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Eriksen-Volnes T, Dalen H. Reply: Body Surface Area Calculation and Its Impact on Indexed Echocardiographic Measurements. JACC Cardiovasc Imaging 2024; 17:842. [PMID: 38960557 DOI: 10.1016/j.jcmg.2024.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 04/25/2024] [Indexed: 07/05/2024]
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Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [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: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
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Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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Losi MA, Bossone E, Piccolo R, Canciello G, Pacella D, Crisci G, Carbone A, Ferrara F, Izzo R, Esposito G, Cittadini A. Exploring the physiologic variations and related determinants of left ventricular diastolic function among 381 healthy Caucasian adults by the 2016 American Society of Echocardiography-European Association of Cardiovascular Imaging guidelines. Eur J Prev Cardiol 2024; 31:e42-e44. [PMID: 37681345 DOI: 10.1093/eurjpc/zwad272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 09/09/2023]
Affiliation(s)
- Maria Angela Losi
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Eduardo Bossone
- Department of Public Health, University Federico II, Ed. 18, I piano, Via Sergio Pansini 5, Naples 80131, Italy
| | - Raffaele Piccolo
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Grazia Canciello
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Daniela Pacella
- Department of Public Health, University Federico II, Ed. 18, I piano, Via Sergio Pansini 5, Naples 80131, Italy
| | - Giulia Crisci
- Department of Translational Medical Sciences, Federico II University, via Pansini 5, Naples 80131, Italy
| | - Andreina Carbone
- Unit of Cardiology, University of Campania Luigi Vanvitelli, piazza Luigi Miraglia, Naples 80138, Italy
| | - Francesco Ferrara
- Heart Department, University Hospital of Salerno, Via San Leonardo, Salerno 84131, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Giovanni Esposito
- Department of Advanced Biomedical Sciences, University Federico II, via Sergio Pansini 5, Naples 80131, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, Federico II University, via Pansini 5, Naples 80131, Italy
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Peverill RE. The reduction of the left ventricular long-axis early diastolic peak velocity (e') evident by early-middle age occurs in the absence of aging-related slowing of active relaxation. Eur J Appl Physiol 2024; 124:1267-1279. [PMID: 37994972 DOI: 10.1007/s00421-023-05351-9] [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: 03/26/2023] [Accepted: 10/30/2023] [Indexed: 11/24/2023]
Abstract
PURPOSE A decrease in the left ventricular (LV) long-axis early diastolic peak velocity (e') is evident by early-middle age, but it is unknown to what extent this decrease is due to slowing of the speed of active relaxation versus a reduction in LV long-axis excursion during early diastole (EDExc). METHODS Pulsed-wave tissue Doppler imaging (TDI) signals were acquired from the septal and lateral borders of the mitral annulus in 62 healthy adult subjects of age 18-45 years. EDExc and LV systolic excursion (SExc) were measured as the integrals of the respective TDI signals. The speed of active relaxation was indirectly assessed using time interval measurements related to the TDI early diastolic signal, including the isovolumic relaxation time (IVRT'), the acceleration time (EDAT), and the duration (EDDur). Multiple linear regression analyses were performed to identify the relationships between e', age, EDExc, SExc, and time intervals. RESULTS The findings were similar for both LV walls. Age was negatively correlated with e' and EDExc, but was not correlated with SExc, IVRT', EDAT, or EDDur. The closest correlate of EDExc was SExc, and EDExc was independently correlated with both SExc and age. e' was also positively correlated with SExc, but the closest correlate of e' was EDExc, and when combined with EDExc, EDDur became an independent predictor of e'. CONCLUSION The aging-related decrease in e' evident by early-middle age occurs in the absence of aging-related slowing of active relaxation and therefore can be largely attributed to the accompanying reduction in EDExc.
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Affiliation(s)
- Roger E Peverill
- Victorian Heart Hospital, Monash Health and Monash University, Blackburn Road, Clayton, VIC, 3168, Australia.
