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Prasad SB, Chan NI, Krishnan A, Martin P, Stewart P, Mallouhi M, Vollbon W, Atherton JJ. Novel combined echocardiographic score comprising prognostically validated measures of left ventricular size and function to predict long-term survival following myocardial infarction: A proposal to improve risk stratification. Echocardiography 2024; 41:e15922. [PMID: 39238443 DOI: 10.1111/echo.15922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2024] [Revised: 08/21/2024] [Accepted: 08/22/2024] [Indexed: 09/07/2024] Open
Abstract
BACKGROUND While left ventricular ejection fraction (LVEF) is the primary variable utilized for prognosis following myocardial infarction (MI), it is relatively indiscriminate for survival in patients with mildly reduced (> 40%) or preserved LVEF (> 50%). Improving risk stratification in patients with mildly reduced or preserved LVEF remains an unmet need, and could be achieved by using a combination approach using prognostically validated measures of left-ventricular (LV) size, geometry, and function. AIMS The aim of this study was to compare the prognostic utility of a Combined Echo-Score for predicting all-cause (ACM) and cardiac mortality (CM) following MI to LVEF alone, including the sub-groups with LVEF > 40% and LVEF > 50%. METHODS Retrospective data on 3094 consecutive patients with MI from 2013 to 2021 who had inpatient echocardiography were included, including both patients with ST-elevation MI (n = 869 [28.1%]) and non-ST-elevation MI (n = 2225 [71.9%]). Echo-Score consisted of LVEF < 40% (2 points) or LVEF < 50% (1 point), and 1 point each for left atrial volume index > 34 mL/m2, septal E/e' > 15, abnormal LV mass-index, tricuspid regurgitation velocity > 2.8 m/s, and abnormal LV end-systolic volume-index. Simple addition was used to derive a score out of 7. RESULTS At a median follow-up of 4.5 years there were 445 deaths (130 cardiac deaths). On Cox proportional-hazards multivariable analysis incorporating significant clinical and echocardiographic predictors, Echo-Score was an independent predictor of both ACM (HR 1.34, p < .001) and CM (HR 1.59, p < .001). Inter-model comparisons of model 𝛘2, Harrel's C and Somer's D, and Receiver operating curves confirmed the superior prognostic value of Echo-Score for both endpoints compared to LVEF. In the subgroups with LVEF > 40% and LVEF > 50%, Echo-Score was similarly superior to LVEF for predicting ACM and CM. CONCLUSIONS An Echo-Score composed of prognostically validated LV parameters is superior to LVEF alone for predicting survival in patients with MI, including the subgroups with mildly reduced and preserved LVEF. This could lead to improved patient risk stratification, better-targeted therapies, and potentially more efficient use of device therapies. Further studies should be considered to define the benefit of further investigation and treatment in high-risk subgroups.
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Affiliation(s)
- Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Faculty of Medicine, Griffith University, Southport, Australia
| | - Nicole Ivy Chan
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Anish Krishnan
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Paul Martin
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Peter Stewart
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Australia
| | - Michael Mallouhi
- Statewide Cardiac Network, Ministry of Health, Brisbane, Queensland, Australia
| | - William Vollbon
- Statewide Cardiac Network, Ministry of Health, Brisbane, Queensland, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Herston, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
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Pawar SG, Saravanan PB, Gulati S, Pati S, Joshi M, Salam A, Khan N. Study the relationship between left atrial (LA) volume and left ventricular (LV) diastolic dysfunction and LV hypertrophy: Correlate LA volume with cardiovascular risk factors. Dis Mon 2024; 70:101675. [PMID: 38262769 DOI: 10.1016/j.disamonth.2024.101675] [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] [Indexed: 01/25/2024]
Abstract
Heart failure (HF) with normal ejection fraction - the isolated diastolic heart failure, depicts increasing prevalence and health care burden in recent times. Having less mortality rate compared to systolic heart failure but high morbidity, it is evolving as a major cardiac concern. With increasing clinical use of Left atrial volume (LAV) quantitation in clinical settings, LAV has emerged as an important independent predictor of cardiovascular outcome in HF with normal ejection fraction. This article is intended to review the diastolic and systolic heart failure, their association with left atrial volume, in depth study of Left atrial function dynamics with determinants of various functional and structural changes.
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Affiliation(s)
| | | | | | | | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Ajal Salam
- Government Medical College, Kottayam, Kerala, India
| | - Nida Khan
- Jinnah Sindh Medical University, Karachi, Pakistan
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3
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Cheng KL, Lai PH, Su CL, Baek JH, Lee HL. Impact of Region-of-Interest Size on the Diagnostic Performance of Shear Wave Elastography in Differentiating Thyroid Nodules. Cancers (Basel) 2023; 15:5214. [PMID: 37958387 PMCID: PMC10648139 DOI: 10.3390/cancers15215214] [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: 09/17/2023] [Revised: 10/26/2023] [Accepted: 10/28/2023] [Indexed: 11/15/2023] Open
Abstract
This study investigated the impact of different region-of-interest (ROI) sizes (Max, 1 mm, and 2 mm) on shear wave elastography (SWE) in differentiating between malignant and benign thyroid nodules. The study cohort comprised 129 thyroid nodules (50 malignant, 79 benign) and 78 normal subjects. Diagnostic efficacy was assessed through pairwise comparisons of area under the curve (AUC) values in receiver operating characteristic analysis by using DeLong's test. Our results indicated significant differences in all SWE elasticity metrics between the groups, with malignant nodules exhibiting higher values than benign nodules (p < 0.05). Smaller ROIs (1 and 2 mm) were found to outperform the max ROI in terms of diagnostic accuracy, particularly for the Emax and Emin elasticity metrics. Emax(1mm) had the highest diagnostic accuracy, with an AUC of 0.883, sensitivity of 74.0%, and specificity of 86.1%. This study underscores the significant influence of ROI size selection on the diagnostic performance of SWE, offering valuable insights for future research and clinical applications in thyroid nodule assessment.
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Affiliation(s)
- Kai-Lun Cheng
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (K.-L.C.); (P.-H.L.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Pin-Hsien Lai
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung 40201, Taiwan; (K.-L.C.); (P.-H.L.)
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
| | - Chun-Lang Su
- Chung Jen Junior College of Nursing, Health Science and Management, Chiayi City 60077, Taiwan;
- Department of Rehabilitation, Tung Wah Hospital, Nantou City 55713, Taiwan
| | - Jung Hwan Baek
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Republic of Korea;
| | - Hsiang-Lin Lee
- School of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Surgery, Chung Shan Medical University Hospital, Taichung 40201, Taiwan
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Teodorovich N, Fabrikant Y, Gandelman G, Swissa M, Jonas M, George J, Shimoni S. The Additive Effect of Left Ventricular Filling Pressure and Renal Function on Long-Term Prognosis of High-Risk Patients Undergoing Coronary Angiography. Cardiorenal Med 2023; 13:271-281. [PMID: 37604117 PMCID: PMC10664344 DOI: 10.1159/000533589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/27/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Impaired relaxation is the earliest manifestation of ischemic cascade. Risk factors and renal function abnormalities are associated with coronary disease and diastolic dysfunction as well. We aimed to study the association of noninvasive assessment of left ventricular filling pressures and renal function with mortality in high-risk patients undergoing coronary angiography. PATIENTS AND METHODS An observational prospective study of 564 consecutive patients undergoing coronary angiography was conducted. The median follow-up was 2,293 days. Patients were categorized into 2 groups according to presence of significant diastolic dysfunction: group 1, 382 patients, with normal and group 2, 182 patients, with elevated filling pressure. Renal insufficiency was determined as calculated glomerular filtration rate <60 mL/min. Patients demographic, clinical, echocardiography, laboratory, and angiographic data were prospectively collected. RESULTS Fifty-three percent of patients underwent angiography due to acute coronary syndrome (ACS), 85.5% had coronary artery disease, 53.4% had reduced (<50%) left ventricular ejection fraction (LVEF), and 47.4% had abnormal renal function. The mortality during the follow-up period was 30.0%. Patients with elevated filling pressure had significantly higher mortality (50.5% vs. 20.2%, p < 0.0001). Impaired renal failure as well, was associated with higher mortality (48% vs. 15%, p < 0.001). The association remained significant in subgroups of patients with and without ACS and reduced and preserved LVEF. In Cox regression model which combined elevated filling pressure, renal insufficiency, age, diabetes mellitus, hypertension, presence of atrial fibrillation, LVEF, and anemia, elevated filling pressure and renal function impairment were independently associated with higher mortality (HR: 3.717, CI: 1.623-8.475, p < 0.0001 and HR: 0.972, CI: 0.958-0.985, p = 0.0001, respectively). There was an incremental prognostic value of elevated filling pressures and renal function impairment on mortality. CONCLUSIONS Advanced diastolic dysfunction and impaired renal function are signals toward worse outcomes and are associated with mortality in high-risk patients undergoing coronary angiography.
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Affiliation(s)
- Nicholay Teodorovich
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yakov Fabrikant
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gera Gandelman
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Swissa
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Jonas
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jacob George
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Sara Shimoni
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Lancini D, Prasad A, Thomas L, Atherton J, Martin P, Prasad S. Predicting new onset atrial fibrillation post acute myocardial infarction: Echocardiographic assessment of left atrial size. Echocardiography 2023. [PMID: 37096734 DOI: 10.1111/echo.15574] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/23/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) commonly occurs following acute myocardial infarction (AMI). Left atrial (LA) size has been reported to predict new onset AF in this cohort, however, the optimal metric of left atrial size for risk stratification following AMI is unknown. METHODS Patients presenting to a tertiary hospital with incident AMI (NSTEMI or STEMI) and no history of AF were recruited. All patients underwent guideline-based workup and management for AMI, including transthoracic echocardiographic assessment. Three alternative metrics of left atrial size were determined: LA area, maximal and minimal LA volume indexed to body surface area (LAVImax and LAVImin). The primary endpoint was new onset AF diagnoses. RESULTS Four hundred thirty three patients were included in the analysis, of which 7.1% had a new diagnosis of AF within a median follow-up of 3.8 years. Univariate predictors of incident AF included age, hypertension, revascularization with CABG, NSTEMI presentation, right atrial area, and all three metrics of LA size. Among three multivariable models created for the prediction of new onset AF utilizing alternate metrics of LA size, LAVImin was the only LA size metric found to be an independent predictor. CONCLUSIONS LAVImin is an independent predictor of new onset AF post AMI. LAVImin outperforms echocardiographic assessment of diastolic dysfunction and alternative metrics of LA size (including LA area and LAVImax) for risk stratification. Further studies are needed to validate our findings in post AMI patients, and evaluate whether LAVImin holds similar advantages over LAVImax in other cohorts.
