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Yuan S, Li L, Pu T, Fan X, Wang Z, Xie P, Li P. The relationship between NLR, LDL-C/HDL-C, NHR and coronary artery disease. PLoS One 2024; 19:e0290805. [PMID: 38985788 DOI: 10.1371/journal.pone.0290805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 05/23/2024] [Indexed: 07/12/2024] Open
Abstract
OBJECTIVE Chronic inflammation and dyslipidemia are key risk factors for atherosclerotic cardiovascular diseases. We retrospectively explored the association between the neutrophil to lymphocyte ratio (NLR), the ratio of low-density lipoprotein cholesterol (LDL-C) to high-density lipoprotein cholesterol (HDL-C), and the neutrophil to HDL-C ratio (NHR), and the severity of coronary lesions in patients with acute coronary syndrome (ACS). METHOD In June 2023, we selected 1210 patients who were diagnosed with ACS based on chest pain from January 2017 to December 2022. Of these, 1100 patients with abnormal coronary angiography were categorized into the experimental group, and 110 patients with normal coronary angiography were classified as the control group. We collected routine blood tests, lipid profiles, and coronary angiography results at admission (before coronary angiography). Patients were then stratified into a control group (Gensini score = 0) and an experimental group (Gensini score = 0) based on the Gensini score. The experimental group was further divided into a low score group (Gensini score < 69) and a high score group (Gensini score ≥ 69). RESULT 1. Statistically significant differences were observed between the control and experimental groups in terms of gender, age, body mass index (BMI), hypertension, diabetes, smoking history, and counts of neutrophils (NEU), lymphocytes (LYM), monocytes (MON), eosinophils (EOS), red cell distribution width (RDW), total cholesterol (TC), HDL-C, LDL-C, NLR, LDL-C/HDL-C, and NHR (P<0.05). Furthermore, differences in BMI, hypertension, diabetes, smoking history, NEU, LYM, MON, TC, triglyceride (TG), HDL-C, LDL-C, NLR, LDL-C/HDL-C, and NHR were significant between the low and high score groups (P<0.05). 2. NEU, LYM, MON, TC, HDL-C, LDL-C, NLR, LDL-C/HDL-C, and NHR showed significant correlations with the Gensini score (r>0.2, P<0.05), with NLR and LDL-C/HDL-C showing the strongest correlations (r = 0.822, P = 0.000). 3. The Receiver Operating Characteristic (ROC) curve indicated that the combination of NLR and LDL-C/HDL-C had superior sensitivity and specificity in predicting the severity of coronary lesions, with a significant difference (P<0.05). The sensitivity was 87.1%, the specificity was 90.9%, and the cut-off point was 2.04. 4. A predictive model was developed based on the ratio of NLR and LDL-C/HDL-C to the Gensini score. The final model score was calculated as 6.803 + 7.029NLR + 13.079LDL-C/HDL-C (R2 = 0.708). CONCLUSION Compared to NLR, LDL-C/HDL-C, and NHR, the combined NLR and LDL-C/HDL-C ratio is a more accurate marker for assessing the severity of coronary artery disease in ACS patients. Its convenience and effectiveness make it a promising tool for early assessment, timely risk stratification, and appropriate clinical intervention, ultimately improving clinical outcomes for ACS patients.
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Affiliation(s)
- Shuaishuai Yuan
- Division of Cardiovascular Intensive Care (C-ICU), Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Lingling Li
- China Medical University, Shenyang, Liaoning, China
| | - Tian Pu
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Xizhen Fan
- Division of Life Science and Medicine, The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, Anhui, China
| | - Zheng Wang
- The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Pailing Xie
- Division of Cardiovascular Intensive Care (C-ICU), Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Peijun Li
- Division of Cardiovascular Intensive Care (C-ICU), Cardiac and Vascular Center, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China
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Sorrell VL, Lindner JR, Pellikka PA, Kirkpatrick JN, Muraru D. Recognized and Unrecognized Value of Echocardiography in Guideline and Consensus Documents Regarding Patients With Chest Pain. J Am Soc Echocardiogr 2023; 36:146-153. [PMID: 36375734 DOI: 10.1016/j.echo.2022.10.024] [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: 06/25/2022] [Revised: 10/21/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022]
Abstract
Guideline and consensus documents have recently been published on the important topic of the noninvasive evaluation of patients presenting with chest pain (CP) or patients with known acute or chronic coronary syndromes. Authors for these documents have included members representing multispecialty imaging societies, yet the process of generating consensus and the need to produce concise written documents have led to a situation where the particular advantages of echocardiography are overlooked. Broad guidelines such as these can be helpful when it comes to "when to do" noninvasive cardiac testing, but they do not pretend to offer nuances on "how to do" noninvasive cardiac testing. This report details the particular value of echocardiography and potential explanations for its understated role in recent guidelines. This report is categorized into the following sections: (1) impact of the level of evidence on guideline creation; (2) versatility of echocardiography in the assessment of CP and the inimitable role for echo Doppler echocardiography in the assessment of dyspnea; (3) value of point-of-care ultrasound in assessing CP and dyspnea; and (4) the future role of echocardiography in ischemic heart disease.