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Khor J, Diaz-Canestro C, Chan KY, Guo M, Montero D. Blood volume contributes to the mechanical synchrony of the myocardium during moderate and high intensity exercise in women. Eur J Appl Physiol 2024; 124:1227-1237. [PMID: 37985476 DOI: 10.1007/s00421-023-05355-5] [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: 10/20/2022] [Accepted: 10/28/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Whether blood volume (BV) primarily determines the synchronous nature of the myocardium remains unknown. This study determined the impact of standard blood withdrawal on left ventricular mechanical dyssynchrony (LVMD) in women. METHODS Transthoracic speckle-tracking echocardiography and central hemodynamic measurements were performed at rest and during moderate- to high-intensity exercise in healthy women (n = 24, age = 53.6 ± 16.3 year). LVMD was determined via the time to peak standard deviation (TPSD) of longitudinal and transverse strain and strain rates (LSR, TSR). Measurements were repeated within a week period immediately after a 10% reduction of BV. RESULTS With intact BV, all individuals presented cardiac structure and function variables within normative values of the study population. Blood withdrawal decreased BV (5.3 ± 0.7 L) by 0.5 ± 0.1 L. Resting left ventricular (LV) end-diastolic volume (- 8%, P = 0.040) and passive filling (- 16%, P = 0.001) were reduced after blood withdrawal. No effect of blood withdrawal was observed for any measure of LVMD at rest (P ≥ 0.225). During exercise at a fixed submaximal workload (100 W), LVMD of myocardial longitudinal strain (LS TPSD) was increased after blood withdrawal (36%, P = 0.047). At peak effort, blood withdrawal led to increased LVMD of myocardial transverse strain rate (TSR TPSD) (31%, P = 0.002). The effect of blood withdrawal on TSR TPSD at peak effort was associated with LV concentric remodeling (r = 0.59, P = 0.003). CONCLUSION Marked impairments in the mechanical synchrony of the myocardium are elicited by moderate blood withdrawal in healthy women during moderate and high intensity exercise.
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Affiliation(s)
- Joyce Khor
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China
| | | | - Koot Yin Chan
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China
| | - Meihan Guo
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China
| | - David Montero
- Faculty of Medicine, Institute of Cardiovascular Medicine and Science, University of Hong Kong, Hong Kong SAR, China.
- Institute of Cardiovascular Science and Medicine, University of Hong Kong, Hong Kong, China.
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.
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Morbach C, Gelbrich G, Schreckenberg M, Hedemann M, Pelin D, Scholz N, Miljukov O, Wagner A, Theisen F, Hitschrich N, Wiebel H, Stapf D, Karch O, Frantz S, Heuschmann PU, Störk S. Population data-based federated machine learning improves automated echocardiographic quantification of cardiac structure and function: the Automatisierte Vermessung der Echokardiographie project. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2024; 5:77-88. [PMID: 38264700 PMCID: PMC10802820 DOI: 10.1093/ehjdh/ztad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 09/08/2023] [Accepted: 10/03/2023] [Indexed: 01/25/2024]
Abstract
Aims Machine-learning (ML)-based automated measurement of echocardiography images emerges as an option to reduce observer variability. The objective of the study is to improve the accuracy of a pre-existing automated reading tool ('original detector') by federated ML-based re-training. Methods and results Automatisierte Vermessung der Echokardiographie was based on the echocardiography images of n = 4965 participants of the population-based Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression Cohort Study. We implemented federated ML: echocardiography images were read by the Academic Core Lab Ultrasound-based Cardiovascular Imaging at the University Hospital Würzburg (UKW). A random algorithm selected 3226 participants for re-training of the original detector. According to data protection rules, the generation of ground truth and ML training cycles took place within the UKW network. Only non-personal training weights were exchanged with the external cooperation partner for the refinement of ML algorithms. Both the original detectors as the re-trained detector were then applied to the echocardiograms of n = 563 participants not used for training. With regard to the human referent, the re-trained detector revealed (i) superior accuracy when contrasted with the original detector's performance as it arrived at significantly smaller mean differences in all but one parameter, and a (ii) smaller absolute difference between measurements when compared with a group of different human observers. Conclusion Population data-based ML in a federated ML set-up was feasible. The re-trained detector exhibited a much lower measurement variability than human readers. This gain in accuracy and precision strengthens the confidence in automated echocardiographic readings, which carries large potential for applications in various settings.
