parameters between the groups. RESULTS 3151 patients with sepsis were included of which 422 (13%) had cirrhosis. In the propensity score matched group with 828 patients, cirrhotic patients had significantly higher left ventricular ejection fraction (64 vs.56%, p < 0.001) and stroke volume (72 vs.48 ml, p < 0.001) along with lower arterial elastance (Ea) (1.35 1vs.20.3, p < 0.001) and systemic vascular resistance (SVR) (851 vs.1209 dynes/s/m-5, p = 0.001). The left ventricular elastance (Ees) (2.83 vs 2.45, p = 0.002) was higher and ventricular-arterial coupling (Ea/Ees) (0.48 vs. 0.86, p < 0.001) lower in cirrhotic compared to non-cirrhotic. CONCLUSIONS Septic patients with cirrhosis had higher LVEF with lower Ea and SVR with higher Ees and significantly lower Ea/Ees suggesting vasodilation as the principal driver of the hyperdynamic profile in cirrhosis.
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Affiliation(s)
- Jee Young You
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Ryota Sato
- Division of Critical Care Medicine, Department of Medicine, The Queen's Medical Center, Honolulu, HI, USA.
| | - Sanchit Chawla
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Aanchal Kapoor
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Xiaofeng Wang
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
| | - Patrick Collier
- Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Georg Auzinger
- Department of Critical Care, Cleveland Clinic London, London, UK; Reader in Critical Care King's College London, London, UK; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA.
| | - Abhijit Duggal
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA.
| | - Siddharth Dugar
- Department of Critical Care Medicine, Respiratory Institute, Cleveland Clinic, Cleveland, OH, USA; Cleveland Clinic Lerner College of Medicine, Case Western University Reserve University, Cleveland, OH, USA.
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Nawaytou HM, Mertens LL. Noninvasive Assessment of Myocardial Work in Children. J Am Soc Echocardiogr 2024:S0894-7317(24)00217-7. [PMID: 38719130 DOI: 10.1016/j.echo.2024.04.012] [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: 04/22/2024] [Revised: 04/29/2024] [Accepted: 04/29/2024] [Indexed: 06/07/2024]
Abstract
The noninvasive assessment of ventricular function is an ongoing challenge, with new tools and measurements always being considered and tested. The noninvasive assessment of myocardial work via the pressure-strain relationship is one of the newer tools proposed to evaluate ventricular systolic function. However, prior to using any new tool, one should understand its properties, utility, and limitations. In this commentary we focus on the noninvasive assessment of myocardial work via the pressure-strain relationship from a pediatric point of view. We address the current knowledge and limitations and propose future directions to better understand this tool.
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Affiliation(s)
- Hythem M Nawaytou
- Department of Pediatrics, Division of Cardiology, University of California San Francisco, San Francisco, California.
| | - Luc L Mertens
- Department of Cardiology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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Oberhoffer FS, Li P, Jakob A, Dalla-Pozza R, Haas NA, Mandilaras G. Energy Drinks Decrease Left Ventricular Efficiency in Healthy Children and Teenagers: A Randomized Trial. SENSORS (BASEL, SWITZERLAND) 2022; 22:7209. [PMID: 36236307 PMCID: PMC9572576 DOI: 10.3390/s22197209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/17/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Background: Minors are considered the main consumer group of energy drinks (EDs). The aim of this study was to investigate the acute effects of ED consumption on left ventricular (LV) hemodynamics and efficiency in healthy children and teenagers. Methods: This study was a randomized, single-blind, placebo-controlled, crossover clinical trial. Study participants consumed a weight-adjusted amount of an ED or a placebo on two consecutive days. LV hemodynamics and efficiency parameters were evaluated non-invasively by generating LV pressure−volume loops (PVLs) through simultaneous echocardiography and blood pressure measurement. Results: A total of 24 children and teenagers (14.90 ± 2.27 years, 13 male) were included in the present study. Conventional echocardiographic parameters of LV function did not show significant differences between both beverage groups. The non-invasive generation of LV PVLs revealed a significantly lower cardiac efficiency 240 min after the ED consumption compared to the placebo intake (140.72 (133.21−149.73) mmHg vs. 135.60 (124.78−140.33) mmHg, p < 0.01). Conclusions: Acute ED consumption is associated with a significantly lower cardiac efficiency in healthy minors. The generation of non-invasive LV PVLs might be beneficial in the assessment of subtle changes in LV efficiency. Further studies need to investigate the influence of chronic ED consumption on LV function and morphology.
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Meloni A, De Luca A, Nugara C, Vaccaro M, Cavallaro C, Cappelletto C, Barison A, Todiere G, Grigoratos C, Calvi V, Novo G, Grigioni F, Emdin M, Sinagra G, Pepe A. Pressure-volume relationship by pharmacological stress cardiovascular magnetic resonance. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:853-861. [PMID: 34787731 DOI: 10.1007/s10554-021-02464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
The variation between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an index of myocardial contractility, easily obtained during routine stress echocardiography and never tested during dipyridamole stress-cardiac magnetic resonance (CMR). We assessed the ΔESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR. One-hundred consecutive patients (24 females, 63.76 ± 10.17 years) were considered. ESPVR index was evaluated at rest and stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson's method. The ΔESPVR index showed a good inter-operator reproducibility. Mean ΔESPVR index was 0.48 ± 1.45 mmHg/mL/m2. ΔESPVR index was significantly lower in males than in females. ΔESPVR index was not correlated to rest left ventricular end-diastolic volume index or ejection fraction. Forty-six of 85 patients had myocardial fibrosis detected by the late gadolinium enhancement technique and they showed significantly lower ΔESPVR values. An abnormal stress CMR was found in 25 patients and they showed significantly lower ΔESPVR values. During a mean follow-up of 56.34 ± 30.04 months, 24 cardiovascular events occurred. At receiver-operating characteristic curve analysis, a ΔESPVR < 0.02 mmHg/mL/m2 predicted the presence of future cardiac events with a sensitivity of 0.79 and a specificity of 0.68. The noninvasive assessment of the ΔESPVR index during a dipyridamole stress-CMR exam is feasible and reproducible. The ΔESPVR index was independent from rest LV dimensions and function and can be used for a comparative assessment of patients with different diseases. ΔESPVR index by CMR can be a useful and simple marker for additional prognostic stratification.