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Affiliation(s)
- Daniel Lancini
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Aveechal Prasad
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Liza Thomas
- Cardiology Department, Westmead Hospital, Sydney, Australia
- Westmead Clinical School, University of Sydney, Sydney, Australia
| | - John Atherton
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Paul Martin
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Sandhir Prasad
- Cardiology Department, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Griffith University, Brisbane, Australia
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Lavine SJ, Kelvas D. Diastolic Dysfunction Criteria and Heart failure Readmission in Patients with Heart Failure and Reduced Ejection Fraction. Open Cardiovasc Med J 2023. [DOI: 10.2174/18741924-v17-e230301-2022-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] Open
Abstract
Background:
Advanced diastolic dysfunction (DDys) correlates with elevated LV filling pressures and predicts heart failure readmission (HF-R). As grade 2-3 DDys has predictive value for HF-R, and requires 2 of 3 criteria (left atrial volume index >34 ml/m2, E/e’>14, or tricuspid regurgitation velocity >2.8 m/s), we hypothesized that all 3 criteria would predict greater HF risk than any 2 criteria.
Methods:
In this single-center retrospective study that included 380 patients in sinus rhythm with HF and reduced ejection, we recorded patient characteristics, Doppler-echo, and HF-R with follow-up to 2167 days (median=1423 days; interquartile range=992-1821 days).
Results:
For grade 1 DDys (223 patients), any single criteria resulted in greater HF-R as compared to 0 criteria (HR=2.52, (1.56-3.88) p<0.0001) with an AUC (area under curve)=0.637, p<0.001. For grade 2 DDys (94 patients), there was greater HF-R for all 3 (vs. 0 criteria: HR=4.0 (2.90-8.36), p<0.0001). There was greater HF-R for 3 vs any 2 criteria (HR=1.81, (1.10-3.39), p=0.0222). For all 3 criteria, there was moderate predictability for HF-R (AUC=0.706, p<0.0001) which was more predictive than any 2 criteria (AUC difference 0.057, (0.011-0.10), p=0.009). For grade 3 DDys (63 patients), E/A>2+2-3 criteria identified a subgroup with the greatest risk of HF-R (HR=5.03 (4.62-22.72), p<0.0001) compared with 0 DDys criteria with moderate predictability for 2-3 criteria (AUC=0.726, p<0.0001) exceeding E/A>2+0-1 criteria (AUC difference=0.120, (0.061-0.182), p<0.001).
Conclusion:
Increasing the number of abnormal criteria increased the risk and predictive value of HF-R for grade 1-3 DDys in patients with HF with reduced ejection fraction.
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Cabrera Cárdenas A, Salanova Villanueva L, Sánchez Horrillo A, Muñoz Ramos P, Ruano P, Quiroga B. Diastolic dysfunction is an independent predictor for cardiovascular events after an acute kidney injury. Nefrologia 2023; 43:224-231. [PMID: 37442710 DOI: 10.1016/j.nefroe.2023.07.002] [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: 06/27/2021] [Accepted: 11/02/2021] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND AND AIM Acute kidney injury (AKI) conditions several short- and long-term complications. The aim of the present study was to analyse the impact of cardiac function and structure in the cardiovascular prognosis after an in-hospital AKI episode. MATERIAL AND METHODS This is an observational retrospective cohorts study including all in-hospital AKI episodes in 2013 and 2014 in our centre. At baseline, epidemiological values, comorbidities and echocardiography parameters were collected. During a follow-up of 49 ± 28 months, cardiovascular events (CVE) were collected, and associated factors were analysed. RESULTS 1255 patients were included (55% male, age 75 ± 13 years). Of the 676 (54%) that had a previous echocardiogram, 46% had left ventricular hypertrophy, 38% pulmonary hypertension, 38% diastolic dysfunction and 22% systolic dysfunction. During the follow-up, 484 (39%) developed a CVE. Associated factors to VCE were male sex, age, diabetes mellitus, hypertension, dyslipidemia, coronary heart disease, heart failure, atrial fibrillation, neoplasia and chronic kidney disease (also, glomerular filtration rate at baseline and after the AKI episode). Survival curves demonstrated that all the echocardiographic parameters were associated to CVE. An adjusted Cox regression model showed that age (HR 1.017), diabetes (HR 1.576) and diastolic dysfunction (HR 1.358) were independent predictors for CVE. CONCLUSION Diastolic dysfunction is an independent predictor for long-term cardiovascular events after an in-hospital acute kidney injury episode.
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Affiliation(s)
| | | | | | | | - Pablo Ruano
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain
| | - Borja Quiroga
- Servicio de Nefrología, Hospital Universitario de La Princesa, Madrid, Spain.
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Lewandowski D, Yang EY, Nguyen DT, Khan MA, Malahfji M, El Tallawi C, Chamsi Pasha MA, Graviss EA, Shah DJ, Nagueh SF. Relation of Left Ventricular Diastolic Function to Global Fibrosis Burden: Implications for Heart Failure Risk Stratification. JACC Cardiovasc Imaging 2023:S1936-878X(23)00032-3. [PMID: 37038874 DOI: 10.1016/j.jcmg.2022.12.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 12/21/2022] [Accepted: 12/22/2022] [Indexed: 04/12/2023]
Abstract
BACKGROUND Left ventricular (LV) diastolic function is primarily assessed by means of echocardiography, which has limited utility in detecting fibrosis. Cardiac magnetic resonance (CMR) readily detects and quantifies fibrosis. OBJECTIVES In this study, the authors sought to determine the association of LV diastolic function by to echocardiography with CMR-determined global fibrosis burden and the incremental value of fibrosis with diastolic function grade in prediction of total mortality and heart failure hospitalizations. METHODS A total of 549 patients underwent comprehensive echocardiography and CMR within 30 days. Echocardiography was used to assess LV diastolic function, and CMR was used to determine LV volumes, mass, ejection fraction, replacement fibrosis, and percentage extracellular volume fraction (ECV). RESULTS Normal diastolic function was present in 142 patients; the rest had diastolic dysfunction grades I to III, except for 18 (3.3%) with indeterminate results. The event rate was higher in patients with diastolic dysfunction compared with patients with normal diastolic function (33.4% vs 15.5; P < 0.001). The model including LV diastolic function grades II and III predicted composite outcome (C-statistic: 0.71; 95% CI: 0.67-0.76), which increased by adding global fibrosis burden (C-statistic: 0.74, 95% CI: 0.70-0.78; P = 0.02). For heart failure hospitalizations, the competing risk model with LV diastolic function grades II and III was good (C-statistic: 0.78; 95% CI: 0.74-0.83) and increased significantly with the addition of global fibrosis burden (C-statistic: 0.80; 95% CI: 0.76-0.85; P = 0.03). CONCLUSIONS Higher grades of diastolic dysfunction are seen in patients with replacement fibrosis and increased ECV. Fibrosis burden as determined with the use of CMR provides incremental prognostic information to echocardiographic evaluation of LV diastolic function.
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Affiliation(s)
| | - Eric Y Yang
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Duc T Nguyen
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA
| | - Mohammad A Khan
- University of Arizona College of Medicine, Phoenix, Arizona, USA
| | - Maan Malahfji
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | | | | | - Edward A Graviss
- Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA; Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Dipan J Shah
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
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Lin X, Yang F, Chen Y, Chen X, Wang W, Chen X, Wang Q, Zhang L, Guo H, Liu B, Yu L, Pu H, Zhang P, Wu Z, Li X, Burkhoff D, He K. Echocardiography-based AI detection of regional wall motion abnormalities and quantification of cardiac function in myocardial infarction. Front Cardiovasc Med 2022; 9:903660. [PMID: 36072864 PMCID: PMC9441592 DOI: 10.3389/fcvm.2022.903660] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 08/04/2022] [Indexed: 11/13/2022] Open
Abstract
Objective To compare the performance of a newly developed deep learning (DL) framework for automatic detection of regional wall motion abnormalities (RWMAs) for patients presenting with the suspicion of myocardial infarction from echocardiograms obtained with portable bedside equipment versus standard equipment. Background Bedside echocardiography is increasingly used by emergency department setting for rapid triage of patients presenting with chest pain. However, compared to images obtained with standard equipment, lower image quality from bedside equipment can lead to improper diagnosis. To overcome these limitations, we developed an automatic workflow to process echocardiograms, including view selection, segmentation, detection of RWMAs and quantification of cardiac function that was trained and validated on image obtained from bedside and standard equipment. Methods We collected 4,142 examinations from one hospital as training and internal testing dataset and 2,811 examinations from other hospital as the external test dataset. For data pre-processing, we adopted DL model to automatically recognize three apical views and segment the left ventricle. Detection of RWMAs was achieved with 3D convolutional neural networks (CNN). Finally, DL model automatically measured the size of cardiac chambers and left ventricular ejection fraction. Results The view selection model identified the three apical views with an average accuracy of 96%. The segmentation model provided good agreement with manual segmentation, achieving an average Dice of 0.89. In the internal test dataset, the model detected RWMAs with AUC of 0.91 and 0.88 respectively for standard and bedside ultrasound. In the external test dataset, the AUC were 0.90 and 0.85. The automatic cardiac function measurements agreed with echocardiographic report values (e. g., mean bias is 4% for left ventricular ejection fraction). Conclusion We present a fully automated echocardiography pipeline applicable to both standard and bedside ultrasound with various functions, including view selection, quality control, segmentation, detection of the region of wall motion abnormalities and quantification of cardiac function.