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Affiliation(s)
- Caroline Morbach
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080 Würzburg, Germany
| | - Götz Gelbrich
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Marcus Schreckenberg
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Maike Hedemann
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Dora Pelin
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Nina Scholz
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Olga Miljukov
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Achim Wagner
- Service Center Medical Informatics, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Fabian Theisen
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
| | - Niklas Hitschrich
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Hendrik Wiebel
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Daniel Stapf
- TOMTEC Imaging Systems GmbH, Freisinger Str. 9, 85716 Unterschleissheim, Germany
| | - Oliver Karch
- Service Center Medical Informatics, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Stefan Frantz
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080 Würzburg, Germany
| | - Peter U Heuschmann
- Institute of Clinical Epidemiology and Biometry, University of Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
- Clinical Trial Center, University Hospital Würzburg, Josef-Schneider-Str. 2, 97080 Würzburg, Germany
| | - Stefan Störk
- Department Clinical Research and Epidemiology, Comprehensive Heart Failure Center, University Hospital Würzburg, Am Schwarzenberg 15, D-97078 Würzburg, Germany
- Department of Medicine I, University Hospital Würzburg, Oberdürrbacherstr. 6, D-97080 Würzburg, Germany
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7
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Erard M, Santens B, Van De Bruaene A, De Meester P, Troost E, Moons P, Voigt JU, Eyskens B, Budts W. Left atrial strain in patients after arterial switch operation for transposition of the great arteries. Acta Cardiol 2023:1-7. [PMID: 38126324 DOI: 10.1080/00015385.2023.2296261] [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: 08/18/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Left atrial (LA) strain, comprising LA reservoir, conduit and contractile function could add mechanistic information of patients after arterial switch operation (ASO) for transposition of the great arteries (TGA). ASO patients might have abnormal ventriculoarterial coupling, which makes them vulnerable to left ventricle (LV) dysfunction and results in reduced exercise capacity. This explorative study aimed to evaluate the relation between LA strain, atrial size, ventricular function, and exercise data obtained by cardiopulmonary exercise testing (CPET). METHODS In a cohort of 44 patients (71% male, mean age 25 ± 4 years) LA strain was measured using transthoracic speckle-tracking echocardiography. Further assessment involved standard echocardiography, CPET evaluation, and blood sampling. LA strain values were compared to normal values. Correlations were calculated. Regression analysis with all strain variables to the CPET data was performed. RESULTS LA reservoir, conduit and contractile strain were normal in 30%, 89% and 50% of the patients, respectively. LA reservoir/contractile strain correlated to LV ejection fraction (ρ 0.310/-0.159, respectively) and LA reservoir/conduit strain correlated to the LA volume index (ρ 0.336/-0.357, respectively). None of the individual LA strain parameters were associated with the CPET variables. In multivariate regression analysis, LA contractile strain was significantly associated with the percentage of predicted maximal heart rate (β - 2.555). CONCLUSIONS These data suggest that in TGA patients after ASO repair LA strain is impaired and correlates with LA size and LV function. However, impaired LA strain wasn't associated with the standard CPET parameters. As such, clinical significance needs to be further unravelled.
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Affiliation(s)
- Margot Erard
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
| | - Béatrice Santens
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Alexander Van De Bruaene
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Pieter De Meester
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Els Troost
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Jens-Uwe Voigt
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
| | - Benedicte Eyskens
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
- Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
| | - Werner Budts
- Faculty of Medicine, Catholic University Leuven, Leuven, Belgium
- Congenital and Structural Cardiology, University Hospitals Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, Catholic University Leuven, Leuven, Belgium
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Gruca MM, Slivnick JA, Singh A, Cotella JI, Subashchandran V, Prabhu D, Asch FM, Siddiki M, Gupta N, Mor-Avi V, Su JL, Lang RM. Noninvasive assessment of left ventricular end-diastolic pressure using machine learning-derived phasic left atrial strain. Eur Heart J Cardiovasc Imaging 2023; 25:18-26. [PMID: 37708373 DOI: 10.1093/ehjci/jead231] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/16/2023] [Accepted: 09/05/2023] [Indexed: 09/16/2023] Open
Abstract
AIMS While transthoracic echocardiography (TTE) assessment of left ventricular end-diastolic pressure (LVEDP) is critically important, the current paradigm is subject to error and indeterminate classification. Recently, peak left atrial strain (LAS) was found to be associated with LVEDP. We aimed to test the hypothesis that integration of the entire LAS time curve into a single parameter could improve the accuracy of peak LAS in the noninvasive assessment of LVEDP with TTE. METHODS AND RESULTS We retrospectively identified 294 patients who underwent left heart catheterization and TTE within 24 h. LAS curves were trained using machine learning (100 patients) to detect LVEDP ≥ 15 mmHg, yielding the novel parameter LAS index (LASi). The accuracy of LASi was subsequently validated (194 patients), side by side with peak LAS and ASE/EACVI guidelines, against invasive filling pressures. Within the validation cohort, invasive LVEDP was elevated in 116 (59.8%) patients. The overall accuracy of LASi, peak LAS, and American Society of Echocardiography/European Association for Cardiovascular Imaging (ASE/EACVI) algorithm was 79, 75, and 76%, respectively (excluding 37 patients with indeterminate diastolic function by ASE/EACVI guidelines). When the number of LASi indeterminates (defined by near-zero LASi values) was matched to the ASE/EACVI guidelines (n = 37), the accuracy of LASi improved to 87%. Importantly, among the 37 patients with ASE/EACVI-indeterminate diastolic function, LASi had an accuracy of 81%, compared with 76% for peak LAS. CONCLUSION LASi allows the detection of elevated LVEDP using invasive measurements as a reference, at least as accurately as peak LAS and current diastolic function guideline algorithm, with the advantage of no indeterminate classifications in patients with measurable LAS.