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Affiliation(s)
- Vincent L Sorrell
- Division of Cardiovascular Medicine, University of Kentucky, Lexington, Kentucky.
| | - Jonathan R Lindner
- Vice-chief for Research in the Cardiology Division, Department of Medicine, University of Virginia, Charlottesville, Virginia
| | | | - James N Kirkpatrick
- Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington
| | - Denisa Muraru
- Department of Cardiology, Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Fournier E, Batteux C, Mostefa-Kara M, Valdeolmillos E, Maltret A, Cohen S, Van Aerschot I, Guirgis L, Azarine A, Sigal-Cinqualbre A, Provost B, Radojevic-Liegeois J, Roussin R, Zoghbi J, Belli E, Hascoët S. Cardiac tomography-echocardiography imaging fusion: a new approach to congenital heart disease. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:10-18. [PMID: 35570123 DOI: 10.1016/j.rec.2022.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/17/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION AND OBJECTIVES Diagnosis, management, and surgical decision-making in children and adults with congenital heart disease are largely based on echocardiography findings. A recent development in cardiac imaging is fusion of different imaging modalities. Our objective was to evaluate the feasibility of computed tomography (CT) and 3-dimensional (3D) transthoracic echocardiography (TTE) fusion in children and adults with congenital heart disease. METHODS We prospectively included 14 patients, 13 of whom had congenital heart disease, and who underwent both CT and 3D TTE as part of their usual follow-up. We described the steps required to complete the fusion process (alignment, landmarks, and superimposition), navigation, and image evaluation. RESULTS Median age was 9.5 [2.7-15.7] years, 57% were male, and median body surface area was 0.9 m2 [0.6-1.7]. Congenital heart disease was classified as simple (n=4, 29%), moderate (n=4, 29%), or complex (n=6, 42%). 3D TTE-CT fusion was successful in all patients. Median total time to complete the fusion process was 735 [628-1163] seconds, with no significant difference according to the degree of complexity of the defects. Landmarks were significantly modified in complex congenital heart disease. CONCLUSIONS We established the feasibility and accuracy of 3D TTE-CT fusion in a population of children and adults with a variety of congenital heart diseases. The simultaneous visualization of many intracardiac structures may help to understand the anatomical features of congenital heart disease without limitations regarding age, weight, or complexity of the congenital defects.
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Affiliation(s)
- Emmanuelle Fournier
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Clément Batteux
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France; UMRS 999, INSERM, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis Robinson, France
| | - Meriem Mostefa-Kara
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Estibaliz Valdeolmillos
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France; UMRS 999, INSERM, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis Robinson, France
| | - Alice Maltret
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Sarah Cohen
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Isabelle Van Aerschot
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Lisa Guirgis
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Arshid Azarine
- UMRS 999, INSERM, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis Robinson, France; Département de Radiologie, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Anne Sigal-Cinqualbre
- Département de Radiologie, Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Bastien Provost
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Jelena Radojevic-Liegeois
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Régine Roussin
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Joy Zoghbi
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Emre Belli
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France
| | - Sebastien Hascoët
- Pôle des Cardiopathies Congénitales de l'Enfant et de l'Adulte, Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Hôpital Marie Lannelongue, Groupe hospitalier Paris Saint Joseph, Université Paris-Saclay, Le Plessis Robinson, France; UMRS 999, INSERM, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis Robinson, France.
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4
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Fusión de imágenes de tomografía computarizada cardiaca y ecocardiografía: un nuevo enfoque en las cardiopatías congénitas. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Li Y, Zheng Q, Cui C, Liu Y, Hu Y, Huang D, Wang Y, Liu J, Liu L. Application value of myocardial work technology by non-invasive echocardiography in evaluating left ventricular function in patients with chronic heart failure. Quant Imaging Med Surg 2022; 12:244-256. [PMID: 34993075 DOI: 10.21037/qims-20-1038] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 06/29/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND Accurate evaluation of left ventricular (LV) systolic function is the premise for diagnosing and treating chronic heart failure. This study aimed to explore the incremental value of echocardiographic myocardial work in evaluating the LV systolic dysfunction in patients with chronic heart failure. METHODS A total of 206 participants were enrolled, including 155 patients with chronic heart failure and 51 healthy controls (HC). The chronic heart failure patients were divided into three groups according to LV ejection fraction (LVEF): Heart failure with preserved ejection fraction (HFpEF group, 54 cases, LVEF ≥50%), heart failure with mid-range ejection fraction (HFmrEF group, 50 cases, 40%≤ LVEF <50%), and heart failure with reduced ejection fraction (HFrEF group, 51 cases, LVEF <40%). Except for the conventional echocardiographic parameters, the left ventricular myocardial work parameters, including the global myocardial work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE), were calculated in the study participants. One-way analysis of variance test followed by Fisher's least significant difference (LSD) t-test were used to obtain parameters with significant differences, which were then fed into a machine learning model established for subsequent multi-classification of the four groups. The selected myocardial work parameters with high importance rankings resulting from the machine learning model were further compared with the traditional LVEF in the multi-classification of the four groups. RESULTS All conventional echocardiographic parameters were significantly different between the HFmrEF and HFrEF groups, but only E/e', left atrium showed notable differences between the HFpEF and HC groups (P<0.05). All myocardial work parameters were markedly different between the four groups (P<0.05). LVEF and GWI were more important than the other parameters according to the multi-classification machine learning model. The multi-classification diagnostic performances of LVEF, GWI, and LVEF + GWI were 82%, 88%, and 98%, respectively, which confirmed that GWI + LVEF could complementarily improve the diagnosis accuracy in classifying the four groups, with a performance increase of approximately 10% than each individually. CONCLUSIONS GWI can play a complementary role to LVEF in the early diagnosis of HFpEF patients from the HC group and improve the clinical evaluation accuracy in chronic heart failure patients. Echocardiographic myocardial work should be utilized along with conventional LVEF to evaluate the systolic function of chronic heart failure patients in clinical practice.