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Affiliation(s)
- Antonella Meloni
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Antonio De Luca
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste, Trieste, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cinzia Nugara
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
- IRCSS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Maria Vaccaro
- Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Camilla Cavallaro
- Cardiovascular Department, University Campus Bio-Medico, Roma, Italy
| | - Chiara Cappelletto
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste, Trieste, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Barison
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Giancarlo Todiere
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Chrysanthos Grigoratos
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Valeria Calvi
- Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuseppina Novo
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
| | | | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gianfranco Sinagra
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy.
- Department of Medicine, Institute of Radiology, University of Padua, Padua, Italy.
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Antohi EL, Chioncel O, Mihaileanu S. Overcoming the Limits of Ejection Fraction and Ventricular-Arterial Coupling in Heart Failure. Front Cardiovasc Med 2022; 8:750965. [PMID: 35127846 PMCID: PMC8813963 DOI: 10.3389/fcvm.2021.750965] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Accepted: 12/21/2021] [Indexed: 12/25/2022] Open
Abstract
Left ventricular ejection fraction (LVEF) and ventricular-arterial coupling (VAC) [VAC = Ea/Ees; Ea: effective arterial elastance; Ees: left ventricle (LV) elastance] are both dimensionless ratios with important limitations, especially in heart failure setting. The LVEF to VAC relationship is a divergent non-linear function, having a point of intersection at the specific value of 0.62, where V0 = 0 ml (V0: the theoretical extrapolated value of the volume-axis intercept at end-systolic pressure 0 mmHg). For the dilated LV, both LVEF and VAC are highly dependent on V0 which is inconclusive when derived from single-beat Ees formulas. VAC simplification should be avoided. Revisiting the relationship between systolic time intervals (STI), pressure, and volumes could provide simple-to-use guiding formulas, affordable for daily clinical practice. We have analyzed by echocardiography the hemodynamics of 21 patients with severe symptomatic heart failure with reduced ejection (HFrEF) compared to 12 asymptomatic patients (at risk of heart failure with mild structural disease). The groups were unequivocally separated by ‘classic’ measures (LVEF, LV end-systolic volume (ESV), LV mass, STI). Chen's Ees formula was weakly correlated with LVEF and indexed ESV (ESVi) but better correlated to the pre-ejection period (PEP); PEP/total ejection time (PEP/TET); systolic blood pressure/PEP (SBP/PEP) (P < 0.001). Combining the predictability of the LVEF to the determinant role of SBP/PEP on the Ees variations, we obtained: (SBP*LVEF)/PEP mm Hg/ms, with an improved R2 value (R2 = 0.848; P < 0.001). The strongest correlations to VAC were for LVEF (R = −0.849; R2 = 0.722) and PEP/TET (R = 0.925; R2 = 0.857). By multiple regression, the VAC was strongly predicted (N = 33): (R = 0.975; R2 = 0.95): VAC = 0.553–0.009*LVEF + 3.463*PEP/TET, and natural logarithm: Ln (VAC) = 0.147–1.4563*DBP/SBP*0.9–0.010*LVEF + 4.207*PEP/TET (R = 0.987; R2 = 0.975; P = 0) demonstrating its exclusive determinants: LVEF, PEP/TET, and DBP/SBP. Considering Ea as a known value, the VAC-derived Ees formula: Ees_d ≈ Ea/(0.553–0.009*LVEF+3.463*PEP/TET) was strongly correlated to Chen's Ees formula (R = 0.973; R2 = 0.947) being based on SBP, ESV, LVEF, and PEP/TET and no exponential power. Thus, the new index supports our hypothesis, in the limited sample of patients with HFrEF. Indices like SBP/PEP, (SBP*LVEF)/PEP, PEP/TET, and DBP/SBP deserve further experiments, underlining the major role of the forgotten STI.
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Affiliation(s)
- Elena-Laura Antohi
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu”, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
- *Correspondence: Elena-Laura Antohi
| | - Ovidiu Chioncel
- Emergency Institute for Cardiovascular Diseases “Prof. Dr. C.C. Iliescu”, Bucharest, Romania
- “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
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Chowdhury SM, Graham EM, Taylor CL, Savage A, McHugh KE, Gaydos S, Nutting AC, Zile MR, Atz AM. Diastolic Dysfunction With Preserved Ejection Fraction After the Fontan Procedure. J Am Heart Assoc 2022; 11:e024095. [PMID: 35023347 PMCID: PMC9238510 DOI: 10.1161/jaha.121.024095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023]
Abstract
Background Heart failure phenotyping in single-ventricle Fontan patients is challenging, particularly in patients with normal ejection fraction (EF). The objective of this study was to identify Fontan patients with abnormal diastolic function, who are high risk for heart failure with preserved ejection fraction (HFpEF), and characterize their cardiac mechanics, exercise function, and functional health status. Methods and Results Data were obtained from the Pediatric Heart Network Fontan Cross-sectional Study database. EF was considered abnormal if <50%. Diastolic function was defined as abnormal if the diastolic pressure:volume quotient (lateral E:e'/end-diastolic volume) was >90th percentile (≥0.26 mL-1). Patients were divided into: controls=normal EF and diastolic function; systolic dysfunction (SD) = abnormal EF with normal diastolic function; diastolic dysfunction (DD) = normal EF with abnormal diastolic pressure:volume quotient. Exercise function was quantified as percent predicted peak VO2. Physical Functioning Summary Score (FSS) was reported from the Child Health Questionnaire. A total of 239 patients were included, 177 (74%) control, 36 (15%) SD, and 26 (11%) DD. Median age was 12.2 (5.4) years. Arterial elastance, a measure of arterial stiffness, was higher in DD (3.6±1.1 mm Hg/mL) compared with controls (2.5±0.8 mm Hg/mL), P<0.01. DD patients had lower predicted peak VO2 compared with controls (52% [20] versus 67% [23], P<0.01). Physical FSS was lower in DD (45±13) and SD (44±13) compared with controls (50±7), P<0.01. Conclusions Fontan patients with abnormal diastolic function and normal EF have decreased exercise tolerance, decreased functional health status, and elevated arterial stiffness. Identification of patients at high risk for HFpEF is feasible and should be considered when evaluating Fontan patients.