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Affiliation(s)
- Martin M Gruca
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Jeremy A Slivnick
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Amita Singh
- Department of Cardiology, Northwestern Medicine Central DuPage Hospital, Winfield, IL, USA
| | - Juan I Cotella
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Varun Subashchandran
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | | | - Federico M Asch
- Health Research Institute, MedStar Health and Georgetown University, Washington, DC, USA
| | - Mikail Siddiki
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Nikhil Gupta
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | - Victor Mor-Avi
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
| | | | - Roberto M Lang
- Noninvasive Cardiac Imaging Laboratory, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, Chicago, IL 60637, USA
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9
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Eriksen-Volnes T, Grue JF, Hellum Olaisen S, Letnes JM, Nes B, Løvstakken L, Wisløff U, Dalen H. Normalized Echocardiographic Values From Guideline-Directed Dedicated Views for Cardiac Dimensions and Left Ventricular Function. JACC Cardiovasc Imaging 2023; 16:1501-1515. [PMID: 36881415 DOI: 10.1016/j.jcmg.2022.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 11/18/2022] [Accepted: 12/02/2022] [Indexed: 02/11/2023]
Abstract
BACKGROUND Continuous technologic development and updated recommendations for image acquisitions creates a need to update the current normal reference ranges for echocardiography. The best method of indexing cardiac volumes is unknown. OBJECTIVES The authors used 2- and 3-dimensional echocardiographic data from a large cohort of healthy individuals to provide updated normal reference data for dimensions and volumes of the cardiac chambers as well as central Doppler measurements. METHODS In the fourth wave of the HUNT (Trøndelag Health) study in Norway 2,462 individuals underwent comprehensive echocardiography. Of these, 1,412 (55.8% women) were classified as normal and formed the basis for updated normal reference ranges. Volumetric measures were indexed to body surface area and height in powers of 1 to 3. RESULTS Normal reference data for echocardiographic dimensions, volumes, and Doppler measurements were presented according to sex and age. Left ventricular ejection fraction had lower normal limits of 50.8% for women and 49.6% for men. According to sex-specific age groups, the upper normal limits for left atrial end-systolic volume indexed to body surface area ranged from 44 mL/m2 to 53 mL/m2, and the corresponding upper normal limit for right ventricular basal dimension ranged from 43 mm to 53 mm. Indexing to height raised to the power of 3 accounted for more of the variation between sexes than indexing to body surface area. CONCLUSIONS The authors present updated normal reference values for a wide range of echocardiographic measures of both left- and right-side ventricular and atrial size and function from a large healthy population with a wide age-span. The higher upper normal limits for left atrial volume and right ventricular dimension highlight the importance of updating reference ranges accordingly following refinement of echocardiographic methods.
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Affiliation(s)
- Torfinn Eriksen-Volnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway.
| | - Jahn Frederik Grue
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Sindre Hellum Olaisen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Jon Magne Letnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway
| | - Bjarne Nes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Lasse Løvstakken
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; School of Human Movement and Nutrition Science, University of Queensland, Brisbane, Queensland, Australia
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St Olav's University Hospital, Trondheim, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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10
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Jinno S, Yamada A, Sugimoto K, Chan J, Nakashima C, Funato Y, Hoshino N, Hoshino M, Takada K, Sato Y, Kawai H, Sarai M, Ito H, Izawa H. Resting echocardiographic parameters can exclude significant coronary artery disease: A comparison with coronary computed tomography angiography. Echocardiography 2023; 40:1251-1258. [PMID: 37855213 DOI: 10.1111/echo.15705] [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: 08/17/2023] [Revised: 10/02/2023] [Accepted: 10/10/2023] [Indexed: 10/20/2023] Open
Abstract
INTRODUCTION Coronary computed tomography angiography (CCTA) is known to have a high negative predictive value (NPV) in identifying coronary artery disease (CAD). This study aimed to examine whether resting echocardiographic parameters could exclude significant CAD on CCTA. METHODS We recruited 142 patients who had undergone both CCTA and echocardiography within a 3-month window. Based on the CCTA findings, patients were divided into two groups: Group A (non-significant CAD, defined as all coronary segments having <50% stenosis) and Group B (significant CAD). Resting echocardiographic parameters were compared between the two groups to identify predictors of non-significant CAD on CCTA. RESULTS A total 92 patients (mean age, 68 ± 13 years; males, 62%) were eligible for this study; 50 in Group A and 42 in Group B. Among the various echo parameters, left atrial volume index (LAVI) and left ventricular (LV) global longitudinal strain (GLS) were significantly lower in Group A (23.5 ± 7.6 vs. 33.6 ± 7.4 mL/m2 , p < .001; -20.2 ± 1.8% vs. -16.8 ± 2.0%, p < .001, respectively). Analysis of the receiver operating characteristic curve revealed that the cutoff value to exclude significant CAD on CCTA was 29.0 mL/m2 for LAVI (NPV 80.8%) and -18.1% for GLS (NPV 80.7%). The NPV increased to 95.0% when these parameters were combined (LAVI < 29.0 mL/m2 and GLS < -18.1%). CONCLUSION The combination of resting LAVI and GLS was clinically useful in excluding significant CAD via CCTA.