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Affiliation(s)
- Yanan Li
- Department of Ultrasound, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Qiang Zheng
- School of Computer and Control Engineering, Yantai University, Yantai, China
| | - Cunying Cui
- Department of Ultrasound, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Ultrasound, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanbin Hu
- Department of Ultrasound, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Danqing Huang
- Department of Ultrasound, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Ying Wang
- Department of Ultrasound, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Jun Liu
- Department of Cardiology, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lin Liu
- Department of Ultrasound, Henan Province People's Hospital, Fuwai Central China Cardiovascular Hospital, People's Hospital of Zhengzhou University, Zhengzhou, China
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Abstract
Inflammation and lipid signaling are involved in the pathogenesis and progression of coronary artery disease (CAD). We proposed that high-sensitivity C-reactive proteins, as a marker of the pro-inflammatory state, and high-density lipoprotein cholesterol (HDL-C), as an anti-atherosclerosis component, should be integrated into a single novel biomarker. Our work was conducted to discuss and compare the predictive ability of the high-sensitivity C-reactive protein to high-density lipoprotein cholesterol ratio (CHR) with other existing indices, for example, neutrophil high-density lipoprotein ratio (NHR) and neutrophil lymphocyte ratio (NLR), in the severity of CAD patients.Based on the results of coronary angiography, patients were divided into the CAD+ group, CAD- group, and control group. The relationship between various serum markers and the severity of coronary artery disease was examined via Spearman's correlation analysis. Logistic regression analysis was conducted to identify the influencing factors of the coronary artery disease severity.This study included 420 patients. The Gensini score was positively correlated with CHR. Multiple regression analysis revealed that the CHR was significantly associated with CAD. CHR is an independent predictor of CAD. The receiver operating characteristic (ROC) analysis provided a cut-off value of 1.17 for CHR to predict CAD, with a specificity of 86.7%, Yoden index of 0.264, and area under the ROC curve of 0.662 (95% confidence intervals 0.606-0.719, P < 0.001). At the same time, the area under the ROC curve of the NHR was 0.652, and that of the NLR was 0.579. The results of the DeLong test indicated that the area under the ROC curve of the CHR was larger than that of the NLR (P = 0.0306). This suggests that the CHR as a predictor of CAD has better diagnostic performance than the NLR.CHR was not only closely related to the presence and severity of CAD but also an independent predictor of severe CAD.
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Affiliation(s)
- Haorou Luo
- School of Medicine, University of Electronic Science and Technology of China
| | - Tuli Kou
- School of Medicine, Southwest Medical University
| | - Lixue Yin
- Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital
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7
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Truong VT, Vo HQ, Ngo TNM, Mazur J, Nguyen TTH, Pham TTM, Le TK, Phan H, Palmer C, Nagueh SF, Chung ES. Normal Ranges of Global Left Ventricular Myocardial Work Indices in Adults: A Meta-Analysis. J Am Soc Echocardiogr 2021; 35:369-377.e8. [PMID: 34800670 DOI: 10.1016/j.echo.2021.11.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Recent studies have demonstrated left ventricular myocardial work (MW) is incremental in diagnosis and prognostication when compared to left ventricular ejection fraction and myocardial strain. We performed a meta-analysis of normal ranges of non-invasive MW indices including global work index (GWI), global constructive work (GCW), global wasted work (GWW), and global work efficiency (GWE) and to determine confounder that may contribute to variance in reported values. METHODS Four databases including Pubmed, Scopus, Embase, and Cochrane Library were searched through January 2021 using the key terms "myocardial work", "global constructive work", "global wasted work", "global work index", "global work efficiency". Studies were included if the articles reported LV myocardial work using 2D transthoracic echocardiography in healthy normal subjects, either in control group or comprising of the entire study cohort. The weighted mean was estimated by using the random effect model with a 95% confidence interval. Heterogeneity across included studies was assessed using the I2 test. Funnel plot and Egger's regression test were used to assess potential publication bias RESULTS: The search yielded 476 articles. After abstract and full-text screening, we included 13 datasets with 1665 patients for the meta-analysis. The reported normal mean values of GWI and GCW among the studies were 2010 mmHg% (95% CI, 1907 to 2113), and 2278 mmHg% (95% CI, 2186 to 2369) respectively. The mean GWW was 80 mmHg% (95% CI, 73 to 87), and the mean GWE was 96.0% (95% CI, 96% to 96%). Furthermore, gender significantly contributed to variations in normal values of GWI, GWW, and GWE. No evidence of significant publication bias was observed. CONCLUSION In this meta-analysis, we provide echocardiographic reference ranges for non-invasive indices of MW. These normal values could be served as a reference for clinical and research use.