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Affiliation(s)
- Shahryar M. Chowdhury
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Eric M. Graham
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Carolyn L. Taylor
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Andrew Savage
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Kimberly E. McHugh
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Stephanie Gaydos
- Division of CardiologyDepartment of MedicineMedical University of South CarolinaCharlestonSC
| | - Arni C. Nutting
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
| | - Michael R. Zile
- Division of CardiologyDepartment of MedicineMedical University of South CarolinaCharlestonSC
| | - Andrew M. Atz
- Division of CardiologyDepartment of PediatricsMedical University of South CarolinaCharlestonSC
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Bischoff AR, Stanford AH, McNamara PJ. Short-term ventriculo-arterial coupling and myocardial work efficiency in preterm infants undergoing percutaneous patent ductus arteriosus closure. Physiol Rep 2021; 9:e15108. [PMID: 34806325 PMCID: PMC8606853 DOI: 10.14814/phy2.15108] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 01/21/2023] Open
Abstract
Definitive closure of a patent ductus arteriosus (PDA) causes significant changes in loading conditions of the left ventricle (LV) which can lead to cardiorespiratory instability including hypotension, low cardiac output, oxygenation, and ventilation impairment. Physiological insights of the adaptation of the LV can be gained by looking at ventriculo-arterial coupling (VAC) and myocardial work-energetics. We conducted a retrospective cohort study of preterm infants with echocardiographic assessment of VAC parameters, including end-systolic and arterial elastance (EES , EA ), and myocardial work indices derived from longitudinal strain analysis before and 1-h after percutaneous PDA closure. A total of 35 patients were included with mean [±SD] age at intervention of 30.8 ± 9.9 days and median [IQR] weight of 1130 [995, 1318] grams. There was a reduction in preload and stroke volume, an increase in EA (38.6 ± 11.4 vs. 60 ± 15.1 mmHg/ml/kg, p < 0.001) and in EES (72 [61.5, 109.8] vs. 91.6 [72.2, 125.2] mmHg/ml/kg, p = 0.003) post-closure. Myocardial work indices reduced after PDA closure, including global work efficiency (93.9 ± 2.3 vs. 91.1 ± 3.6%, p < 0.001). A total of 17 (48.6%) patients developed post-closure instability which was associated with younger age, lower preload, and higher EA and EES . Percutaneous PDA closure is associated with major short-term changes in VAC and myocardium energetics, which may provide novel insights on the physiology of PDA closure and on the differential vulnerability to changes in loading conditions.
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Affiliation(s)
- Adrianne R. Bischoff
- Division of NeonatologyDepartment of PediatricsUniversity of IowaIowa CityIowaUSA
| | - Amy H. Stanford
- Division of NeonatologyDepartment of PediatricsUniversity of IowaIowa CityIowaUSA
| | - Patrick J. McNamara
- Division of NeonatologyDepartment of PediatricsUniversity of IowaIowa CityIowaUSA
- Department of Internal MedicineUniversity of IowaIowa CityIowaUSA
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Fialho GL, Wolf P, Walz R, Lin K. Left ventricle end-systolic elastance, arterial-effective elastance, and ventricle-arterial coupling in Epilepsy. Acta Neurol Scand 2021; 143:34-38. [PMID: 32772359 DOI: 10.1111/ane.13334] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVE Sudden unexpected death in epilepsy (SUDEP) is a tragic event. Cardiac models of sudden death state that, paradoxically, healthy individuals compose most of the victims of this event. Exploration of cardiac physiological variables related to outcome could help unveil risk markers for sudden death in epilepsy. We investigated left ventricle end-systolic elastance, arterial-effective elastance and ventricle-arterial coupling (VAC) in PWE compared with controls. MATERIAL & METHODS Adult patients with temporal lobe epilepsy without known cardiovascular diseases were submitted to treadmill test and transthoracic echocardiogram. Individuals without epilepsy matched by sex, age, and body mass index composed the control group. Cardiac risk factors, exercise performance, autonomic data from treadmill test, systolic and diastolic function, morphological cardiac data, and left ventricle pressure-volume loop were recorded. RESULTS Sixty subjects were consecutively enrolled (30 PWE and 30 controls). Epilepsy duration was 22.5 ± 10.7 years (age of onset 15.2 ± 10.1 years). Treadmill variables were significantly worse in TLE patients compared with controls. End-systolic elastance, arterial-effective elastance, and ventricle-arterial coupling were similar between groups. Female sex, percentage of maximal predicted heart rate achieved in exercise, exercise time, and epilepsy duration explained 28,4% of VAC in PWE in multiple stepwise linear regression (P = .018). CONCLUSIONS Some aspects of the cardiac pressure-volume curves, mainly linked to left ventricle systolic performance, contractile function and their interaction with afterload appears normal in young PWE and cannot explain their increase risk to adverse outcomes or lower physical fitness.