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Affiliation(s)
- Xixiang Lin
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Feifei Yang
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
| | | | | | - Wenjun Wang
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
| | - Xu Chen
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
- Medical School of Chinese PLA, Beijing, China
| | - Qiushuang Wang
- Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Liwei Zhang
- Fourth Medical Center of PLA General Hospital, Beijing, China
| | - Huayuan Guo
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
| | - Bohan Liu
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
| | - Liheng Yu
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
| | | | | | | | - Xin Li
- Sixth Medical Center of PLA General Hospital, Beijing, China
| | - Daniel Burkhoff
- Cardiovascular Research Foundation, New York, NY, United States
| | - Kunlun He
- Medical Big Data Center, Chinese PLA General Hospital, Beijing, China
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10
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Krishnan A, Prasad SB, Guppy-Coles KB, Holland DJ, Hammett C, Whalley G, Thomas L, Atherton JJ. Composite Echocardiographic Score to Predict Long-Term Survival Following Myocardial Infarction. Heart Lung Circ 2022; 31:795-803. [PMID: 35221203 DOI: 10.1016/j.hlc.2022.01.005] [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: 06/23/2021] [Revised: 12/07/2021] [Accepted: 01/09/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Whilst the left ventricular ejection fraction (LVEF) remains the primary echocardiographic measure widely utilised for risk stratification following myocardial infarction (MI), it has a number of well recognised limitations. The aim of this study was to compare the prognostic utility of a composite echocardiographic score (EchoScore) composed of prognostically validated measures of left-ventricular (LV) size, geometry and function, to the utility of LVEF alone, for predicting survival following MI. METHODS Retrospective data on 394 consecutive patients with a first-ever MI were included. Comprehensive echocardiography was performed within 24 hours of admission for all patients. EchoScore consisted of LVEF<50%, left atrial volume index>34 mL/m2, average E/e >14, E/A ratio>2, abnormal LV mass index, and abnormal LV end-systolic volume index. A single point was allocated for each measure to derive a score out of 6. The primary outcome measure was all-cause mortality. RESULTS At a median follow-up of 24 months there were 33 deaths. On Kaplan-Meier analysis, a high EchoScore (>3) displayed significant association with all-cause mortality (log-rank χ2=74.48 p<0.001), and was a better predictor than LVEF<35% (log-rank χ2=17.01 p<0.001). On Cox proportional-hazards multivariate analysis incorporating significant clinical and echocardiographic predictors, a high EchoScore was the strongest independent predictor of all-cause mortality (HR 6.44 95%CI 2.94-14.01 p<0.001), and the addition of EchoScore resulted in greater increment in model power compared to addition of LVEF (model χ2 56.29 vs 44.71 p<0.001, Harrell's C values 0.83 vs 0.79). CONCLUSIONS A composite echocardiographic score composed of prognostically validated measures of LV size, geometry, and function is superior to LVEF alone for predicting survival following MI.
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Affiliation(s)
- Anish Krishnan
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, Griffith University, Brisbane, Qld, Australia.
| | | | - David J Holland
- Department of Cardiology, Sunshine Coast University Hospital, Birtinya, Qld, Australia
| | - Christopher Hammett
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | | | | | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
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11
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Wong JM, Abouzeid CM, Nguyen TD, Fang Q, Bibby D, Schiller NB. Interrater reproducibility of the 2016 American society of echocardiography left ventricular diastolic function guidelines. Echocardiography 2022; 39:678-684. [PMID: 35342988 DOI: 10.1111/echo.15345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/22/2022] [Accepted: 03/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Little data exist regarding interreader variability of diastolic measurements and their application by the 2016 American Society of Echocardiography left ventricular (LV) diastolic function guidelines. METHODS Volunteers (n = 49) were recruited from an outpatient cardiology practice. The presence and grade of diastology dysfunction (DD) was determined by the 2016 LV diastology guideline algorithm. We determined the mean, standard deviation, coefficient of variation, and intraclass correlation coefficient (ICC) for each measurement and Fleiss K-statistic to define differences in grading DD. We determined predictors associated with disagreement of DD grade using odds ratios. RESULTS The mean LVEF was 56%, LAVI 32 ml/m2 , and peak TR velocity was 2.3 m/s. The ICC for mitral inflow and tissue Doppler velocities were >.90, for LV volumes were .80-.86, and for LA volume was .56. The Fleiss K-value for the agreement of the presence of DD was .68 and for DD grade was .59. Variables with increased odds of disagreement were (1) at least one reader considering a TR signal uninterpretable (OR 12.0; 95% CI 1.3-109.6), (2) at least one reader assessing both LVEF 50%-55% and LAVI 29-39 ml/m2 (OR 9.3; 95% CI 1.0-87), and (3) at least one reader assessing LVEF 50-55% (OR 3.8; 95% CI 1.1-13.4). CONCLUSIONS Using the 2016 ASE/EACVI diastology guidelines, we found excellent interrater reliability of Doppler measurements, moderate-good interrater reliability of volumetric measurements, and moderate-good but not excellent agreement for diastology grade.
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Affiliation(s)
- Jonathan M Wong
- California Pacific Medical Center, San Francisco, California, USA
| | | | - Thuy D Nguyen
- University of California San Francisco, San Francisco, California, USA
| | - Qizhi Fang
- University of California San Francisco, San Francisco, California, USA
| | - Dwight Bibby
- University of California San Francisco, San Francisco, California, USA
| | - Nelson B Schiller
- University of California San Francisco, San Francisco, California, USA
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12
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Smiseth OA, Morris DA, Cardim N, Cikes M, Delgado V, Donal E, Flachskampf FA, Galderisi M, Gerber BL, Gimelli A, Klein AL, Knuuti J, Lancellotti P, Mascherbauer J, Milicic D, Seferovic P, Solomon S, Edvardsen T, Popescu BA. Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e34-e61. [PMID: 34729586 DOI: 10.1093/ehjci/jeab154] [Citation(s) in RCA: 148] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022] Open
Abstract
Nearly half of all patients with heart failure (HF) have a normal left ventricular (LV) ejection fraction (EF) and the condition is termed heart failure with preserved ejection fraction (HFpEF). It is assumed that in these patients HF is due primarily to LV diastolic dysfunction. The prognosis in HFpEF is almost as severe as in HF with reduced EF (HFrEF). In contrast to HFrEF where drugs and devices are proven to reduce mortality, in HFpEF there has been limited therapy available with documented effects on prognosis. This may reflect that HFpEF encompasses a wide range of different pathological processes, which multimodality imaging is well placed to differentiate. Progress in developing therapies for HFpEF has been hampered by a lack of uniform diagnostic criteria. The present expert consensus document from the European Association of Cardiovascular Imaging (EACVI) provides recommendations regarding how to determine elevated LV filling pressure in the setting of suspected HFpEF and how to use multimodality imaging to determine specific aetiologies in patients with HFpEF.
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Affiliation(s)
- Otto A Smiseth
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, N° 100, Lisbon, Portugal
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France.,Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate, 10/2806 Brussels, Belgium
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, Pisa 56124, Italy
| | - Allan L Klein
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Julia Mascherbauer
- Department of Internal Medicine 3, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Krems, Austria
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Petar Seferovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Scott Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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13
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Oh S, Kim JH, Cho KH, Kim MC, Sim DS, Hong YJ, Ahn Y, Jeong MH. Clinical impact of pulmonary hypertension on the outcomes of acute myocardial infarction patients with or without chronic obstructive pulmonary disease. Medicine (Baltimore) 2022; 101:e28627. [PMID: 35060541 PMCID: PMC8772642 DOI: 10.1097/md.0000000000028627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 12/21/2021] [Accepted: 01/02/2022] [Indexed: 01/05/2023] Open
Abstract
ABSTRACT Acute myocardial infarction (AMI) and chronic obstructive pulmonary disease (COPD) are leading global causes of morbidity and mortality. In patients with both of these conditions, the presence of pulmonary hypertension (PH) can further worsen their prognosis. We examined the outcomes of AMI patients with COPD (AMI+COPD) and without COPD (AMI-COPD), depending on the presence or absence of PH.A total of 318 AMI patients with COPD (AMI+COPD cohort) (n = 109) or without COPD (AMI-COPD cohort) (n = 209) were included in this study and were subdivided into 2 groups according to right ventricular systolic pressure (RVSP) level (PH group [RVSP ≥35 mm Hg] and no PH group [RVSP <35 mm Hg]).We investigated characteristics and clinical outcomes in both the AMI-COPD and AMI+COPD cohorts. When investigating in-hospital clinical outcomes, the PH group had a higher proportion of new-onset heart failure (HF) in both cohorts. In the AMI+COPD cohort, however, the PH group had a higher incidence of cardiogenic shock than the no PH group, which was consistent with the result of the post-inverse probability of treatment weighting (IPTW) analysis. When investigating 1-year clinical outcomes, the PH group had higher incidences of a major adverse cardiac event and all-cause mortality in both cohorts. This finding was mainly driven by cardiac death in the AMI-COPD cohort, whereas it was mainly driven by non-cardiac death in the AMI+COPD cohort. After IPTW adjustment, these differences were statistically attenuated such that all variables were similar between both groups.PH may be associated with the development of new-onset HF (in all patients) and cardiogenic shock (in the AMI+COPD cohort). In addition, PH may be also associated with all-cause mortality, although it was statistically attenuated after IPTW adjustment.