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Affiliation(s)
- Vien T Truong
- The Christ Hospital Health Network, Cincinnati, Ohio, USA; The Linder Research Center, Cincinnati, Ohio, USA.
| | - Ha Q Vo
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Tam N M Ngo
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Jan Mazur
- The Ohio State University, Columbus, Ohio, USA
| | - Tuy T H Nguyen
- Heart Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam
| | - Thuy T M Pham
- Heart Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam
| | - Tuyen K Le
- Heart Institute, Ho Chi Minh City, Vietnam
| | - Hoang Phan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania
| | - Cassady Palmer
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Eugene S Chung
- The Christ Hospital Health Network, Cincinnati, Ohio, USA
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Radulescu LM, Radulescu D, Ciuleanu TE, Crisan D, Buzdugan E, Romitan DM, Buzoianu AD. Cardiotoxicity Associated with Chemotherapy Used in Gastrointestinal Tumours. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:medicina57080806. [PMID: 34441012 PMCID: PMC8400748 DOI: 10.3390/medicina57080806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/25/2021] [Accepted: 08/04/2021] [Indexed: 12/12/2022]
Abstract
Cardiotoxicity is a well-recognised side effect of cancer-related therapies with a great impact on outcomes and quality of life in the cancer survivor population. The pathogenesis of chemotherapy-induced cardiotoxicity in patients with gastrointestinal cancers involves various molecular mechanisms, and the combined use of various chemotherapies augments the risk of each drug used alone. In terms of cardiotoxicity diagnosis, novel biomarkers, such as troponins, brain natriuretic peptide (BNP), myeloperoxidases and miRNAs have been recently assessed. Echocardiography is a noninvasive imaging method of choice for the primary assessment of chemotherapy-treated patients to generally evaluate the cardiovascular impact of these drugs. Novel echocardiography techniques, like three-dimensional and stress echocardiography, will improve diagnosis efficacy. Cardiac magnetic resonance (CMR) can evaluate cardiac morphology, function and wall structure. Corroborated data have shown the importance of CMR in the early evaluation of patients with gastrointestinal cancers, treated with anticancer drugs, but further studies are required to improve risk stratification in these patients. In this article, we review some important aspects concerning the cardiotoxicity of antineoplastic drugs used in gastrointestinal cancers. We also discuss the mechanism of cardiotoxicity, the role of biomarkers and the imaging methods used in its detection.
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Affiliation(s)
- Liliana Maria Radulescu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hațieganu University of Medicine and Pharmacy, 400005 Cluj-Napoca, Romania; (L.M.R.); (A.D.B.)
- Department of Cardiology, Cluj Municipal Hospital, 400005 Cluj-Napoca, Romania; (E.B.); (D.-M.R.)
| | - Dan Radulescu
- Department of Cardiology, Cluj Municipal Hospital, 400005 Cluj-Napoca, Romania; (E.B.); (D.-M.R.)
- Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400005 Cluj-Napoca, Romania;
- Correspondence: ; Tel.: +40-741041707
| | - Tudor-Eliade Ciuleanu
- Department of Oncology, Iuliu Hatieganu University of Medicine and Pharmacy, 400015 Cluj-Napoca, Romania;
| | - Dana Crisan
- Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400005 Cluj-Napoca, Romania;
- Department of Internal Medicine, Cluj Municipal Hospital, 400139 Cluj-Napoca, Romania
| | - Elena Buzdugan
- Department of Cardiology, Cluj Municipal Hospital, 400005 Cluj-Napoca, Romania; (E.B.); (D.-M.R.)
- Department of Internal Medicine, Iuliu Hațieganu University of Medicine and Pharmacy, 400005 Cluj-Napoca, Romania;
| | - Dragos-Mihai Romitan
- Department of Cardiology, Cluj Municipal Hospital, 400005 Cluj-Napoca, Romania; (E.B.); (D.-M.R.)
| | - Anca Dana Buzoianu
- Department of Pharmacology, Toxicology and Clinical Pharmacology, Iuliu Hațieganu University of Medicine and Pharmacy, 400005 Cluj-Napoca, Romania; (L.M.R.); (A.D.B.)
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9
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The non-invasive assessment of myocardial work by pressure-strain analysis: clinical applications. Heart Fail Rev 2021; 27:1261-1279. [PMID: 34041679 PMCID: PMC9197903 DOI: 10.1007/s10741-021-10119-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/28/2021] [Indexed: 11/10/2022]
Abstract
Pressure–volume (PV) analysis is the most comprehensive way to describe cardiac function, giving insights into cardiac mechanics and energetics. However, PV analysis still remains a highly invasive and time-consuming method, preventing it from integration into clinical practice. Most of the echocardiographic parameters currently used in the clinical routine to characterize left ventricular (LV) systolic function, such as LV ejection fraction and LV global longitudinal strain, do not take the pressure developed within the LV into account and therefore fall too short in describing LV function as a hydraulic pump. Recently, LV pressure-strain analysis has been introduced as a new technique to assess myocardial work in a non-invasive fashion. This new method showed new insights in comparison to invasive measurements and was validated in different cardiac pathologies, e.g., for the detection of coronary artery disease, cardiac resynchronization therapy (CRT)-response prediction, and different forms of heart failure. Non-invasively assessed myocardial work may play a major role in guiding therapies and estimating prognosis. However, its incremental prognostic validity in comparison to common echocardiographic parameters remains unclear. This review aims to provide an overview of pressure-strain analysis, including its current application in the clinical arena, as well as potential fields of exploitation.