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Affiliation(s)
- Shinji Jinno
- Clinical Laboratory, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Akira Yamada
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Kunihiko Sugimoto
- Clinical Laboratory, Fujita Health University Hospital, Toyoake, Aichi, Japan
| | - Jonathan Chan
- Department of Cardiology, School of Medicine and Menzies Health Queensland, Griffith University, G40 Griffith Health Centre, Southport, QLD, Australia
| | - Chihiro Nakashima
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yusuke Funato
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Naoki Hoshino
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Meiko Hoshino
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Kayoko Takada
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Yoshihiro Sato
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Hideki Kawai
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Masayoshi Sarai
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
| | - Hiroyasu Ito
- Clinical Laboratory, Fujita Health University Hospital, Toyoake, Aichi, Japan
- Department of Joint Research Laboratory of Clinical Medicine, Fujita Health University, Toyoake, Aichi, Japan
| | - Hideo Izawa
- Department of Cardiology, Fujita Health University, Toyoake, Aichi, Japan
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11
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Qin S, Liu H, Cao X, Zhang R. Clinical application value of echocardiography in evaluating left ventricular diastolic function in patients with acute pulmonary embolism. Perfusion 2023; 38:477-483. [PMID: 35484778 DOI: 10.1177/02676591211058287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the clinical value of echocardiography in the assessment of left ventricular diastolic function in patients with acute pulmonary embolism (APE). METHODS APE patients in our hospital from June 2019 to June 2021 were selected as the observation group. They were divided into low-risk group (19 cases), medium-risk group (16 cases) and high-risk group (15 cases). The non-APE people in our hospital during the same period were selected as the control group. All subjects underwent echocardiography to observe the performance of APE patients under echocardiography. The peak velocity ratio S-wave/D-wave (S/D), early diastolic annular velocity/advanced diastolic annular velocity (Ea/Aa), early filling/early diastolic annular velocity (E/Ea), and early filling/early diastolic annular velocity (E/Ea) were compared with Ar and Vp, respectively; receiver operator characteristic (ROC) curve was used to evaluate the value of echocardiography in evaluating left ventricular diastolic function in patients with APE. RESULTS Echocardiography show different manifestations of APE patients. Compared with the control group, S/D, Ea/Aa, and Vp in the observation group were significantly decreased and E/Ea and Ar in the observation group were significantly increased (p < 0.05). With the increase of risk stratification, S/D, Ea/Aa, and Vp gradually decreased, E/Ea and Ar gradually increased, and the difference was statistically significant (p < 0.05). The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, area under curve (AUC), and 95% CI were 89.52%, 65.57%, 72.86%, 80.82%, 75.38%, 0.730, and 0.629-0.831, respectively. CONCLUSION Echocardiography can effectively evaluate left ventricular diastolic function in patients with APE, and there are significant differences in left ventricular diastolic function in different risk stratification, which has important reference value for clinical diagnosis and treatment of APE.
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Affiliation(s)
- Shiyang Qin
- Department of Ultrasound, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Huiling Liu
- Department of Ultrasound, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Xuesong Cao
- Department of Ultrasound, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
| | - Rui Zhang
- Department of physical examination, RinggoldID:117914Affiliated Hospital of Chengde Medical College, Chengde, China
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12
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Altes A, Vermes E, Levy F, Vancraeynest D, Pasquet A, Vincentelli A, Gerber BL, Tribouilloy C, Maréchaux S. Quantification of primary mitral regurgitation by echocardiography: A practical appraisal. Front Cardiovasc Med 2023; 10:1107724. [PMID: 36970355 PMCID: PMC10036770 DOI: 10.3389/fcvm.2023.1107724] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
The accurate quantification of primary mitral regurgitation (MR) and its consequences on cardiac remodeling is of paramount importance to determine the best timing for surgery in these patients. The recommended echocardiographic grading of primary MR severity relies on an integrated multiparametric approach. It is expected that the large number of echocardiographic parameters collected would offer the possibility to check the measured values regarding their congruence in order to conclude reliably on MR severity. However, the use of multiple parameters to grade MR can result in potential discrepancies between one or more of them. Importantly, many factors beyond MR severity impact the values obtained for these parameters including technical settings, anatomic and hemodynamic considerations, patient's characteristics and echocardiographer' skills. Hence, clinicians involved in valvular diseases should be well aware of the respective strengths and pitfalls of each of MR grading methods by echocardiography. Recent literature highlighted the need for a reappraisal of the severity of primary MR from a hemodynamic perspective. The estimation of MR regurgitation fraction by indirect quantitative methods, whenever possible, should be central when grading the severity of these patients. The assessment of the MR effective regurgitant orifice area by the proximal flow convergence method should be used in a semi-quantitative manner. Furthermore, it is crucial to acknowledge specific clinical situations in MR at risk of misevaluation when grading severity such as late-systolic MR, bi-leaflet prolapse with multiple jets or extensive leak, wall-constrained eccentric jet or in older patients with complex MR mechanism. Finally, it is debatable whether the 4-grades classification of MR severity would be still relevant nowadays, since the indication for mitral valve (MV) surgery is discussed in clinical practice for patients with 3+ and 4+ primary MR based on symptoms, specific markers of adverse outcome and MV repair probability. Primary MR grading should be seen as a continuum integrating both quantification of MR and its consequences, even for patients with presumed “moderate” MR.