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Affiliation(s)
- Guilherme L. Fialho
- Cardiology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
| | - Peter Wolf
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Neurology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Danish Epilepsy Centre Dianalund Denmark
| | - Roger Walz
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Neurology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Center for Applied Neurosciences (CeNAp) Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
| | - Katia Lin
- Medical Sciences Post‐graduate Program Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Neurology Division Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
- Center for Applied Neurosciences (CeNAp) Federal University of Santa Catarina, (UFSC) Florianópolis Brazil
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Matsuoka R, Muneuchi J, Nagatomo Y, Sugitani Y, Ezaki H, Doi H, Watanabe M. Headache and Left Ventricular Efficiency After Transcatheter Closure of Atrial Septal Defect. Headache 2020; 60:2421-2430. [PMID: 33045096 DOI: 10.1111/head.13990] [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: 06/13/2020] [Revised: 08/12/2020] [Accepted: 08/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE/BACKGROUND This study aimed to clarify the relationship between migraine-like headache and ventriculo-arterial coupling after transcatheter closure of the atrial septal defect in children. We hypothesized that migraine headache after defect closure would be related to an abnormal hemodynamic response against an increased left ventricular filling. DESIGN A retrospective cohort study. METHODS We calculated the end-ventricular systolic elastance (Ees), effective arterial elastance (Ea), and ventricular energy efficiency approximated based on echocardiography before and after defect closure, and compared these parameters between the subjects with and without headache after defect closure. RESULTS A total of 167 subjects were studied. Age at the procedure, defect diameter, and pulmonary to systemic blood flow ratio were 11 (9-17) years, 12.8 (9.2-16.0) mm, and 1.8 (1.6-2.3), respectively. We identified 47 (28%) subjects with migraine headache after defect closure. Although there was no significant difference in the Ees, Ea, and ventricular energy efficiency before defect closure between the groups, the Ees (4.0 [3.4-4.9] vs 4.8 [3.7-6.1], P = .014) and ventricular energy efficiency (0.79 [0.76-0.82] vs 0.83 [0.79-0.85], P = .001) after defect closure in subjects with headache were significantly lower than those in subjects without headache. Migraine headache after defect closure was significantly associated with age (odds ratio: 0.97, 95% confidential interval: 0.94-1.00, P = .036) and a decrease in the ventricular energy efficiency after defect closure (odds ratio: 6.42, 95% confidential interval: 2.76-14.90, P < .001). CONCLUSION A loss of ventricular energy efficiency was common in pediatric subjects with migraine-like headache after transcatheter closure of the atrial septal defect, which suggested that the left ventricular function maladaptation was related to headache development after defect closure. We advocate that an impaired ventriculo-arterial coupling may be one of the mechanisms for developing attacks in not only this population but also in other patients with migraine.
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Affiliation(s)
- Ryohei Matsuoka
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Jun Muneuchi
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Yusaku Nagatomo
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan.,Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Sugitani
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Hiroki Ezaki
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Hirohito Doi
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
| | - Mamie Watanabe
- Department of Pediatrics, Japan Community Healthcare Organization Kyusyu Hospital, Kitakyusyu, Japan
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11
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Winkler C, Neidlin M, Sonntag SJ, Grünwald A, Groß-Hardt S, Breuer J, Linden K, Herberg U. Estimation of left ventricular stroke work based on a large cohort of healthy children. Comput Biol Med 2020; 123:103908. [PMID: 32768048 DOI: 10.1016/j.compbiomed.2020.103908] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/04/2020] [Accepted: 07/04/2020] [Indexed: 11/19/2022]
Abstract
Left ventricular stroke work is an important prognostic marker to analyze cardiac function. Standard values for children are, however, missing. For clinicians, standards can help to improve the treatment decision of heart failures. For engineers, they can help to optimize medical devices. In this study, we estimated the left ventricular stroke work for children based on modeled pressure-volume loops. A lumped parameter model was fitted to clinical data of 340 healthy children. Reference curves for standard values were created over age, weight, and height. Left ventricular volume was measured with 3D echocardiography, while maximal ventricular pressure was approximated with a regression model from the literature. For validation of this method, we used 18 measurements acquired by a conductance catheter in 11 patients. The method demonstrated a low absolute mean difference of 0.033 J (SD: 0.031 J) for stroke work between measurement and estimation, while the percentage error was 21.66 %. According to the resulting reference curves, left ventricular stroke work of newborns has a median of 0.06 J and increases to 1.15 J at the age of 18 years. Stroke work increases over weight and height in a similar trend. The percentile curves depict the distribution. We demonstrate how reference curves can be used for quantification of differences and comparison in patients.
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Affiliation(s)
- Christian Winkler
- Department of Pediatric Cardiology, University Hospital of Bonn, Germany.
| | - Michael Neidlin
- Department of Mechanical Engineering, National Technical University of Athens, Greece; Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Germany
| | | | - Anna Grünwald
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Germany
| | - Sascha Groß-Hardt
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Helmholtz Institute, Medical Faculty, RWTH Aachen University, Germany
| | - Johannes Breuer
- Department of Pediatric Cardiology, University Hospital of Bonn, Germany
| | - Katharina Linden
- Department of Pediatric Cardiology, University Hospital of Bonn, Germany
| | - Ulrike Herberg
- Department of Pediatric Cardiology, University Hospital of Bonn, Germany
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12
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Iacobelli R, Ricci Z, Marinari E, Haiberger R, Di Molfetta A, Toscano A, Di Chiara L. Effects of levosimendan on ventriculo-arterial coupling and cardiac efficiency in paediatric patients with single-ventricle physiology after surgical palliation: retrospective study. Interact Cardiovasc Thorac Surg 2020; 30:623-629. [PMID: 31986196 DOI: 10.1093/icvts/ivz319] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/12/2019] [Accepted: 12/19/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
OBJECTIVES
The use of levosimendan for paediatric patients with low cardiac output after congenital heart surgery has been recently described. We sought to evaluate ventriculo-arterial coupling (VAC) and other ventricular energetic parameters before and after 72 h from levosimendan start in infants with single-ventricle physiology and cardiac failure after palliation with Norwood or hybrid procedures.
METHODS
In this single-centre retrospective study, 9 consecutive patients affected by hypoplastic left heart syndrome-like anatomy were retrospectively analysed. Systolic elastance, diastolic elastance, arterial elastance, VAC and cardiac mechanical efficiency were calculated by measuring, through 2-dimensional echocardiography, end-systolic volume and end-diastolic volume and by recording mean arterial pressure and central venous pressure.
RESULTS
The median (range) weight and age were 2.8 (2.3–6) kg and 16.5 (6–116) days, respectively. After 72 h from levosimendan start, end-systolic volume significantly decreased (−1 ml, −3.2 to −0.1, P = 0.007), whereas mean arterial pressure and end-diastolic volume remained stable. Heart rate showed a significant decrease (−28 beats/min, −41 to 22, P = 0.008). Systolic elastance (2.9 mmHg/ml, 0.4–5.4, P = 0.008), arterial elastance (−5.9, −24 to −0.5, P = 0.038), VAC (−0.86, −1.5 to −0.16, P = 0.009) and cardiac mechanical efficiency (0.18, 0.03–0.22, P = 0.008) differences also showed significant modifications.