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10
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Kou T, Luo H, Yin L. Relationship between neutrophils to HDL-C ratio and severity of coronary stenosis. BMC Cardiovasc Disord 2021; 21:127. [PMID: 33676400 PMCID: PMC7936429 DOI: 10.1186/s12872-020-01771-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Accepted: 11/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Lipid and inflammatory molecules play a key role in the development of inflammation. Neutrophil counts are used as markers of inflammation duration, and HDL-C is used as an anti-atherosclerosis component. However, few studies have been found to integrate these two indicators to explore coronary stenosis. We suggested that neutrophil count as a marker of inflammation persistence and HDL-C as an anti-atherosclerotic component should be integrated into a single biomarker NHR to explore its correlation with CAD degree and predict the severity of coronary stenosis among CAD patients. Methods We examined 404 eligible patients who underwent coronary angiography. Based on the results of coronary angiography, patients in CAD+ group (n = 155) were defined as those having angiographic coronary stenosis of at least 50% lumen reduction in at least one major coronary artery (including left anterior descending artery, left circumflex artery, left main coronary artery, right coronary artery). Patients with luminal stenosis but no more than 50% were defined as CAD− group (n = 49), and patients without luminal stenosis (n = 200) were regarded as control group. The relationship between various serum markers and the severity of coronary stenosis was examined by Spearman correlation analysis. Logistic regression analysis was performed to identify the influencing factors of the severity of coronary artery disease. Results The modified Gensini score was positively correlated with neutrophil HDL-C ratio and negatively correlated with albumin and HDL-C. Multiple regression analysis showed that neutrophil HDL-C ratio were significantly associated with CAD. Neutrophil HDL-C ratio is an independent predictor of CAD. The ROC analysis provided a cut-off value of 1.51 for neutrophil HDL-C ratio to predict CAD with 94.8% sensitivity and 0.024 Yoden index, and area under the ROC curve of 0.617 (95% CI 0.560–0.675, P < 0.001). Conclusion Neutrophil HDL-C ratio is not only closely related to coronary artery stenosis, but also an independent predictor of severe coronary stenosis.
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Affiliation(s)
- Tuli Kou
- Southwest Medical University, Luzhou, China
| | - Haorou Luo
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lixue Yin
- School of Medicine, University of Electronic Science and Technology of China, Chengdu, Sichuan, China. .,Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China.
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11
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Wang RR, Tian T, Li SQ, Leng XP, Tian JW. Assessment of Left Ventricular Global Myocardial Work in Patients With Different Degrees of Coronary Artery Stenosis by Pressure-Strain Loops Analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2021; 47:33-42. [PMID: 33109380 DOI: 10.1016/j.ultrasmedbio.2020.09.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 09/17/2020] [Accepted: 09/22/2020] [Indexed: 06/11/2023]
Abstract
Global myocardial work (MW) analysis by pressure-strain loops (PSL) allows the non-invasive assessment of left ventricular (LV) function. We aimed to investigate the relationship between LV global MW and the degree of coronary artery stenosis in suspected coronary artery disease (CAD) patients with normal LV ejection fraction and regional wall motion. A total of 164 suspected CAD patients were divided into four groups according to coronary artery angiography. The results showed that global work efficiency (GWE) as the most significant predictor in all MW parameters had the optimal cut-off value of 94.5% for detecting moderate stenosis, and the sensitivity and specificity was 89.7% and 85.8%, respectively. A cut-off value of 94.0% for GWE was the most significant predictor of severe stenosis, and the sensitivity and specificity was 81.4% and 76.1%, respectively. In conclusion, LV global MW is a sensitive tool in detecting the degree of coronary artery stenosis and a potential valuable method to provide early diagnosis for CAD patients.