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14
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La disfunción diastólica es un predictor independiente de eventos cardiovasculares tras un fracaso renal agudo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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15
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Oeun B, Hikoso S, Nakatani D, Mizuno H, Suna S, Kitamura T, Okada K, Dohi T, Sotomi Y, Kojima T, Kida H, Sunaga A, Sato T, Takeda Y, Kurakami H, Yamada T, Tamaki S, Abe H, Nakagawa Y, Higuchi Y, Fuji H, Mano T, Uematsu M, Yasumura Y, Yamada T, Sakata Y. Prognostic Impact of Echocardiographic Diastolic Dysfunction on Outcomes in Patients With Heart Failure With Preserved Ejection Fraction - Insights From the PURSUIT-HFpEF Registry. Circ J 2021; 86:23-33. [PMID: 34456213 DOI: 10.1253/circj.cj-21-0300] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although diastolic dysfunction is important pathophysiology in heart failure with preserved ejection fraction (HFpEF), its prognostic impact in HFpEF patients, including those with atrial fibrillation (AF), remains to be elucidated.Methods and Results:We included the data for 863 patients (321 patients with AF) registered in a prospective multicenter observational study of patients with HFpEF. Patients were divided into 3 groups according to the 2016 ASE/EACVI recommendations. The primary endpoint was a composite of all-cause death or HF rehospitalization. Median age was 83 years, and 55.5% were female. 196 (22.7%) were classified with normal diastolic function (ND), 253 (29.3%) with indeterminate (ID) and 414 (48.0%) with diastolic dysfunction (DD). The primary endpoint occurred more frequently in patients with DD than in those with ND or ID (log-rank P<0.001 for DD vs. ND, and log-rank P=0.007 for DD vs. ID, respectively). Taking ND as the reference, multivariable Cox regression analysis revealed that DD (hazard ratio (HR): 1.57, 95% confidence interval (CI):1.06-2.32, P=0.024) was independently associated with the composite endpoint, whereas ID (HR: 1.28, 95% CI: 0.84-1.95, P=0.255) was not. DD was associated with the composite endpoint in both patients with and without AF. CONCLUSIONS HFpEF patients classified with DD using the 2016 ASE/EACVI recommendations had worse clinical outcomes than those with ND or ID. DD may be considered a prognostic marker in patients with HFpEF regardless of AF.
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Affiliation(s)
- Bolrathanak Oeun
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shungo Hikoso
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Daisaku Nakatani
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hiroya Mizuno
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Shinichiro Suna
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tetsuhisa Kitamura
- Department of Social and Environmental Medicine, Osaka University Graduate School of Medicine
| | - Katsuki Okada
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Tomoharu Dohi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yohei Sotomi
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Takayuki Kojima
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hirota Kida
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Akihiro Sunaga
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Taiki Sato
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | | | - Tomomi Yamada
- Department of Medical Innovation, Osaka University Hospital
| | | | | | | | | | | | | | | | | | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
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16
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Bae S, Yoon HJ, Kim KH, Kim HY, Park H, Cho JY, Kim MC, Kim Y, Ahn Y, Cho JG, Jeong MH. Usefulness of Diastolic Function Score as a Predictor of Long-Term Prognosis in Patients With Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:730872. [PMID: 34568464 PMCID: PMC8460859 DOI: 10.3389/fcvm.2021.730872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Left ventricular diastolic function (LVDF) evaluation using a combination of several echocardiographic parameters is an important predictor of adverse events in patients with acute myocardial infarction (AMI). To date, the clinical impact of each individual LVDF marker is well-known, but the clinical significance of the sum of the abnormal diastolic function markers and the long-term clinical outcome are not well-known. This study aimed to investigate the usefulness of LVDF score in predicting clinical outcomes of patients with AMI. Methods: LVDF scores were measured in a 2,030 patients with AMI who underwent successful percutaneous coronary intervention from 2012 to 2015. Four LVDF parameters (septal e' ≥ 7 cm/s, septal E/e' ≤ 15, TR velocity ≤ 2.8 m/s, and LAVI ≤ 34 ml/m2) were used for LVDF scoring. The presence of each abnormal LVDF parameter was scored as 1, and the total LVDF score ranged from 0 to 4. Mortality and hospitalization due to heart failure (HHF) in relation to LVDF score were evaluated. To compare the predictive ability of LVDF scores and left ventricular ejection fraction (LVEF) for mortality and HHF, receiver operating characteristic (ROC) curve and landmark analyses were performed. Results: Over the 3-year clinical follow-up, all-cause mortality occurred in 278 patients (13.7%), while 91 patients (4.5%) developed HHF. All-cause mortality and HHF significantly increased as LVDF scores increased (all-cause mortality-LVDF score 0: 2.3%, score 1: 8.8%, score 2: 16.7%, score 3: 31.8%, and score 4: 44.5%, p < 0.001; HHF-LVDF score 0: 0.6%, score 1: 1.8%, score 2: 6.3%, score 3: 10.3%, and score 4: 18.2%, p < 0.001). In multivariate analysis, a higher LVDF score was associated with significantly higher adjusted hazard ratios for all-cause mortality and HHF. In landmark analysis, LVDF score was a better predictor of long-term mortality than LVEF (area under the ROC curve: 0.739 vs. 0.640, p < 0.001). Conclusion: The present study demonstrated that LVDF score was a significant predictor of mortality and HHF in patients with AMI. LVDF scores are useful for risk stratification of patients with AMI; therefore, careful monitoring and management should be performed for patients with AMI with higher LVDF scores.
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Affiliation(s)
- SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Hyun Ju Yoon
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Kye Hun Kim
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyung Yoon Kim
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyukjin Park
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae Yeong Cho
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Chul Kim
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Youngkeun Ahn
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jeong Gwan Cho
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
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17
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Lavine SJ, Murtaza G, Rahman ZU, Kelvas D, Paul TK. Diastolic function grading by American Society of Echocardiography guidelines and prediction of heart failure readmission and all-cause mortality in a community-based cohort. Echocardiography 2021; 38:1988-1998. [PMID: 34555216 DOI: 10.1111/echo.15206] [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: 10/20/2020] [Revised: 06/25/2021] [Accepted: 08/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Diastolic function (DF) guidelines have been simplified but lack extensive outcome data. Using a rural university heart failure (HF) database, we assessed whether DF grading could predict HF, HF readmission, and all-cause mortality (ACM). METHODS In this single-center retrospective study that included 613 patients in sinus rhythm hospitalized for HF (HF with preserved-254 patients, with mid-range-216 patients, and reduced ejection fraction-143 patients), we recorded demographics, Doppler-echo, Framingham HF score, laboratories, HF readmission, and ACM with follow-up to 2167 days. RESULTS Diastolic dysfunction (Ddys) parameters (left atrial volume index [LAVI] > 34 ml/m2 , tricuspid regurgitation [TR] velocity > 2.8 m/sec, and E/e' > 14) had moderate sensitivity (46.2%-65.0%) for predicting HF among all phenotypes combined with DF grading having moderate predictability and additive to a clinical composite for HF prediction (AUC = .677, P < 0.0001; difference = .043, P < 0.001) for combined phenotypes. Ddys parameters and Ddys severity (2016 ASE criteria: grade II and III) were significantly associated with HF readmission for decompensated HF within 60-2167 days of follow-up (LAVI > 34 ml/m2 : HR 1.56 [1.26-2.19]; E/e' > 14: HR 1.44 [1.21-1.99]; TR > 2.8 m/sec: H1.43 [1.19-1.88]; LV Dys grade II: HR 2.12 [1.42-2.96]; LV Ddys grade III: HR 2.39 [1.57-4.82]). CONCLUSION The findings of this study highlight the clinical and prognostic relevance of determining the severity of LV Ddys in patients with HF with regard to HF verification and HF readmission.
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Affiliation(s)
- Steven J Lavine
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA.,Department of Medicine/Cardiology, Washington University of St. Louis, St. Louis, Missouri, USA
| | - Ghulam Murtaza
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Zia Ur Rahman
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Danielle Kelvas
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
| | - Timir K Paul
- Department of Medicine, Quillen College of Medicine, East Tennessee State University, Johnson City, Tennessee, USA
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18
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Nayyar D, Nguyen T, Pathan F, Vo G, Richards D, Thomas L, Dimitri H, Otton J. Cardiac magnetic resonance derived left atrial strain after ST-elevation myocardial infarction: an independent prognostic indicator. Cardiovasc Diagn Ther 2021; 11:383-393. [PMID: 33968617 DOI: 10.21037/cdt-20-879] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Background The prognostic value of cardiac magnetic resonance (CMR) derived left atrial (LA) strain, ejection fraction (LAEF) and indexed volumes (LAVImax and LAVImin) after ST-elevation myocardial infarction (STEMI) remains controversial. The aim of this study was to assess the relationship between LA function and major adverse cardiovascular events (MACE) after STEMI. Methods A total of 202 prospectively recruited patients who underwent CMR at median day 4 after STEMI had complete CMR data for feature tracking assessment. LA reservoir and booster strain were quantified based on the average of three independently repeated measurements. Results MACE occurred in 35 patients during a median follow up of 607 days. Patients with MACE had lower median LA reservoir strain (18.9% vs. 29.4%, P<0.001), LA booster strain (9.4% vs. 13.0%, P=0.002) and LAEF (41.5% vs. 49.2%, P<0.001) than patients without MACE. Kaplan-Meier analyses demonstrated a difference in MACE between high- and low-risk groups for LA reservoir strain (cutoff 19.2%, P<0.001), LA booster strain (cutoff 9.7%, P<0.001) and LAEF (cutoff 38.5%, P<0.001). The AUC increased from 0.713 (95% CI: 0.608-0.818) for LVEF to 0.775 (95% CI: 0.680-0.870) when LA reservoir strain was added to LVEF (P=0.047). Univariate Cox regression analysis showed that all LA parameters had a significant effect on MACE, while multivariate analysis found LA reservoir strain was an independent predictor of MACE (HR 0.905; 95% CI: 0.843-0.972, P=0.006). Conclusions CMR derived LA reservoir strain independently predicted MACE after STEMI when adjusted for standard risk measures.