CONCLUSIONS
In a small case series of patients with single-ventricle physiology, levosimendan showed to improve contractility and optimize VAC, with a reduction of heart rate. Monitoring of VAC and ventricular energetics can be an interesting aspect to improve the management of heart failure in infants with univentricular anatomy.
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Affiliation(s)
- Roberta Iacobelli
- Pediatric Cardiology Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Zaccaria Ricci
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Eleonora Marinari
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Roberta Haiberger
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Arianna Di Molfetta
- Department of Cardiac Surgery, Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alessandra Toscano
- Pediatric Cardiology Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Luca Di Chiara
- Pediatric Cardiac Intensive Care Unit, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children’s Hospital, Rome, Italy
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13
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Left ventricular remodelling among Turner syndrome patients: insights from non-invasive 3D echocardiography-derived pressure-volume loop analysis. Clin Res Cardiol 2019; 109:892-903. [PMID: 31786629 DOI: 10.1007/s00392-019-01579-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 11/20/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Turner syndrome (TS) is a X-chromosomal disease affecting one in 2500-3000 female newborns. TS individuals are at high cardiovascular risk and more likely to be overweight or obese. The aim of this study was to assess left ventricular performance in TS patients through three-dimensional speckle tracking echocardiography (3DSTE) and non-invasive left ventricular pressure-volume loop (PVL) analysis. Moreover, this study focused on the impact of excess weight on the left ventricular efficiency in TS patients. METHODS Thirty-six TS patients and 19 healthy age-matched controls were included in this study. 3DSTE and non-invasive left ventricular PVL analysis were performed and left ventricular efficiency parameters were calculated. RESULTS TS patients had significantly lower values than controls in longitudinal strain (- 16.67 ± 3.23% vs. - 18.47 ± 1.87%; p = 0.029), but significantly higher values for arterial elastance (BSA) (3.31, 1.87-5.88 mmHg/mL vs. 2.99, 2.31-4.61 mmHg/mL; p = 0.011) and cardiac work (BSA) (292,070 ± 71,348 mmHg*mL*HR vs. 248,595 ± 70,510 mmHg*mL*HR; p = 0.036). Compared with normal weight patients, overweight and obese TS subjects demonstrated worse left ventricular efficiency (175.08 ± 17.73 mmHg vs. 157.24 ± 26.75 mmHg; p = 0.037). Even after excluding TS patients with cardiovascular morbidity, arterial elastance (BSA) was compared to healthy peers, significantly increased in TS patients. CONCLUSIONS 3DSTE and non-invasive left ventricular PVL analysis might be useful tools to detect early cardiac changes in TS. Arterial elastance seems to be significantly increased in TS patients, independent of cardiovascular morbidity. Compared with normal weight TS patients, overweight/obese TS patients displayed lower left ventricular efficiency.
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14
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Nguyen M, Berhoud V, Bartamian L, Martin A, Ellouze O, Bouhemad B, Guinot PG. Agreement between different non-invasive methods of ventricular elastance assessment for the monitoring of ventricular-arterial coupling in intensive care. J Clin Monit Comput 2019; 34:893-901. [PMID: 31599374 DOI: 10.1007/s10877-019-00397-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/01/2019] [Indexed: 01/03/2023]
Abstract
Ventricular-arterial coupling is calculated as the arterial elastance to end systolic elastance ratio (EA/Ees). Although the gold standard is invasive pressure volume loop analysis, Chen method is the clinical reference non-invasive method for estimating end systolic elastance (Ees). Several simplified methods calculate Ees from the end systolic pressure to volume ratio (ESP/ESV). The objective of the present study was to determine whether ESP/ESV simplification can be used instead of the Chen formula to measure ventricular-arterial coupling and to monitor changes following therapeutic intervention. In this retrospective, single-center study, 3 non-invasive EA/Ees calculation methods were applied to 86 cardiac ICU patients. The Chen method was used as the reference method. Ees was also calculated according to method 1: Ees1 = 0.9 × SAP/ESV and method 2: Ees2= EA/(1/LVEF) - 1. EA was estimated as 0.9 × SAP/SV (mmHg ml-1). After simplification: EA/Ees1 = EA/Ees2 = (1/LVEF) - 1, with the stroke volume estimated as the product of the aortic velocity-time integral (VTIAo) and the aortic area or as the difference between the end diastolic volume (EDV) and the ESV. All patients received fluid infusion, norepinephrine, or dobutamine. At baseline, the concordance correlation coefficient with EA/EesChen was 0.13 [- 0.07; 0.31] for EA/Ees1 and 0.32 [0.19; 0.44] for EA/Ees2. Bias and limit of agreement were 0.28 [- 0.02; 0.36] and [- 5.8; 2.6] for EA/Ees1 and of 0.44 [0.31; 0.53] and [- 3.2; 2.6] for EA/Ees2. When used to follow variations in EA/Ees following therapeutic interventions, only 65% (for EA/Ees1) and 70% (for EA/Ees2) of measures followed the same trend as EA/EesChen. Our results do not support the use of ESP/ESV based method as substitute for Chen method to measure and assess changes in ventriculo-arterial coupling (EA/Ees) in cardiac intensive care patients. Further investigations are needed to establish the most reliable non-invasive method.
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Affiliation(s)
- Maxime Nguyen
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France. .,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France.