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Affiliation(s)
- Ran-Ran Wang
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Tian Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Shou-Qiang Li
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Xiao-Ping Leng
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China.
| | - Jia-Wei Tian
- Department of Ultrasound, the Second Affiliated Hospital of Harbin Medical University, Harbin, China
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12
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Cui C, Liu L, Li Y, Liu Y, Huang D, Hu Y, Zhang L. Left Ventricular Pressure-Strain Loop-Based Quantitative Examination of the Global and Regional Myocardial Work of Patients with Dilated Cardiomyopathy. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:2834-2845. [PMID: 32654917 DOI: 10.1016/j.ultrasmedbio.2020.06.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 06/07/2020] [Accepted: 06/10/2020] [Indexed: 06/11/2023]
Abstract
The aim of our prospective pilot study was to explore the distribution characteristics of myocardial work (MW) of patients with dilated cardiomyopathy (DCM) and their clinical value in evaluation of therapeutic effects. Thirty patients with DCM were enrolled in the case group, and 30 healthy patients were randomly allocated to the control group. Global myocardial work (GMW) and regional myocardial work (RMW) of the control and case groups before and after therapy were evaluated by using left ventricular pressure-strain loops and then compared. We found significant differences in GMW and RMW between the control and case groups (p < 0.05). Compared with before therapy, the global work index and 6-min walking distance increased, but LV ejection fraction and global longitudinal strain did not significantly change after therapy. GMW was significantly correlated with LV ejection fraction and global longitudinal strain (p < 0.01). Bland-Altman plot analysis revealed that GMW values were consistent between and within the groups. The results suggest that LV MW values were diffusely impaired in patients with DCM and that the global work index may be used as an indicator in evaluation of therapeutic effects.
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Affiliation(s)
- Cunying Cui
- Department of Ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Lin Liu
- Department of Ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yanan Li
- Department of Ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yuanyuan Liu
- Department of Ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Danqing Huang
- Department of Ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Yanbin Hu
- Department of Ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China
| | - Lianzhong Zhang
- Department of Ultrasonography, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Fuwai Central China Cardiovascular Hospital, Zhengzhou, China.
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13
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Nabeshima Y, Seo Y, Takeuchi M. A review of current trends in three-dimensional analysis of left ventricular myocardial strain. Cardiovasc Ultrasound 2020; 18:23. [PMID: 32591001 PMCID: PMC7320541 DOI: 10.1186/s12947-020-00204-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022] Open
Abstract
Three-dimensional (3D) left ventricular (LV) myocardial strain measurements using transthoracic 3D echocardiography speckle tracking analysis have several advantages over two-dimensional (2D) LV strain measurements, because 3D strain values are derived from the entire LV myocardium, yielding more accurate estimates of global and regional LV function. In this review article, we summarize the current status of 3D LV myocardial strain. Specifically, we describe how 3D LV strain analysis is performed. Next, we compare characteristics of 2D and 3D strain, and we explain validation of 3D strain measurements, feasibility and measurement differences between 2D and 3D strain, reference values of 3D strain, and its applications in several clinical scenarios. In some parts of this review, we used a meta-analysis to draw reliable conclusions. We also describe the added value of 3D over 2D strain in several specific pathologies and prognoses. Finally, we discuss novel techniques using 3D strain and suggest its future directions.
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Affiliation(s)
- Yosuke Nabeshima
- Second Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, 1-1 Iseigaoka, Yahatanishi, Kitakyushu, 807-8555, Japan.
| | - Yoshihiro Seo
- Department of Cardiology, Graduate School of Medical Sciences, Nagoya City University, Nagoya, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, School of Medicine, Hospital of University of Occupational and Environmental Health, Kitakyushu, Japan
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14
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Abstract
Echocardiography has become an extension of the physical examination in cardiovascular practice. Frequently, it is used to confirm a clinical diagnostic suspicion. Another important role is to detect the underlying cardiovascular lesion to explain a patient's symptom complex or an abnormality found on chest radiography, electrocardiography, or cardiac enzyme tests. Patients are referred to the echocardiography laboratory because of their symptoms or due to non-specific laboratory abnormalities, and echocardiographers are expected to provide a definite diagnosis or a therapeutic clue. The introduction of the matrix array transducer into clinical practice allowed the acquisition of three-dimensional (3D) datasets. 3D echocardiography (3DE) has many advantages over 2-dimensional echocardiography, such as: (1) improved visualization of the complex shapes and spatial relations between cardiac structures; (2) improved quantification of the cardiac volumes and function; and (3) improved display and assessment of valve dysfunction. 3DE is increasingly utilized during routine clinical practice. This review article is aimed to examine the current clinical utility and future directions of 3DE.
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Affiliation(s)
- Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine
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15
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Peters A, Motiwala A, O'Neill B, Patil P. Novel use of fused cardiac computed tomography and transesophageal echocardiography for left atrial appendage closure. Catheter Cardiovasc Interv 2020; 97:E719-E723. [PMID: 32150324 DOI: 10.1002/ccd.28840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/23/2020] [Accepted: 02/25/2020] [Indexed: 11/08/2022]
Abstract
The use of the Watchman left atrial appendage occlusion device (Boston Scientific Inc.) is becoming increasingly frequent in patients with atrial fibrillation. Cardiac computed tomography (CT) for device sizing pre-procedure can help facilitate more accurate device selection compared with transesophageal echo (TEE) alone. CT can also help identify minor lobes and trabeculations that may not be apparent on TEE. We report a series of three cases to highlight the utility of a novel application of CT-TEE fusion imaging to provide procedural guidance during Watchman implant and to assess for peri-device leak post-implant.