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Affiliation(s)
- Dhruv Nayyar
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.,School of Medicine, Western Sydney University, Sydney, NSW, Australia
| | - Tuan Nguyen
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.,South West Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Faraz Pathan
- Cardiology Department, Nepean Hospital, Sydney, NSW, Australia.,Charles Perkins Centre Sydney, Nepean Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Giau Vo
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia
| | - David Richards
- Westmead Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Liza Thomas
- South West Clinical School, University of New South Wales, Sydney, NSW, Australia.,Westmead Clinical School, University of Sydney, Sydney, NSW, Australia.,Cardiology Department, Westmead Hospital, Sydney, NSW, Australia
| | - Hany Dimitri
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.,South West Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - James Otton
- Cardiology Department, Liverpool Hospital, Sydney, NSW, Australia.,South West Clinical School, University of New South Wales, Sydney, NSW, Australia
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19
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Rahman M, Kerut EK. Update of clinical echocardiographic assessment of heart failure with preserved ejection fraction. Curr Opin Cardiol 2021; 36:198-204. [PMID: 33395079 DOI: 10.1097/hco.0000000000000835] [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] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Heart failure with preserved ejection fraction (HFpEF) has an increasing global prevalence. Diastolic dysfunction is the predominant cause of symptoms, most commonly, exertional dyspnea. Although prevalent, the syndrome is challenging to identify due to the comorbid conditions that can present similarly. This paper will review established, guideline recommended, echocardiographic variables, and pathophysiology. RECENT FINDINGS Echocardiography is the primary diagnostic modality. The latest advances in strain analysis, algorithmic use of multiple parameters, and deeper understanding of exercise hemodynamics have improved our classification of those with HFpEF. SUMMARY There remains a paucity of therapies with mortality benefit in this subgroup. Thus, improving diagnostic efficacy is important as it can clarify epidemiologic, phenotypic, and pathologic features of HFpEF.
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Affiliation(s)
- Mehnaz Rahman
- LSU Health Sciences Section of Cardiology, New Orleans
| | - Edmund Kenneth Kerut
- LSU Health Sciences Section of Cardiology, New Orleans
- West Jefferson Heart Clinic of Louisiana, Marrero, Louisiana, USA
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20
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Wang Y, Zhang L, Liu S, Li G, Kong F, Zhao C, Yang J, Ma C. Validation of evaluating left ventricular diastolic function with estimated left atrial volume from anteroposterior diameter. BMC Cardiovasc Disord 2021; 21:110. [PMID: 33622243 PMCID: PMC7903781 DOI: 10.1186/s12872-021-01920-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Left atrial (LA) volume (LAV) is one of the recommended key variables for evaluating left ventricular (LV) diastolic function. However, only LA anteroposterior diameter (LAAP) is available in numerous large-scale existing databases. Therefore, this study aimed to validate whether LV diastolic function could be evaluated with estimated LAV from LAAP. Methods A total of 552 inpatients with sinus rhythm were consecutively enrolled. LAV was measured by biplane Simpson’s disk summation method. LV diastolic function was evaluated according to the 2016 proposed recommendations. Best-fitting regression models of LAAP index (LAAPI)–LAV index (LAVI) were developed and equations with the highest F-value were chosen in the first 276 subjects (derivation set), and concordance for evaluating LV diastolic function between using estimated and observed LAVI was verified in the remaining 276 subjects (validation set). Results In the derivation set, the linear model has the highest F-value in all subjects and in the subjects with normal or depressed LV ejection fraction. In the validation set, using the linear equation (LAVI = 2.05 × LAAPI − 13.86), the higher area under curve and narrower range of difference were shown between estimated LAVI and observed LAVI, respectively. Further, concordance for diagnosis (overall proportion of agreement, 88.4%; κ = 0.79) and grading (overall proportion of agreement, 84.8%; κ = 0.74) of LV diastolic dysfunction was substantial between using estimated and observed LAVI. Conclusions LV diastolic function can be evaluated with estimated LAVI from LAAPI, which might provide a surrogate method when the direct measurement of LAV is not available.
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Affiliation(s)
- Yonghuai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Liang Zhang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Shuang Liu
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Guangyuan Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Fanxin Kong
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Cuiting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Shenyang, 110001, Liaoning, People's Republic of China.
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21
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S SK, Desai N, Gona OJ, K VK, B M. Impact of Updated 2016 ASE/EACVI VIS-À-VIS 2009 ASE Recommendation on the Prevalence of Diastolic Dysfunction and LV Filling Pressures in Patients with Preserved Ejection Fraction. J Cardiovasc Imaging 2021; 29:31-43. [PMID: 33511798 PMCID: PMC7847794 DOI: 10.4250/jcvi.2020.0117] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 09/06/2020] [Accepted: 09/13/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Assessment of diastolic dysfunction (DD) and left ventricular filling pressures (LVFP) by echocardiography is complex in patients with preserved ejection fraction (EF). The American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) jointly published recommendations in 2016 to simplify the diagnosis and classification of DD and the assessment of LVFP. We aimed to study the impact of the updated 2016 ASE/EACVI guidelines vis-à-vis the 2009 ASE recommendations on prevalence of DD and LVFP in patients with preserved EF. METHODS Five hundred patients referred to the echocardiography laboratory from March 2020 to May 2020 were analyzed. Patients with left ventricular ejection fraction (LVEF) < 50% were excluded. All patients underwent comprehensive transthoracic echocardiography. DD and LVFP were assessed by the 2016 ASE/EACVI and 2009 ASE recommendations. The concordance between the guidelines was analyzed by kappa coefficient and overall proportion of agreement. RESULTS Mean age was 53 ± 13 years and 63.4% were men. Prevalence of DD and abnormal LVFP were significantly lower with the 2016 recommendations than with the 2009 recommendations (9.4% vs. 16.8%, p < 0.001 and 8.4% vs. 12.8%, p < 0.05). Patients with Grade 1 DD (100%) and Grade 2 DD (46.4%) were reclassified by the 2016 recommendations. Indeterminate diastolic function (9.8%) was strikingly high according to the 2016 recommendations. The concordance between the two recommendations was moderate (kappa = 0.569). The overall proportion of agreement was 85.4%. CONCLUSIONS Prevalence of DD and abnormal LV filling pressures were lower with application of the 2016 ASE/EACVI recommendations in patients with preserved EF. There was moderate agreement between the 2009 and 2016 recommendations.
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Affiliation(s)
- Sunil Kumar S
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India.
| | - Nagaraj Desai
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
| | - Oliver Joel Gona
- Department of Pharmacy Practice, JSS College of Pharmacy, JSS Academy of Higher Education and Research, Mysore, India
| | - Vinay Kumar K
- Department of Cardiology, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
| | - Madhu B
- Department of Community Medicine, JSS Medical College and Hospital, JSS Academy of Higher Education and Research, Mysore, India
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22
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Bahrami HSZ, Pedersen FHG, Myhr KA, Møgelvang R, Hassager C. Feasibility, repeatability, and reproducibility of contemporary diastolic parameters and classification. Int J Cardiovasc Imaging 2021; 37:931-944. [PMID: 33394217 DOI: 10.1007/s10554-020-02069-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 10/09/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE To evaluate feasibility, time of acquisition, retest repeatability and reproducibility of echocardiographic indexes and classification algorithms of diastolic function. METHODS A total of 356 patients were examined before coronary artery bypass-grafting and/or aortic valve surgery. A subgroup of 50 was examined with 3 successive echocardiograms in conditions reflecting daily clinical practice. Diastolic parameters were obtained and analysed according to previous (2009) and current (2016) guidelines. Acquisition and analysis time, plus intra- and inter-observer variability were assessed. RESULTS Feasibility of diastolic parameters was between 93 and 99%, except the maximal tricuspid regurgitation velocity (TR Vmax) (65%). Mean acquisition and analysis time were highest for left atrial volumes (141 ± 24 s) in contrast to other parameters which were obtained in approximately one minute. Mean 368 and 360 s were needed to classify diastolic function according to the 2009 and 2016 algorithms, respectively (non-significant). Reproducibility was overall moderate (Pearson r = 0.62 to 0.87), with TR Vmax having the highest (r = 0.62) and mitral valve E/A ratio the lowest (r = 0.87) variation. The 2009 algorithm resulted in more indeterminate cases than the 2016 algorithm. Inter-examiner analysis resulted in reclassification of 20 vs. 8 patients using the 2009 and 2016 algorithms, respectively. CONCLUSION Diastolic parameters are highly feasible and moderately reproducible, except TR Vmax. The 2016 algorithm is more restrictive than the 2009 algorithm in classifying patients with advanced stages of diastolic dysfunction. Time of acquisition according to the two guidelines is not significantly different.
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Affiliation(s)
- Hashmat S Z Bahrami
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
| | - Frederik H G Pedersen
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Katrine A Myhr
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Southern Denmark, Svendborg, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Ø, Denmark
| | - Christian Hassager
- Department of Cardiology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen Ø, Denmark
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23
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Diastolic dysfunction, frailty and prognosis in elderly patients with acute coronary syndromes. Int J Cardiol 2020; 327:31-35. [PMID: 33271207 DOI: 10.1016/j.ijcard.2020.11.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 11/04/2020] [Accepted: 11/23/2020] [Indexed: 12/22/2022]
Abstract
Background To investigate the relationship between 1-year outcome and diastolic dysfunction (DD) and frailty and/or physical performance (PP) in older adults admitted to hospital for acute coronary syndrome (ACS). Methods and results Older (age ≥ 70 years) hospitalized for ACS and receiving coronary artery angiography ± percutaneous coronary intervention were included. Before discharge a complete transthoracic echocardiogram (TTE) was performed with the assessment of DD, following the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging algorithm. Seven different scales of frailty and PP were assessed. The relationship between DD and tests of frailty and PP was investigated, as well as the association with the 1-year occurrence of all-cause death or re-hospitalization. Overall, 329 patients were included in the analysis. Patients were stratified in two groups: DD grade 0-1 versus 2-3. Those with undetermined degree of DD have been excluded by the analysis (n = 106). Mean age of the groups was 77 ± 5 vs 79 ± 6 years, respectively. Scales of frailty and/or PP were significantly poor in patients with DD grade 2-3 compared to the others. After multivariate Cox regression (considering age, female sex, haemoglobin, albumin, clinical presentation, LVEF and SPPB) DD (degree 2-3 vs. 0-1) emerged as an independent predictor of the composite endpoint (HR 1.69, 95%CI 1.04-2.75, p = 0.033). This was mainly driven by 1-year re-hospitalization (HR 2.01, 95%CI 1.22-3.27, p < 0.001). Conclusions In older ACS patients the assessment of DD is related to parameters of frailty and PP and it is an independent predictor of 1-year outcome.