| | - Vivien Berhoud
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Loïc Bartamian
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Audrey Martin
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Omar Ellouze
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France
| | - Bélaïd Bouhemad
- Department of Anesthesiology and Intensive Care, C.H.U. Dijon, Dijon, France.,Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
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15
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Yamashita Y, Tanoue Y, Sonoda H, Ushijima T, Kimura S, Oishi Y, Tatewaki H, Hiasa K, Arita T, Shiose A. Comparison of cardiac energetics after transcatheter and surgical aortic valve replacements. Interact Cardiovasc Thorac Surg 2019; 28:587-593. [PMID: 30364945 DOI: 10.1093/icvts/ivy292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 08/17/2018] [Accepted: 09/16/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The effect of transcatheter aortic valve replacement (TAVR) on cardiac energetics has not been described. We compared changes in cardiac energetics after TAVR with those after surgical aortic valve replacement (SAVR). METHODS We retrospectively estimated end-systolic elastance (Ees) and effective arterial elastance (Ea) using blood pressure and left ventricular (LV) volume obtained from echocardiography. LV efficiency [ventriculoarterial coupling (Ea/Ees) and the stroke work to pressure-volume area ratio (SW/PVA)] was calculated. Measurements were taken before, 1 week after and 1 year after bioprosthetic aortic valve replacement (TAVR, n = 56; SAVR, n = 61) in patients with severe aortic stenosis and preserved ejection fraction. RESULTS Patients with TAVR had a lower aortic valve pressure gradient and larger stroke volume 1 week after the procedure than those with SAVR. Ea was more markedly decreased, and LV efficiency was significantly improved 1 week after TAVR (SW/PVA 68.1% ± 8.4% to 72.0% ± 8.5%, P < 0.001), but LV efficiency was unchanged 1 week after SAVR (SW/PVA 70.1% ± 7.4% to 69.1% ± 8.0%). LV efficiency was improved 1 year after both procedures (SW/PVA 75.5% ± 6.1% in TAVR; 74.7% ± 6.4% in SAVR). CONCLUSIONS TAVR decreases the transvalvular pressure gradient further without deteriorating stroke volume in the early postoperative period, which is accompanied by early improvement in afterload and LV efficiency compared with SAVR. Improvement in LV efficiency at mid-term follow-up is satisfactory after both procedures.
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Affiliation(s)
- Yoshiyuki Yamashita
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Yoshihisa Tanoue
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Hiromichi Sonoda
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Tomoki Ushijima
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Satoshi Kimura
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Yasuhisa Oishi
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Hideki Tatewaki
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
| | - Kenichi Hiasa
- Department of Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Takeshi Arita
- Department of Hematology, Oncology and Cardiovascular Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Akira Shiose
- Department of Cardiovascular Surgery, Kyushu University Hospital, Fukuoka, Japan
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16
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Capone CA, Lamour JM, Lorenzo J, Tria B, Ye K, Hsu DT, Mahgerefteh J. Ventricular Arterial Coupling: A Novel Echocardiographic Risk Factor for Disease Progression in Pediatric Dilated Cardiomyopathy. Pediatr Cardiol 2019; 40:330-338. [PMID: 30415380 DOI: 10.1007/s00246-018-2021-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 11/01/2018] [Indexed: 11/25/2022]
Abstract
In adult heart failure (HF) patients, a higher ventricular arterial (VA) coupling ratio measured non-invasively is associated with worse HF prognosis and response to treatment. There are no data regarding the relationship of VA coupling to outcome in pediatric dilated cardiomyopathy (DCM) patients. We investigated the association of VA coupling ratio with worse outcome (mechanical circulatory support, transplant, or death) in 48 children with DCM and 97 age-gender matched controls. Mean age at presentation was 9 ± 7 years; DCM patients had a higher arterial elastance (3.8 ± 1.7 vs 2.7 ± 0.7 respectively p = 0.001), a lower LV elastance (1.1 ± 0.65 vs 4.5 ± 1.4, respectively p = 0.001) and higher VA coupling ratio (5.0 ± 3.9 vs 0.34 ± 0.14, respectively p = 0.001). Outcome events occurred in 27/48 (56%) patients. Patients with an outcome event had a higher NYHA class (p = 0.001), lower LV elastance (0.8 ± 0.47 vs 1.6 ± 0.57, respectively p = 0.001), higher arterial elastance (4.5 ± 1.8 vs 2.9 ± 1.1, respectively p = 0.002), and a higher VA coupling ratio (7.1 ± 3.8 vs 2.2 ± 1.5, respectively p = 0.001) compared to those without. In a multivariate CART analysis, VA coupling was the top and only discriminator of poor outcome. In conclusion, a higher VA coupling ratio is associated with worse outcome in pediatric patients with DCM. VA coupling is promising as a bedside analysis tool that may provide insight into the mechanisms of HF in pediatric DCM and identify potential targets for therapy.
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Affiliation(s)
- Christine A Capone
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA.
| | - Jacqueline M Lamour
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA
| | - Josemiguel Lorenzo
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA
| | - Barbara Tria
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA
| | - Kenny Ye
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Daphne T Hsu
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA
| | - Joseph Mahgerefteh
- Division of Pediatric Cardiology, Department of Pediatrics, The Children's Hospital at Montefiore, Albert Einstein College of Medicine, 3415 Bainbridge Avenue, R1, 10467, Bronx, NY, USA
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17
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Oh J, Song IK, Cho J, Yun TJ, Park CS, Choi JM, Gwak M, Shin WJ. Acute Change in Ventricular Contractility-Load Coupling After Corrective Surgery for Congenital Heart Defect: A Retrospective Cohort Study. Pediatr Cardiol 2019; 40:1618-1626. [PMID: 31482237 PMCID: PMC6848039 DOI: 10.1007/s00246-019-02195-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 08/23/2019] [Indexed: 11/29/2022]
Abstract
Ventricular performance and its loading condition change drastically after surgical correction of congenital heart defect. Pressure-volume loops analysis can provide quantitative information about ventriculo-arterial coupling (VAC) indicating the interaction between ventricular contractility and loading condition. Therefore, we investigated changes in VAC after corrective surgery for ventricular septal defect (VSD)/tetralogy of Fallot (TOF), and implication of ventriculo-arterial decoupling as a prognostic factor of post-operative outcomes. In children with VSD/TOF, pre- and post-operative arterial elastance (Ea), end-systolic ventricular elastance (Ees) and VAC (Ea/Ees) were non-invasively estimated using echocardiographic parameters. Post-operative outcomes included maximum vasoactive-inotropic score, the duration of mechanical ventilation and hospital stay. Preoperatively, patients with VSD had significantly lower Ea and Ees than patients with TOF; however, VAC were preserved in both. In patients with VSD, post-operative Ea increased disproportionately to change in Ees, resulting in increased VAC. Post-operative higher VAC in patients with VSD was independently associated with maximum vasoactive-inotropic score (odds ratio [OR] 63.9; 95% Confidence Interval [CI] 4.0-553.0; P = 0.003), prolonged mechanical ventilation (OR 6.3; 95% CI 1.1-37.8; P = 0.044) and longer hospitalization (OR 17.6; 95% CI 1.6-187.0; P = 0.018). In patients with TOF, Ea and Ees reduced post-operatively; however, VAC remained unchanged and was not associated with post-operative outcomes. Despite of different loading condition, preoperative VAC maintained in both of VSD and TOF. However, particularly in VSD patients, abrupt increase in post-operative loading state induces contractility-load decoupling, which leads to worse post-operative outcomes.