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Affiliation(s)
- Alexandre Altes
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- 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, Brussels, Belgium
| | | | - Franck Levy
- Department of Cardiology, Center Cardio-Thoracique de Monaco, Monaco, Monaco
| | - David Vancraeynest
- 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, Brussels, Belgium
| | - Agnès Pasquet
- 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, Brussels, Belgium
| | - André Vincentelli
- Cardiac Surgery Department, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - 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, Brussels, Belgium
| | | | - Sylvestre Maréchaux
- GCS-Groupement des Hôpitaux de l’Institut Catholique de Lille/Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
- Correspondence: Sylvestre Maréchaux
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13
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Confounders mediate AI prediction of demographics in medical imaging. NPJ Digit Med 2022; 5:188. [PMID: 36550271 PMCID: PMC9780355 DOI: 10.1038/s41746-022-00720-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 11/02/2022] [Indexed: 12/24/2022] Open
Abstract
Deep learning has been shown to accurately assess "hidden" phenotypes from medical imaging beyond traditional clinician interpretation. Using large echocardiography datasets from two healthcare systems, we test whether it is possible to predict age, race, and sex from cardiac ultrasound images using deep learning algorithms and assess the impact of varying confounding variables. Using a total of 433,469 videos from Cedars-Sinai Medical Center and 99,909 videos from Stanford Medical Center, we trained video-based convolutional neural networks to predict age, sex, and race. We found that deep learning models were able to identify age and sex, while unable to reliably predict race. Without considering confounding differences between categories, the AI model predicted sex with an AUC of 0.85 (95% CI 0.84-0.86), age with a mean absolute error of 9.12 years (95% CI 9.00-9.25), and race with AUCs ranging from 0.63 to 0.71. When predicting race, we show that tuning the proportion of confounding variables (age or sex) in the training data significantly impacts model AUC (ranging from 0.53 to 0.85), while sex and age prediction was not particularly impacted by adjusting race proportion in the training dataset AUC of 0.81-0.83 and 0.80-0.84, respectively. This suggests significant proportion of AI's performance on predicting race could come from confounding features being detected. Further work remains to identify the particular imaging features that associate with demographic information and to better understand the risks of demographic identification in medical AI as it pertains to potentially perpetuating bias and disparities.
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14
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Matsushita K, Minamishima T, Sakata K, Satoh T, Soejima K. Comparison of the prognostic value of lateral versus septal early mitral annulus velocity in patients with acute decompensated heart failure. Int J Cardiovasc Imaging 2022; 39:707-714. [PMID: 36445512 DOI: 10.1007/s10554-022-02770-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/24/2022] [Indexed: 11/30/2022]
Abstract
Mitral annular early diastolic velocity (e') measured using Doppler echocardiography is important for the noninvasive estimation of left ventricular filling pressure (LVFP). However, it remains unknown whether lateral or septal e' is prognostically more reliable. Accordingly, here, we compared the prognostic utility of lateral e' with that of septal e' in patients hospitalized for acute decompensated heart failure (HF). We retrospectively analyzed the data of 193 consecutive patients with acute decompensated HF. According to the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines, the cut-off values of high lateral e' and septal e' were 10 cm/s and 7 cm/s, respectively. Kaplan-Meier survival curves and log-rank tests were used to compare 90-day mortality between groups. For the entire cohort, 90-day mortality was 15.5%. Lateral e' <10 was significantly correlated with higher 90-day mortality (log-rank, P = 0.026), whereas septal e' <7 was not significantly associated with 90-day mortality (log-rank, P = 0.405). Receiver operating characteristic curve analyses revealed that the best cut-off values for lateral e' and septal e' in this cohort were 10 cm/s and 6 cm/s, respectively. However, septal e' <6 was also not associated with 90-day mortality (log-rank, P = 0.141). This study demonstrated that, when comparing lateral e' with septal e', the former provides better prognostic utility for patients with acute decompensated HF. If a dissociation between lateral e' and septal e' is detected, the value measured at the lateral site may be more credible for determining LVFP in HF.