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24
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Prasad SB, Guppy-Coles KB, Holland DJ, Whalley G, Thomas L, Atherton JJ. Hemodynamic and Prognostic Validation of Novel Combined Algorithm to Assess Diastolic Function and Filling Pressures. JACC Cardiovasc Imaging 2020; 13:2275-2276. [DOI: 10.1016/j.jcmg.2020.06.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 10/23/2022]
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25
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Oh JK, Miranda WR, Bird JG, Kane GC, Nagueh SF. The 2016 Diastolic Function Guideline: Is it Already Time to Revisit or Revise Them? JACC Cardiovasc Imaging 2020; 13:327-335. [PMID: 31918901 DOI: 10.1016/j.jcmg.2019.12.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jared G Bird
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas.
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26
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Nagueh SF. Diastology: 2020-A practical guide. Echocardiography 2020; 37:1919-1925. [PMID: 32476157 DOI: 10.1111/echo.14742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 05/09/2020] [Accepted: 05/11/2020] [Indexed: 01/25/2023] Open
Abstract
Left ventricular (LV) diastolic function can be most conveniently assessed by echocardiography which provides reliable assessments of LV structure and function. Most patients with structural heart disease have variable degrees of myocardial dysfunction. LV structural changes as pathologic hypertrophy and systolic functional abnormalities as depressed LV long-axis systolic function are associated with diastolic dysfunction. The recognition of structural abnormalities and abnormal LV long-axis function as indices of diastolic dysfunction is an important difference between 2016 and 2009 guidelines. In addition, there are other Doppler findings indicative of diastolic dysfunction and abnormally elevated LV filling pressures. In the absence of clinical, 2D echocardiographic, and specific Doppler indices of diastolic dysfunction, mitral annulus early diastolic velocity (e'), left atrium (LA) maximum volume index, peak velocity of tricuspid regurgitation jet by continuous-wave Doppler, and ratio of mitral inflow early diastolic velocity to e' velocity can be used to draw inferences about LV diastolic function. In the presence of diastolic dysfunction, mean LA pressure and grade of diastolic dysfunction should be determined. When LA pressure at rest is normal, it is reasonable to proceed to diastolic stress testing in an attempt to identify patients with dyspnea due to heart failure. There are specific algorithms recommended in patients with atrial fibrillation, moderate or severe mitral annular calcification, and noncardiac pulmonary hypertension.
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Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, TX, USA
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27
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Gopalakrishnan P, Biederman R. Impact of the 2016 ASE/EACVI Guidelines on diastolic function reporting in routine clinical practice. Echocardiography 2020; 37:546-553. [PMID: 32298005 DOI: 10.1111/echo.14645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/20/2020] [Accepted: 03/08/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To evaluate the impact of 2016 ASE/EACVI guidelines on Diastolic Function (DF) reporting during routine clinical practice. METHODS Transthoracic echos performed 9 months before and 18 months after the 2016 guidelines (DF2016) were retrospectively analyzed. RESULTS Twenty thousand eight hundred forty three echos performed between July 1, 2015, and September 30, 2017, were analyzed. Quarterly trends showed a stable proportion of normal DF (nDF), diastolic dysfunction (DD), indeterminate DF (DF-I), and nonreported DF (DF-NR) for 3 quarters preceding DF2016. After DF2016 release, reporting of DD decreased by 57% (P < .001), nDF increased by 76% (P < .001), DF-NR increased by 266% (P < .001), and DF-I did not change significantly (P = .40). Grade 1 DD decreased by 64% (P < .001), grade 2 DD decreased by 51% (P < .001), and grade 3 DD did not change significantly (P = .18). Provider level analysis showed increased heterogeneity in grade 1 DD reporting and decreased heterogeneity in DD grades 2 or higher, after DF2016. Systolic dysfunction reporting remained relatively stable (22%→21%→20%) compared to a significant decrease in isolated DD (35%→21%→10%). CONCLUSION The 2016 guidelines update has impacted DF reporting patterns significantly. The likelihood of reporting DD decreased significantly, especially for grades 1 and 2. Inter-provider heterogeneity in DF reporting improved for grades 2 and 3 but worsened for grade 1. There was more than threefold increase in failure to report DF, suggesting a decrease in provider confidence.
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Affiliation(s)
| | - Robert Biederman
- Gerald McGinnis Cardiovascular Institute, Allegheny General Hospital, Pittsburgh, Pennsylvania
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28
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Liang HY, Lo YC, Chiang HY, Chen MF, Kuo CC. Validation and Comparison of the 2003 and 2016 Diastolic Functional Assessments for Cardiovascular Mortality in a Large Single-Center Cohort. J Am Soc Echocardiogr 2020; 33:469-480. [DOI: 10.1016/j.echo.2019.11.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 11/23/2019] [Accepted: 11/24/2019] [Indexed: 01/28/2023]
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29
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Bursi F, Persampieri S, Sabatelli L, Bencini C, Santangelo G, Bosotti L, Tayar A, Valli F, Ferrante G, Caretta A, Torta D, Massironi L, Castini D, Carugo S. Diastolic dysfunction grade in acute coronary syndromes: Application of 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging recommendations. Int J Cardiol 2020; 305:18-24. [DOI: 10.1016/j.ijcard.2020.01.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 01/13/2020] [Accepted: 01/22/2020] [Indexed: 10/25/2022]
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Hemodynamic Validation of the E/e' Ratio as a Measure of Left Ventricular Filling Pressure in Patients With Non-ST Elevation Myocardial Infarction. Am J Cardiol 2020; 125:507-512. [PMID: 31836128 DOI: 10.1016/j.amjcard.2019.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 01/19/2023]
Abstract
The E/e' ratio has an established role in the assessment of left ventricular filling pressure (LVFP) in stable patients, but its accuracy in acute myocardial ischemia is less well established. The aim of this study was to validate the relation between the E/e' ratio and invasively measured LVFP in patients with non-ST elevation myocardial infarction (NSTEMI). A total of 120 unselected patients with NSTEMI underwent cardiac catheterization with measurement of left ventricular end-diastolic pressure (LVEDP; elevated ≥15 mm Hg) and Doppler echocardiography with either simultaneous (n = 30) or same-day (n = 90) measurement of E/e'. Patients were aged 64.1 ± 11.8 years, 72% were male and mean left ventricular ejection fraction was 48.0 ± 20.9%. Septal, lateral, and average E/e' ratios all showed a significant correlation with LVEDP (Pearson's r: 0.42, 0.43, 0.48, respectively [all p <0.001]). Receiver operating characteristics curves showed an area under the curve of 0.72, 0.72, and 0.75 (all p <0.001) for septal, lateral, and average E/e', respectively. The sensitivity, specificity, positive (PPV), and negative (NPV) predictive values for the guideline-recommended threshold of average E/e' >14 for elevated LVEDP was 27%, 93%, 79%, and 44%, respectively. Utilizing lower E/e' boundaries of 6, 7, and 8 for lateral, average, and medial E/e', respectively, improved the NPV to ≥80% for each parameter. In conclusion, the E/e' ratio is a robust measure of LVFP during acute NSTEMI using upper and lower thresholds to achieve a high PPV and NPV, respectively, with the use of adjunctive guideline-recommend measures required in patients with nonconclusive E/e'.
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31
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The Association between Left Ventricular Diastolic Dysfunction and Myocardial Scar and Their Collective Impact on All-Cause Mortality. J Am Soc Echocardiogr 2019; 33:161-170. [PMID: 31836269 DOI: 10.1016/j.echo.2019.09.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 01/07/2023]
Abstract
BACKGROUND Left ventricular diastolic dysfunction (DD) and myocardial scar are important contributors to cardiovascular morbidity and mortality. The aim of this study was to test the hypothesis that myocardial scar is a substrate of DD and that collectively they contribute to increased risk for all-cause mortality. METHODS The study included 607 consecutive patients who underwent echocardiography and cardiac magnetic resonance imaging within 1 week. DD was assessed by echocardiography according to the contemporary guidelines and myocardial scar by late gadolinium enhancement (LGE). All-cause mortality was the main outcome. RESULTS Scar prevalence was significantly higher comparing no DD with mild and advanced DD (25%, 61%, and 80%, respectively; P < .001), and scar burden was greater by semiquantitative LGE scores (1.4 ± 3.4, 4.8 ± 6.3, and 6.8 ± 8.8, respectively; P < .001). After 10 years of follow-up, 50 patients (8.2%) had died. The mortality incidence was significantly higher comparing no DD with mild and advanced DD (2.5, 17.3, and 55.7 deaths per 1,000 person-years, respectively; P < .001). It was also higher in patients with higher LGE scores (4.3, 22.7, and 35.2 deaths per 1,000 person-years in groups with LGE scores of 0, 1-6, and ≥7, respectively; P < .001). The risk for death was higher among patients with both DD and scar. The additive interaction of DD and scar for mortality was significant (P < .001). In the multivariate Cox proportional-hazards analysis, DD and scar were associated with mortality (P < .001). CONCLUSIONS There is a strong link between the echocardiographic findings of DD and the morphologic changes of myocardial tissue. DD assessed according to contemporary guidelines effectively differentiates mortality risk. The additive interaction of DD and scar on mortality risk highlights the pivotal role of myocardial tissue characterization in patients with DD.