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Affiliation(s)
- Jimi Oh
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - In-Kyung Song
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Junki Cho
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Tae-Jin Yun
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Chun Soo Park
- Department of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Jae Moon Choi
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Mijeung Gwak
- Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505 Seoul, Republic of Korea
| | - Won-Jung Shin
- Department of Anesthesiology and Pain Medicine, Laboratory for Cardiovascular Dynamics, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, 05505, Seoul, Republic of Korea.
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18
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Chowdhury SM, Butts RJ, Taylor CL, Bandisode VM, Chessa KS, Hlavacek AM, Nutting A, Shirali GS, Baker GH. Longitudinal measures of deformation are associated with a composite measure of contractility derived from pressure-volume loop analysis in children. Eur Heart J Cardiovasc Imaging 2018; 19:562-568. [PMID: 29053805 PMCID: PMC5909637 DOI: 10.1093/ehjci/jex167] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 06/02/2017] [Accepted: 06/05/2017] [Indexed: 11/13/2022] Open
Abstract
Aims The relationship between echocardiographic measures of left ventricular (LV) systolic function and reference-standard measures have not been assessed in children. The objective of this study was to assess the validity of echocardiographic indices of LV systolic function via direct comparison to a novel composite measure of contractility derived from pressure-volume loop (PVL) analysis. Methods and results Children with normal loading conditions undergoing routine left heart catheterization were prospectively enrolled. PVLs were obtained via conductance catheters. A composite invasive composite contractility index (ICCI) was developed using data reduction strategies to combine four measures of contractility derived from PVL analysis. Echocardiograms were performed immediately after PVL analysis under the same anesthetic conditions. Conventional and speckle-tracking echocardiographic measures of systolic function were measured. Of 24 patients, 18 patients were heart transplant recipients, 6 patients had a small patent ductus arteriosus or small coronary fistula. Mean age was 9.1 ± 5.6 years. Upon multivariable regression, longitudinal strain was associated with ICCI (β = -0.54, P = 0.02) while controlling for indices of preload, afterload, heart rate, and LV mass under baseline conditions. Ejection fraction and shortening fraction were associated with LV mass and load indices, but not contractility. Conclusion Speckle-tracking derived longitudinal strain is associated ICCI in children with normal loading conditions. Longitudinal measures of deformation appear to accurately assess LV contractility in children.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Ryan J Butts
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Carolyn L Taylor
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Karen S Chessa
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Anthony M Hlavacek
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Arni Nutting
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
| | - Girish S Shirali
- The Ward Family Heart Center, Children’s Mercy Hospital, 2401 Gillham Road, Kansas City, MO, 64108, USA
| | - G Hamilton Baker
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, 165 Ashley Ave, MSC 915, Charleston, SC, 29425, USA
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Left ventricular pumping during the transition-adaptation sequence in preterm infants: impact of the patent ductus arteriosus. Pediatr Res 2018. [PMID: 29538367 DOI: 10.1038/pr.2018.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BackgroundPostnatally, the immature left ventricle (LV) is subjected to high systemic afterload. Hypothesizing that LV pumping would change during transition-adaptation, we analyzed the LV in preterm infants (GA≤32+6), clinically stable or with a hemodynamically significant patent ductus arteriosus (hPDA) by applying a pump model.MethodsPumping was characterized by EA (effective arterial elastance, reflecting afterload), EES (end-systolic LV elastance, reflecting contractility), EA/EES coupling ratios, descriptive EA:EES relations, and EA/EES graphs. Data calculated from echocardiography and blood pressure were analyzed by diagnosis (S group: clinically stable, no hPDA, n=122; hPDA group, n=53) and by periods (early transition: days of life 1-3; late transition: 4-7; and adaptation: 8-30).ResultsS group: LV pumping was characterized by an increased EA/EES coupling ratio of 0.65 secondary to low EES in early transition, a tandem rise of both EA and EES in late transition, and an EA/EES coupling ratio of 0.45 secondary to high EES in adaptation; hPDA group: time-trend analyses showed significantly lower EA (P<0.0001) and EES (P=0.006). Therefore, LV pumping was characterized by a lower EA/EES coupling ratio (P=0.088) throughout transition-adaptation.ConclusionsIn stable infants, facing high afterload, the immature LV, enhanced by the physiological PDA, increases its contractility. In hPDA, facing low afterload, the overloaded immature LV exhibits a consistently lower contractility.
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20
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Chowdhury SM, Butts RJ, Hlavacek AM, Taylor CL, Chessa KS, Bandisode VM, Shirali GS, Nutting A, Baker GH. Echocardiographic Detection of Increased Ventricular Diastolic Stiffness in Pediatric Heart Transplant Recipients: A Pilot Study. J Am Soc Echocardiogr 2017; 31:342-348.e1. [PMID: 29246510 DOI: 10.1016/j.echo.2017.11.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pediatric heart transplant recipients are at risk for increased left ventricular (LV) diastolic stiffness. However, the noninvasive evaluation of LV stiffness has remained elusive in this population. The objective of this study was to compare novel echocardiographic measures of LV diastolic stiffness versus gold-standard measures derived from pressure-volume loop (PVL) analysis in pediatric heart transplant recipients. METHODS Patients undergoing left heart catheterization were prospectively enrolled. PVLs were obtained via conductance. The end-diastolic pressure-volume relationship was obtained via balloon occlusion. The stiffness constant, β, was calculated. Echocardiographic measures of diastolic function were derived from spectral and tissue Doppler and two-dimensional speckle-tracking. Ventricular volumes were measured using three-dimensional echocardiography. The novel echocardiographic estimates of ventricular stiffness included E:e'/end-diastolic volume (EDV) and E:early diastolic strain rate/EDV. RESULTS Of 24 children, 18 were heart transplant recipients. Six control patients had hemodynamically insignificant patent ductus arteriosus or coronary fistula. The mean age was 9.1 ± 5.6 years. Median end-diastolic pressure was 9 mm Hg (interquartile range, 8-13 mm Hg). Lateral E:e'/EDV (r = 0.59, P < .01), septal E:e'/EDV (r = 0.57, P < .01), and (E:circumferential early diastolic strain rate)/EDV (r = 0.54, P < .01) correlated with β. Lateral E:e'/EDV displayed a C statistic of 0.93 in detecting patients with abnormal LV stiffness (β > 0.015 mL-1). A lateral E:e'/EDV of >0.15 mL-1 had 89% sensitivity and 93% specificity in detecting an abnormal β. CONCLUSIONS Echocardiographic estimates of ventricular stiffness may be accurate compared with the gold standard in pediatric heart transplant recipients. The clinical usefulness of these noninvasive measures in assessing LV stiffness merits further study in children.