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Affiliation(s)
- Andrew Peters
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Afaq Motiwala
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Brian O'Neill
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Pravin Patil
- Section of Cardiology, Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
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16
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Stendahl JC, Parajuli N, Lu A, Boutagy NE, Guerrera N, Alkhalil I, Lin BA, Staib LH, O'Donnell M, Duncan JS, Sinusas AJ. Regional myocardial strain analysis via 2D speckle tracking echocardiography: validation with sonomicrometry and correlation with regional blood flow in the presence of graded coronary stenoses and dobutamine stress. Cardiovasc Ultrasound 2020; 18:2. [PMID: 31941514 PMCID: PMC6964036 DOI: 10.1186/s12947-019-0183-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/23/2019] [Indexed: 01/17/2023] Open
Abstract
Background Quantitative regional strain analysis by speckle tracking echocardiography (STE) may be particularly useful in the assessment of myocardial ischemia and viability, although reliable measurement of regional strain remains challenging, especially in the circumferential and radial directions. We present an acute canine model that integrates a complex sonomicrometer array with microsphere blood flow measurements to evaluate regional myocardial strain and flow in the setting of graded coronary stenoses and dobutamine stress. We apply this unique model to rigorously evaluate a commercial 2D STE software package and explore fundamental regional myocardial flow-function relationships. Methods Sonomicrometers (16 crystals) were implanted in epicardial and endocardial pairs across the anterior myocardium of anesthetized open chest dogs (n = 7) to form three adjacent cubes representing the ischemic, border, and remote regions, as defined by their relative locations to a hydraulic occluder on the mid-left anterior descending coronary artery (LAD). Additional cardiac (n = 3) and extra-cardiac (n = 3) reference crystals were placed to define the cardiac axes and aid image registration. 2D short axis echocardiograms, sonometric data, and microsphere blood flow data were acquired at baseline and in the presence of mild and moderate LAD stenoses, both before and during low-dose dobutamine stress (5 μg/kg/min). Regional end-systolic 2D STE radial and circumferential strains were calculated with commercial software (EchoInsight) and compared to those determined by sonomicrometry and to microsphere blood flow measurements. Post-systolic indices (PSIs) were also calculated for radial and circumferential strains. Results Low-dose dobutamine augmented both strain and flow in the presence of mild and moderate stenoses. Regional 2D STE strains correlated moderately with strains assessed by sonomicrometry (Rradial = 0.56, p < 0.0001; Rcirc = 0.55, p < 0.0001) and with regional flow quantities (Rradial = 0.61, Rcirc = 0.63). Overall, correspondence between 2D STE and sonomicrometry was better in the circumferential direction (Bias ± 1.96 SD: − 1.0 ± 8.2% strain, p = 0.06) than the radial direction (5.7 ± 18.3%, p < 0.0001). Mean PSI values were greatest in low flow conditions and normalized with low-dose dobutamine. Conclusions 2D STE identifies changes in regional end-systolic circumferential and radial strain produced by mild and moderate coronary stenoses and low-dose dobutamine stress. Regional 2D STE end-systolic strain measurements correlate modestly with regional sonomicrometer strain and microsphere flow measurements.
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Affiliation(s)
- John C Stendahl
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA
| | - Nripesh Parajuli
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Allen Lu
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Nabil E Boutagy
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA
| | - Nicole Guerrera
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA
| | - Imran Alkhalil
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA
| | - Ben A Lin
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA
| | - Lawrence H Staib
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, CT, 06520, USA
| | - Matthew O'Donnell
- Department of Bioengineering, University of Washington, Seattle, WA, 98195-5061, USA
| | - James S Duncan
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, 06520, USA.,Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, CT, 06520, USA
| | - Albert J Sinusas
- Section of Cardiovascular Medicine, Department of Medicine, Yale Translational Research Imaging Center, Yale University School of Medicine, P.O. Box 208017, Dana 3, New Haven, CT, 06520, USA. .,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT, 06520, USA. .,Department of Biomedical Engineering, Yale University School of Engineering and Applied Science, New Haven, CT, 06520, USA.
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17
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New horizon of fusion imaging using echocardiography: its progress in the diagnosis and treatment of cardiovascular disease. J Echocardiogr 2019; 18:9-15. [DOI: 10.1007/s12574-019-00455-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 11/16/2019] [Indexed: 12/18/2022]
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18
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Lang RM, Addetia K, Narang A, Mor-Avi V. 3-Dimensional Echocardiography: Latest Developments and Future Directions. JACC Cardiovasc Imaging 2019; 11:1854-1878. [PMID: 30522687 DOI: 10.1016/j.jcmg.2018.06.024] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/31/2018] [Accepted: 06/22/2018] [Indexed: 01/03/2023]
Abstract
The ongoing refinements in 3-dimensional (3D) echocardiography technology continue to expand the scope of this imaging modality in clinical cardiology by offering new features that stem from the ability to image the heart in its complete dimensionality. Over the years, countless publications have described these benefits and tested new frontiers where 3D echocardiographic imaging seemed to offer promising ways to improve patients' care. These include improved techniques for chamber quantification and novel ways to visualize cardiac valves, including 3D printing, virtual reality, and holography. The aims of this review article are to focus on the most important developments in the field in the recent years, discuss the current utility of 3D echocardiography, and highlight several interesting future directions.
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Affiliation(s)
- Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois.