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32
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Nagueh SF, Abraham TP, Aurigemma GP, Bax JJ, Beladan C, Browning A, Chamsi-Pasha MA, Delgado V, Derumeaux G, Dolci G, Donal E, Edvardsen T, El Tallawi KC, Ernande L, Esposito R, Flachskampf FA, Galderisi M, Gentry J, Goldstein SA, Harb SC, Hubert A, Hung J, Klein AL, Lancellotti P, Mahmood RZ, Marino P, Popescu BA, Previato M, Sanghai SR, Smiseth OA, Xu J. Interobserver Variability in Applying American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 Guidelines for Estimation of Left Ventricular Filling Pressure. Circ Cardiovasc Imaging 2019; 12:e008122. [PMID: 30632389 DOI: 10.1161/circimaging.118.008122] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Assessment of left ventricular (LV) filling pressure is among the important components of a comprehensive echocardiographic report. Previous studies noted wide limits of agreement using 2009 American Society of Echocardiography/European Association of Echocardiography guidelines, but reproducibility of 2016 guidelines update in estimating LV filling pressure is unknown. METHODS Echocardiographic and hemodynamic data were obtained from 50 patients undergoing cardiac catheterization for clinical indications. Clinical and echocardiographic findings but not invasive hemodynamics were provided to 4 groups of observers, including experienced echocardiographers and cardiology fellows. Invasively acquired LV filling pressure was the gold standard. RESULTS In group I of 8 experienced echocardiographers from the guidelines writing committee, sensitivity for elevated LV filling pressure was 92% for all observers, and specificity was 93±6%. Fleiss κ-value for the agreement in group I was 0.80. In group II of 4 fellows in training, sensitivity was 91±2%, and specificity was 95±2%. Fleiss κ-value for the agreement in group II was 0.94. In group III of 9 experienced echocardiographers who had not participated in drafting the guidelines, sensitivity was 88±5%, and specificity was 91±7%. Fleiss κ-value for the agreement in group III was 0.76. In group IV of 7 other fellows, sensitivity was 91±3%, and specificity was 92±5%. Fleiss κ-value for the agreement in group IV was 0.89. CONCLUSIONS There is a good level of agreement and accuracy in the estimation of LV filling pressure using the American Society of Echocardiography/European Association of Cardiovascular Imaging 2016 recommendations update, irrespective of the experience level of the observer.
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Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Center for Outcomes Research, Houston Methodist Research Institute, TX (S.F.N., M.A.C.-p., K.C.E.t., J.X.)
| | - Theodore P Abraham
- Department of Medicine, University of Massachusetts Medical School, Worcester (G.P.A., S.R.S.).,Division of Cardiology, University of California at San Francisco (T.P.A., A.B.)
| | | | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.J.B., V.D., G. Dolci)
| | - Carmen Beladan
- University of Medicine and Pharmacy "Carol Davila," Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania (C.B., B.A.P.)
| | - Alyssa Browning
- Division of Cardiology, University of California at San Francisco (T.P.A., A.B.)
| | - Mohammed A Chamsi-Pasha
- Methodist DeBakey Heart and Vascular Center, Center for Outcomes Research, Houston Methodist Research Institute, TX (S.F.N., M.A.C.-p., K.C.E.t., J.X.)
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.J.B., V.D., G. Dolci)
| | - Genevieve Derumeaux
- Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France (G. Derumeaux, L.E., M.P.)
| | - Giulia Dolci
- Department of Cardiology, Leiden University Medical Center, the Netherlands (J.J.B., V.D., G. Dolci)
| | - Erwan Donal
- Service de Cardiologie et Maladies Vasculaires, LTSI INSERM 1099, Universite Rennes-1, CHU Rennes, France (E.D., A.H.)
| | | | - Kinan Carlos El Tallawi
- Methodist DeBakey Heart and Vascular Center, Center for Outcomes Research, Houston Methodist Research Institute, TX (S.F.N., M.A.C.-p., K.C.E.t., J.X.)
| | - Laura Ernande
- Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France (G. Derumeaux, L.E., M.P.)
| | - Roberta Esposito
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy (R.E., M.G.)
| | - Frank A Flachskampf
- Department of Medical Sciences, Uppsala University, Clinical Physiology and Cardiology, Uppsala, Sweden (F.A.F.)
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy (R.E., M.G.)
| | | | - Steven A Goldstein
- Department of Cardiology, MedStar Heart and Vascular Institute, Washington, DC (S.A.G., R.Z.M.)
| | | | - Arnaud Hubert
- Service de Cardiologie et Maladies Vasculaires, LTSI INSERM 1099, Universite Rennes-1, CHU Rennes, France (E.D., A.H.)
| | - Judy Hung
- Division of Cardiology, Corrigan Minehan Heart Center, Massachusetts General Hospital, Harvard Medical School, Boston (J.H.)
| | | | | | - Redah Z Mahmood
- Department of Cardiology, MedStar Heart and Vascular Institute, Washington, DC (S.A.G., R.Z.M.)
| | - Paolo Marino
- Universita Piemonte Orientale, Novara, Italy (P.M.)
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila," Euroecolab, Institute of Cardiovascular Diseases, Bucharest, Romania (C.B., B.A.P.)
| | - Martina Previato
- Physiology Department, DHU Ageing-Thorax-Vessel-Blood, Henri Mondor Hospital, Assistance Publique Hôpitaux de Paris, Créteil, France (G. Derumeaux, L.E., M.P.)
| | - Saket R Sanghai
- Department of Medicine, University of Massachusetts Medical School, Worcester (G.P.A., S.R.S.)
| | | | - Jiaqiong Xu
- Methodist DeBakey Heart and Vascular Center, Center for Outcomes Research, Houston Methodist Research Institute, TX (S.F.N., M.A.C.-p., K.C.E.t., J.X.)
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Torii Y, Kusunose K, Yamada H, Nishio S, Hirata Y, Amano R, Yamao M, Zheng R, Saijo Y, Yamada N, Ise T, Yamaguchi K, Yagi S, Soeki T, Wakatsuki T, Sata M. Updated Left Ventricular Diastolic Function Recommendations and Cardiovascular Events in Patients with Heart Failure Hospitalization. J Am Soc Echocardiogr 2019; 32:1286-1297.e2. [DOI: 10.1016/j.echo.2019.06.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/27/2022]
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Polovina MM, Coats A, Seferovic P. Is left atrium the best kept secret of the heart? Left atrial dilatation and cardiovascular outcomes. Heart 2019; 105:1848-1849. [DOI: 10.1136/heartjnl-2019-315695] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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35
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Echocardiographic predictors of all-cause mortality in patients with left ventricular ejection fraction >35%: Value of guideline based assessment of diastolic dysfunction. IJC HEART & VASCULATURE 2019; 24:100407. [PMID: 31428670 PMCID: PMC6692060 DOI: 10.1016/j.ijcha.2019.100407] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/26/2019] [Accepted: 07/29/2019] [Indexed: 01/28/2023]
Abstract
Background Recent data suggests that the majority of cardiac deaths in patients with heart failure occur in patients with a left ventricular ejection fraction (LVEF) >35%. This study sought to determine the value of guideline based assessment of diastolic dysfunction in predicting all-cause mortality in patients with a first-ever myocardial infarction (MI) with an LVEF >35%. Methods A retrospective single centre study involving 383 patients with a first-ever MI (STEMI or NSTEMI) with LVEF >35% was performed. Clinical, angiographic and echocardiographic data were obtained from prospectively maintained institutional databases. Outcomes data were obtained from national death registry. Echocardiography was performed early post-admission for all patients. Significant diastolic dysfunction (DD) was defined was grade 2/3 diastolic dysfunction according to current American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Results At a median follow up of 2 years, there were 32 deaths. On Cox proportional hazards multivariate analysis incorporating significant clinical variables (age, chronic kidney disease and extent of coronary artery disease), significant DD (HR 2.57, 95%CI 1.16–5.68, p = 0.020) and left ventricular end-diastolic volume index (HR 1.03, 1.04–1.07, p = 0.021) were the only independent echocardiographic predictors of all-cause mortality. Intermodel comparisons using model χ2 and Harrel's-C confirmed incremental value of DD. In the subgroup with LVEF 36–55% (n = 176), significant DD was the only independent echocardiographic predictor (HR 3.56, 95%CI 2.46–9.09, p = 0.006). Conclusions The presence of significant DD identifies patients with LVEF >35% following MI who are at a higher risk of all-cause mortality, and who may benefit from further risk stratification and treatment. The majority of deaths in heart failure patients occur in patients with LVEF>35%. Diastolic dysfunction identifies elevated risk of death in patients with LVEF>35%. Diastolic dysfunction thus identifies patients for further risk stratification.
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Prasad SB, Guppy-Coles K, Stanton T, Armstrong J, Krishnaswamy R, Whalley G, Atherton JJ, Thomas L. Relation of Left Atrial Volumes in Patients With Myocardial Infarction to Left Ventricular Filling Pressures and Outcomes. Am J Cardiol 2019; 124:325-333. [PMID: 31151655 DOI: 10.1016/j.amjcard.2019.05.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/10/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
The inter-relationships between minimal and maximal left atrial volume index (LAVI), left ventricular filling pressures and survival have not been well studied. This study aimed to compare LAVImin with LAVImax with respect to (1) relative prognostic value, and (2) correlation with left ventricular end-diastolic pressures (LVEDP), in patients with myocardial infarction (MI). A retrospective study involving consecutive patients with a first-ever MI (n = 419) was undertaken. LAVIs were determined using Simpson's biplane method from 2D echocardiography performed the day after admission. LAVmin ≥ 18 mls/m2 and LAVImax ≥ 34 mls/m2 were considered enlarged. The primary end point was composite major adverse cardiovascular events (MACE) (death/MI/heart failure). Correlation between LVEDP and LAVI was assessed in 120 patients who underwent echocardiography and cardiac catheterization either simultaneously (n = 30) or same-day (n = 90). At a median follow-up of 24 months, there were 61 MACE events. On Cox proportional hazards multivariate analysis incorporating significant clinical predictors and LVEF, whereas both LAVImin ≥ 18 mls/m2 (hazard ratio 3.15 [95% confidence interval 1.70 to 5.54], p <0.001) and LAVImax ≥ 34 mls/m2 (hazard ratio 1.79 [95% confidence interval 1.02 to 3.14], p = 0.041) were independent predictors of MACE, LAVImin showed a stronger association. Intermodel comparisons of the model chi-square and Harrell's C-statistic confirmed better prognostication with LAVImin. In the invasive cohort, because LAVImin and LAVImax had a similar correlation with LVEDP ≥ 15 mm Hg (r = 0.41 [p <0.001] vs r = 0.42 [p <0.001]), LAVmin ≥ 18 mls/m2 had a greater sensitivity for LVEDP ≥ 15 mm Hg than LAVImax ≥ 34 mls/m2 (sensitivity 59.4% vs 34.4%). In conclusion, utilizing thresholds of ≥18 and ≥34 mls/m2, respectively, LAVImin was a better predictor of survival than LAVImax, the pathophysiologic basis of which relates to a better sensitivity for elevated left ventricular filling pressures with LAVImin at these thresholds. There may be incremental clinical value in measuring LAVImin alongside LAVImax.