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Affiliation(s)
- Kenichi Matsushita
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan.
- Division of Advanced Cardiovascular Therapeutics, Department of Cardiovascular Medicine, Kumamoto University Hospital, Kumamoto, Japan.
| | - Toshinori Minamishima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Konomi Sakata
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Toru Satoh
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
| | - Kyoko Soejima
- Department of Cardiovascular Medicine, Kyorin University School of Medicine, Tokyo, Japan
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15
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Wang S, Fu J, Wu L, Liu XY, Zhang Y. Percentile curves of normal echocardiographic measurements values for left heart structures in 1570 Han Chinese preterm and term infants. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1331-1337. [PMID: 35844083 DOI: 10.1002/jcu.23252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 04/24/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was designed to evaluate echocardiographic measurements in Han Chinese preterm and term infants and to build percentile curves of normal echocardiographic measurements values related to the weight. METHOD From December 2014 to December 2021, a total of 797 male infants and 773 female infants born in * were included in the study. The echocardiographic measurements of each subject were as follows: left ventricular internal diameter at end-diastole (LVIDd), left ventricular internal diameter at end-systole (LVIDs), left ventricular posterior wall thickness at end-diastole (LVPWd), left ventricular posterior wall thickness at end-systole (LVPWs), interventricular septal thickness at end-diastole (IVSd), interventricular septal thickness at end-systole (IVSs), ascending aorta diameter (AO), left atrium (LA) dimension, left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS) and left ventricular mass (LVM). The correlations between echocardiography measurements and birth weight (BW), length (L), gestational age (GA), and body surface area (BSA) were analyzed. RESULTS There was a good correlation between the echocardiographic measurements and birth weight and percentile curves of the echocardiographic measurements were established according to different birth weight. The echocardiographic measurements were not affected by gender. However, LVEF and LVFS did not change with BW or gender. CONCLUSIONS The percentile curves of normal values make it possible to classify echocardiographic measurements for left heart structures and function as normal or abnormal and is helpful for the diagnosis of neonatal heart disease in preterm and term infants.
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Affiliation(s)
- Shanshan Wang
- Department of Pediatrics, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Jihe Fu
- Department of Ultrasound, Changzhou Second People's Hospital, Nanjing Medical University, Changzhou, China
| | - Lijun Wu
- Department of Echocardiography, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Xing-Yuan Liu
- Department of Pediatrics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yuqi Zhang
- Department of Pediatric Cardiology, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China
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16
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Haddad F, Cauwenberghs N, Daubert MA, Kobayashi Y, Bloomfield GS, Fleischman D, Koweek L, Maron DJ, Rodriguez F, Liao YJ, Moneghetti K, Amsallem M, Mega J, Hernandez A, Califf R, Mahaffey KW, Shah SH, Kuznetsova T, Douglas PS. Association of left ventricular diastolic function with coronary artery calcium score: A Project Baseline Health Study. J Cardiovasc Comput Tomogr 2022; 16:498-508. [PMID: 35872137 PMCID: PMC10870833 DOI: 10.1016/j.jcct.2022.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/23/2022] [Accepted: 06/20/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Coronary artery calcium (CAC) and left ventricular diastolic dysfunction (LVDD) are strong predictors of cardiovascular events and share common risk factors. However, their independent association remains unclear. METHODS In the Project Baseline Health Study (PBHS), 2082 participants underwent cardiac-gated, non-contrast chest computed tomography (CT) and echocardiography. The association between left ventricular (LV) diastolic function and CAC was assessed using multidimensional network and multivariable-adjusted regression analyses. Multivariable analysis was conducted on continuous LV diastolic parameters and categorical classification of LVDD and adjusted for traditional cardiometabolic risk factors. LVDD was defined using reference limits from a low-risk reference group without established cardiovascular disease, cardiovascular risk factors or evidence of CAC, (n = 560). We also classified LVDD using the American Society of Echocardiography recommendations. RESULTS The mean age of the participants was 51 ± 17 years with 56.6% female and 62.6% non-Hispanic White. Overall, 38.1% had hypertension; 13.7% had diabetes; and 39.9% had CAC >0. An intertwined network was observed between diastolic parameters, CAC score, age, LV mass index, and pulse pressure. In the multivariable-adjusted analysis, e', E/e', and LV mass index were independently associated with CAC after adjustment for traditional risk factors. For both e' and E/e', the effect size and statistical significance were higher across increasing CAC tertiles. Other independent correlates of e' and E/e' included age, female sex, Black race, height, weight, pulse pressure, hemoglobin A1C, and HDL cholesterol. The independent association with CAC was confirmed using categorical analysis of LVDD, which occurred in 554 participants (26.6%) using population-derived thresholds. CONCLUSION In the PBHS study, the subclinical coronary atherosclerotic disease burden detected using CAC scoring was independently associated with diastolic function. CLINICALTRIALS GOV IDENTIFIER NCT03154346.