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Affiliation(s)
- Shahryar M Chowdhury
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina.
| | - Ryan J Butts
- Department of Pediatrics, Division of Cardiology, UT Southwestern Medical Center, Dallas, Texas
| | - Anthony M Hlavacek
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Carolyn L Taylor
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Karen S Chessa
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Varsha M Bandisode
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - Girish S Shirali
- The Ward Family Heart Center, Children's Mercy Hospital, Kansas City, Missouri
| | - Arni Nutting
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
| | - G Hamilton Baker
- Department of Pediatrics, Division of Cardiology, Medical University of South Carolina, Charleston, South Carolina
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21
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Carrillo SA. "What we know is little, and what we are ignorant of is immense". J Thorac Cardiovasc Surg 2017; 154:2052-2053. [PMID: 28964490 DOI: 10.1016/j.jtcvs.2017.08.111] [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: 08/28/2017] [Accepted: 08/30/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Sergio A Carrillo
- Children's Heart Center Nevada and the Department of Surgery, University of Nevada, Las Vegas (UNLV), Las Vegas, Nev.
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22
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Gray MA, Graham EM, Atz AM, Bradley SM, Kavarana MN, Chowdhury SM. Preoperative echocardiographic measures of left ventricular mechanics are associated with postoperative vasoactive support in preterm infants undergoing patent ductus arteriosus ligation. J Thorac Cardiovasc Surg 2017; 154:2054-2059.e1. [PMID: 28743382 DOI: 10.1016/j.jtcvs.2017.06.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 06/13/2017] [Accepted: 06/27/2017] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Preoperative risk factors associated with poor outcomes after patent ductus arteriosus ligation in preterm infants have not been well defined. The aim of this study was to determine the association between preoperative echocardiographic measures of left ventricular mechanics and postoperative clinical outcomes after patent ductus arteriosus ligation. METHODS Preterm infants less than 90 days of age with no other significant congenital anomalies who underwent patent ductus arteriosus ligation between 2007 and 2015 were considered for retrospective analysis. The primary outcome was peak postoperative vasoactive inotropic score. Conventional echocardiographic measures of ventricular size, function, and patent ductus arteriosus size were performed. Echocardiographic single-beat, pressure-volume loop analysis estimates of contractility (end-systolic elastance) and afterload (arterial elastance) were calculated. Ventriculoarterial coupling was assessed using the arterial elastance/end-systolic elastance ratio. Multivariable linear regression was performed using clinical and echocardiographic data. RESULTS Echocardiograms from 101 patients (42.5% male) were analyzed. We found a statistically significant association between vasoactive inotropic score and both end-systolic elastance and arterial elastance. No patient with arterial elastance/end-systolic elastance greater than 0.78 (n = 32) had a vasoactive inotropic score 20 or greater. Analysis of our secondary outcomes found associations between preoperative end-systolic elastance and postoperative urine output less than 1 mL/kg/h at 24 hours, creatinine change greater than 0.5 mg/dL, and time to first extubation. CONCLUSIONS End-systolic elastance and arterial elastance were the only predictors of postoperative vasoactive inotropic score after patent ductus arteriosus ligation in preterm infants. Those neonates with increased contractility and low afterload were at highest risk for elevated inotropic support. These findings suggest a role for echocardiographic end-systolic elastance and arterial elastance in the preoperative assessment of preterm infants undergoing patent ductus arteriosus ligation.
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Affiliation(s)
- Margaret A Gray
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC.
| | - Eric M Graham
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Andrew M Atz
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Scott M Bradley
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Minoo N Kavarana
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, SC
| | - Shahryar M Chowdhury
- Division of Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
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23
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Elhoff JJ, Chowdhury SM, Taylor CL, Hassid M, Savage AJ, Atz AM, Butts RJ. Decline in ventricular function as a result of general anesthesia in pediatric heart transplant recipients. Pediatr Transplant 2016; 20:1106-1110. [PMID: 27796066 PMCID: PMC5558209 DOI: 10.1111/petr.12825] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2016] [Indexed: 01/05/2023]
Abstract
Echocardiography is frequently performed under anesthesia during procedures such as cardiac catheterization with EMB in pediatric HTx recipients. Anesthetic agents may depress ventricular function, resulting in concern for rejection. The aim of this study was to compare ventricular function as measured by echocardiography before and during GA in 17 pediatric HTx recipients. Nearly all markers of ventricular systolic function were significantly decreased under GA, including EF (-4.2% ±1.2, P < .01) and RV FAC (-0.05 ± 0.02, P = .04). Subjects in the first post-transplant year (n = 9) trended toward a more significant decrease in EF vs those beyond the first post-transplant year (n = 8; -6.0% ±1.2 vs -2.1 ± 2.0, P = .1). This information quantifies a decline in biventricular function that should be expected in pediatric HTx recipients while under GA and can assist the transplant clinician in avoiding unnecessary treatment of transient GA-induced ventricular dysfunction.
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Affiliation(s)
- Justin J. Elhoff
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Shahryar M. Chowdhury
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Carolyn L. Taylor
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Marc Hassid
- Division of Pediatric Anesthesia, Department of Anesthesia and Perioperative Medicine, Medical University of South Carolina Charleston, SC, USA
| | - Andrew J. Savage
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Andrew M. Atz
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
| | - Ryan J. Butts
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina, Charleston, SC, USA
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