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Machino-Ohtsuka T, Seo Y, Ishizu T, Hamada-Harimura Y, Yamamoto M, Sato K, Sai S, Sugano A, Obara K, Yoshida I, Nishi I, Aonuma K, Ieda M. Clinical utility of the 2016 ASE/EACVI recommendations for the evaluation of left ventricular diastolic function in the stratification of post-discharge prognosis in patients with acute heart failure. Eur Heart J Cardiovasc Imaging 2019; 20:1129-1137. [DOI: 10.1093/ehjci/jez082] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Accepted: 04/09/2019] [Indexed: 01/07/2023] Open
Abstract
Abstract
Aims
Left ventricular diastolic dysfunction (LVDD) has prognostic significance in heart failure (HF). We aimed to assess the impact of LVDD grade stratified by the updated 2016 echocardiographic algorithm (DD2016) on post-discharge outcomes in patients admitted for acute HF and compare with the previous 2009 algorithm (DD2009).
Methods and results
The study included 481 patients hospitalized for acute decompensated HF. Comprehensive echocardiography and LVDD evaluation were performed just before hospital discharge. The primary endpoint was a composite of cardiovascular death and readmission for HF. The concordance between DD2016 and DD2009 was moderate (κ = 0.44, P < 0.001); the reclassification rate was 39%. During the follow-up (median: 15 months), 127 (26%) patients experienced the primary endpoint. In the Kaplan–Meier analysis, Grade III in DD2016 showed a lower event-free survival rate than Grades I and II (log rank, P < 0.001 and P = 0.048, respectively) and was independently associated with a higher incidence of the primary endpoint than Grade I [hazard ratio 1.89; 95% confidence interval (CI) 1.17–3.04; P = 0.009]. Grade II or III in DD2016, reflecting elevation of left ventricular (LV) filling pressure, added an incremental predictive value of the primary endpoint to clinical variables irrespective of LV ejection fraction. DD2016 was comparable to DD2009 in predicting the endpoint (net reclassification improvement = 11%; 95% CI −7% to 30%, P = 0.23).
Conclusion
Despite simplification of the algorithm for LVDD evaluation, the prognostic value of DD2016 for post-discharge cardiovascular events in HF patients was maintained and not compromised in comparison with DD2009.
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Affiliation(s)
- Tomoko Machino-Ohtsuka
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Yoshihiro Seo
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Tomoko Ishizu
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Yoshie Hamada-Harimura
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Masayoshi Yamamoto
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Kimi Sato
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Seika Sai
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Akinori Sugano
- Department of Cardiology, Tsukuba Medical Center Hospital, 1-3-1, Amakubo, Tsukuba, Ibaraki, Japan
| | - Kenichi Obara
- Department of Cariology, Ryugasaki Saiseikai General Hospital, 1-1, Nakazato, Ryugasaki, Ibaraki, Japan
| | - Ikuo Yoshida
- Department of Cardiology, Moriya Daiichi General Hospital, Moriya, 1-17, Matsumaedai, Moriya, Ibaraki, Japan
| | - Isao Nishi
- Department of Cardiology, Tsuchiura Clinical Education and Training Center, University of Tsukuba Hospital, Tsukuba, Japan
| | - Kazutaka Aonuma
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
| | - Masaki Ieda
- Department of Cardiology, Faculty of Medicine, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Ibaraki, Japan
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Prasad SB, Holland DJ, Atherton JJ, Whalley G. New Diastology Guidelines: Evolution, Validation and Impact on Clinical Practice. Heart Lung Circ 2019; 28:1411-1420. [PMID: 31064714 DOI: 10.1016/j.hlc.2019.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/22/2019] [Indexed: 01/12/2023]
Abstract
The 2016 American Society of Echocardiography/European Association of Echocardiography (ASE/EACVI) guidelines on the assessment of diastolic function sought to simplify the assessment of diastolic function by recommending a streamlined, stepped approach with a focus on four key variables. Haemodynamic validation using simultaneous cardiac catheterisation and echocardiographic assessment of diastolic function have shown robust prediction of left ventricular filling pressure (LVFP) using the streamlined 2016 algorithms, with favourable comparisons to the 2009 guidelines. Similarly, prognostic validation data demonstrates that the 2016 algorithms are easier to implement in clinical practice, have superior inter-observer reliability across a broad range of observer experience, and are better at predicting clinical outcomes. Furthermore, published data show improved classification of clinical heart failure patients. However, increased specificity of the updated 2016 guidelines results in a lower prevalence of diastolic dysfunction compared to the 2009 recommendations. Further refinement of guidelines for the identification and diagnosis of diastolic dysfunction is possible through incorporation of new diastolic parameters.
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Affiliation(s)
- Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
| | - David J Holland
- Department of Cardiology, Sunshine Coast University Hospital, Brisbane, Qld, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Gillian Whalley
- Department of Medicine, University of Otago, Dunedin, New Zealand
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Thomas L, Marwick TH, Popescu BA, Donal E, Badano LP. Left Atrial Structure and Function, and Left Ventricular Diastolic Dysfunction: JACC State-of-the-Art Review. J Am Coll Cardiol 2019; 73:1961-1977. [PMID: 31000000 DOI: 10.1016/j.jacc.2019.01.059] [Citation(s) in RCA: 370] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 01/15/2019] [Indexed: 01/31/2023]
Abstract
Defining left atrial (LA) function has recently emerged as a powerful parameter, particularly in evaluation of left ventricular (LV) diastolic dysfunction (LVDD) and heart failure with preserved ejection fraction. Echocardiographic assessment of LVDD by echocardiography remains a challenging task; recent recommendations provide a simpler approach than previous. However, the shortcomings of the proposed approach (including transmitral flow, tissue velocity, maximum left atrial volume [LAV], and estimated pulmonary artery systolic pressure), lead to the presence and severity of LVDD remaining undetermined in a significant proportion of patients. Maximum LAV is a surrogate measure of the chronicity and severity of LVDD, but LAV alone is an insensitive biomarker of early phases of LVDD, because the LA may take time to remodel. Because the primary function of the LA is to modulate LV filling, it is not surprising that functional LA changes become evident at the earliest stages of LVDD. Moreover, LA function may provide additive value, not only in diagnosing LVDD, but also in grading its severity and in monitoring the effects of treatment. The current review provides a critical appraisal on the existing evidence for the role of LA metrics in evaluation of LVDD and consequent heart failure with preserved ejection fraction.
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Affiliation(s)
- Liza Thomas
- University of Sydney, Sydney, NSW, Australia; Department of Cardiology Westmead Hospital; South West Clinical School, University of New South Wales, Sydney, NSW, Australia.
| | - Thomas H Marwick
- Baker IDI heart and Diabetes Institute and the Alfred Hospital, Melbourne, Victoria, Australia
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila"-Euroecolab, Department of Cardiology, Institute of Cardiovascular Diseases "Prof. Dr. C. C. Iliescu," Bucharest, Romania
| | - Erwan Donal
- University of Rennes, CHU Rennes, Inserm, LTSI-UMR 1099, Rennes, France
| | - Luigi P Badano
- University of Milano-Bicocca, Milan, Italy; IRCCS, Istituto Auxologico Italiano, S. Luca Hospital, Milan, Italy
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Kosmala W, Marwick TH. Asymptomatic Left Ventricular Diastolic Dysfunction: Predicting Progression to Symptomatic Heart Failure. JACC Cardiovasc Imaging 2019; 13:215-227. [PMID: 31005530 DOI: 10.1016/j.jcmg.2018.10.039] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/01/2018] [Accepted: 10/01/2018] [Indexed: 01/07/2023]
Abstract
Asymptomatic left ventricular diastolic dysfunction (ALVDD) (diastolic abnormalities and normal ejection fraction in the absence of symptoms) is associated with incident heart failure (HF) and decreased survival. Abnormalities of diastolic function might therefore be included in the definition of stage B HF, which denotes individuals at risk for the development of HF. Imaging techniques, especially echocardiography, are necessary for the recognition of preclinical left ventricular (LV) diastolic disturbances, as well as further tracking of pathological changes and responses to treatment. The transition of ALVDD to symptomatic HF is underlain by multiple factors, including both cardiovascular and noncardiovascular determinants. The initiation of management strategies targeting cardiovascular and systemic comorbidities in patients identified as having ALVDD may delay symptomatic progression and improve prognosis.
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Affiliation(s)
- Wojciech Kosmala
- Cardiology Department, Wroclaw Medical University, Wroclaw, Poland; Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia.
| | - Thomas H Marwick
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia; Baker Heart and Diabetes Institute, Melbourne, Australia
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Kossaify A, Nasr M. Diastolic Dysfunction and the New Recommendations for Echocardiographic Assessment of Left Ventricular Diastolic Function: Summary of Guidelines and Novelties in Diagnosis and Grading. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2019. [DOI: 10.1177/8756479319836781] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Antoine Kossaify
- Cardiology Division, Echocardiography and Arrhythmia Units, University Hospital Notre Dame des Secours, USEK, Byblos, Jbeil, Lebanon
| | - Mireille Nasr
- Intensive Care Unit, University Hospital Notre Dame des secours, USEK, Byblos, Jbeil, Lebanon
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Kim MJ. Echocardiographic Hemodynamic Assessment in Patients with Ischemic Heart Disease: the Impact of Diastolic Remodeling on Long-term Prognosis. J Cardiovasc Imaging 2018; 26:226-228. [PMID: 30607390 PMCID: PMC6310759 DOI: 10.4250/jcvi.2018.26.e31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 12/21/2018] [Indexed: 11/30/2022] Open
Affiliation(s)
- Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Korea
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Classification of Left Ventricular Diastolic Dysfunction and Heart Failure Diagnosis and Prognosis. J Am Soc Echocardiogr 2018; 31:1209-1211. [DOI: 10.1016/j.echo.2018.09.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Indexed: 11/20/2022]
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