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Akhil Narang
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, Chicago, Illinois
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19
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Automated 4-dimensional regional myocardial strain evaluation using cardiac computed tomography. Int J Cardiovasc Imaging 2019; 36:149-159. [PMID: 31538258 DOI: 10.1007/s10554-019-01696-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 09/08/2019] [Indexed: 01/12/2023]
Abstract
Evaluation of myocardial regional function is generally performed by visual "eyeballing" which is highly subjective. A robust quantifiable parameter of regional function is required to provide an objective, repeatable and comparable measure of myocardial performance. We aimed to evaluate the clinical utility of novel regional myocardial strain software from cardiac computed tomography (CT) datasets. 93 consecutive patients who had undergone retrospectively gated cardiac CT were evaluated by the software, which utilizes a finite element based tracking algorithm through the cardiac cycle. Circumferential (CS), longitudinal (LS) and radial (RS) strains were calculated for each of 16 myocardial segments and compared to a visual assessment, carried out by an experienced cardiologist on cine movies of standard "echo" views derived from the CT data. A subset of 37 cases was compared to speckle strain by echocardiography. The automated software performed successfully in 93/106 cases, with minimal human interaction. Peak CS, LS and RS all differentiated well between normal, hypokinetic and akinetic segments. Peak strains for akinetic segments were generally post-systolic, peaking at 50 ± 17% of the RR interval compared to 43 ± 9% for normokinetic segments. Using ROC analysis to test the ability to differentiate between normal and abnormal segments, the area under the curve was 0.84 ± 0.01 for CS, 0.80 ± 0.02 for RS and 0.68 ± 0.02 for LS. There was a moderate agreement with speckle strain. Automated 4D regional strain analysis of CT datasets shows a good correspondence to visual analysis and successfully differentiates between normal and abnormal segments, thus providing an objective quantifiable map of myocardial regional function.
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20
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Tanabe K, Yamaguchi K. Incorporating three-dimensional echocardiography into clinical practice. J Echocardiogr 2019; 17:169-176. [PMID: 31512104 DOI: 10.1007/s12574-019-00443-y] [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: 08/24/2019] [Accepted: 08/26/2019] [Indexed: 10/26/2022]
Abstract
Three-dimensional echocardiography (3DE) has many advantages over two-dimensional echocardiography, such as (1) improved visualization of the complex shapes and spatial relations between cardiac structures, (2) improved quantification of the cardiac volumes and function, and (3) improved display and assessment of valve dysfunction. The aim of this review article is to focus on the current clinical utility of 3DE.
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Affiliation(s)
- Kazuaki Tanabe
- Division of Cardiology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan.
| | - Kazuto Yamaguchi
- Division of Cardiology, Faculty of Medicine, Shimane University, 89-1 Enya-cho, Izumo, 693-8501, Japan
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21
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Edwards NF, Scalia GM, Shiino K, Sabapathy S, Anderson B, Chamberlain R, Khandheria BK, Chan J. Global Myocardial Work Is Superior to Global Longitudinal Strain to Predict Significant Coronary Artery Disease in Patients With Normal Left Ventricular Function and Wall Motion. J Am Soc Echocardiogr 2019; 32:947-957. [DOI: 10.1016/j.echo.2019.02.014] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Indexed: 11/16/2022]
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22
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Nudi F, Biondi-Zoccai G, Romagnoli A, Schillaci O, Nudi A, Versaci F. Hybrid anatomo-functional imaging of coronary artery disease: Beneficial irrespective of its core components. J Nucl Cardiol 2019; 26:752-762. [PMID: 30565061 DOI: 10.1007/s12350-018-01562-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Accepted: 09/19/2018] [Indexed: 02/05/2023]
Abstract
Coronary artery disease (CAD) is the most common and important cause of ischemic heart disease, with major implications on global morbidity and mortality. Non-invasive testing is crucial in the diagnostic and prognostic work-up of patients with or at risk of CAD, and also to guide decision making in terms of pharmacologic and revascularization therapy. The traditional paradigm is to view anatomic (i.e., coronary computed tomography) and functional imaging (e.g., myocardial perfusion scintigraphy) tests as opposing alternatives. Such approach is too reductionist and does not capitalize on the strengths of each type of test while risking to overlook the inherent limitations. The combination of anatomic and functional tests in a logic of hybrid imaging holds the promise of overcoming the limitations inherent to anatomic and functional testing, enabling more accurate diagnosis, prognosis, and guidance for revascularization in patients with CAD.
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Affiliation(s)
- Francesco Nudi
- Service of Hybrid Cardio Imaging, Madonna Della Fiducia Clinic, Rome, Italy.
- Ostia Radiologica, Rome, Italy.
- Replycare, Viale Africa 36, 00144, Rome, Italy.
| | - Giuseppe Biondi-Zoccai
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
- IRCCS NEUROMED, Pozzilli, Italy
| | | | - Orazio Schillaci
- IRCCS NEUROMED, Pozzilli, Italy
- Department of Nuclear Medicine, Tor Vergata University, Rome, Italy
| | - Alessandro Nudi
- Service of Hybrid Cardio Imaging, Madonna Della Fiducia Clinic, Rome, Italy
- Replycare, Viale Africa 36, 00144, Rome, Italy
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