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Affiliation(s)
- Francois Haddad
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA.
| | - Nicholas Cauwenberghs
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Melissa A Daubert
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Yukari Kobayashi
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Gerald S Bloomfield
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Dominik Fleischman
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Lynne Koweek
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - David J Maron
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Stanford Prevention Research Center, Stanford University, Palo Alto, CA, USA
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Yaping Joyce Liao
- Departments of Ophthalmology and Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Kegan Moneghetti
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | - Myriam Amsallem
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Adrian Hernandez
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | | | - Kenneth W Mahaffey
- Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Stanford Center for Clinical Research (SCCR); Department of Medicine, Stanford School of Medicine, Stanford, CA, USA
| | - Svati H Shah
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Tatiana Kuznetsova
- Stanford Cardiovascular Institute, Stanford University School of Medicine, Stanford, CA, USA; Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Pamela S Douglas
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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17
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Parikh RR, Norby FL, Wang W, Thenappan T, Prins KW, Van't Hof JR, Lutsey PL, Solomon SD, Shah AM, Chen LY. Association of Right Ventricular Afterload With Atrial Fibrillation Risk in Older Adults: The Atherosclerosis Risk in Communities Study. Chest 2022; 162:884-893. [PMID: 35562059 PMCID: PMC9659616 DOI: 10.1016/j.chest.2022.05.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 05/03/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is widely perceived to originate from the left atrium (LA). Whether increases in right ventricular (RV) afterload in older adults play an etiological role in AF genesis independent of LA and left ventricular (LV) remodeling is unknown. RESEARCH QUESTION Is higher RV afterload associated with greater AF risk independent of LA and LV remodeling? STUDY DESIGN AND METHODS In this observational prospective study, we included 2,246 community-dwelling older adults (mean age, 75 years) without known cardiovascular disease, with LV ejection fraction > 50%, LA volume index < 34 mL/m2, and E/e' ratio < 14 and a measurable functional tricuspid regurgitation jet velocity. From 2D-echocardiograms, we estimated pulmonary artery systolic pressure (PASP) and pulmonary vascular resistance (PVR). We ascertained incident AF (through 2018) from hospital discharge codes and death certificates. We estimated hazard ratios (HR) by Cox regression. RESULTS During follow-up (median, 6.3 years; interquartile interval, 5.5-6.9 years), 215 participants developed AF. AF risk was significantly higher in the third (vs first) tertile of PASP (HR, 1.65; 95% CI, 1.08-2.54) and PVR (HR, 1.38; 95% CI, 1.00-2.08) independent of LA and LV structure and function, heart rate, BMI, prevalent sleep apnea, systemic BP, antihypertensive medications, and lung, kidney, and thyroid function. These associations persisted after further exclusion of participants with tricuspid regurgitation jet velocity > 2.8 m/s and lateral and septal mitral annular velocity above age- and sex-specific reference limits. INTERPRETATION In older adults, higher RV afterload is associated with greater AF risk independent of LA and LV remodeling. Future research should focus on confirming this novel association and elucidate underlying mechanisms.
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Affiliation(s)
- Romil R Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Faye L Norby
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Center for Cardiac Arrest Prevention, Department of Cardiology, Cedars-Sinai Smidt Heart Institute, Los Angeles, CA
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN; Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Thenappan Thenappan
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Kurt W Prins
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Jeremy R Van't Hof
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN
| | - Pamela L Lutsey
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Scott D Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Amil M Shah
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA
| | - Lin Yee Chen
- Lillehei Heart Institute and Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, MN.
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18
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Henry MP, Cotella J, Mor-Avi V, Addetia K, Miyoshi T, Schreckenberg M, Blankenhagen M, Hitschrich N, Amuthan V, Citro R, Daimon M, Gutiérrez-Fajardo P, Kasliwal R, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Tude Rodrigues AC, Ronderos R, Sadeghpour A, Scalia G, Takeuchi M, Tsang W, Tucay ES, Zhang M, Lang RM, Asch FM. Three-Dimensional Transthoracic Static and Dynamic Normative Values of the Mitral Valve Apparatus: Results from the Multicenter World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr 2022; 35:738-751.e1. [PMID: 35245668 DOI: 10.1016/j.echo.2022.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 01/31/2022] [Accepted: 02/22/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent advances in mitral valve (MV) percutaneous interventions have escalated the need for a more quantitative and comprehensive assessment of the MV, which can be best achieved using three-dimensional echocardiography. Understanding normal valve size, structure, and function is essential for differentiation of healthy from disease states. The aims of this study were to establish normative values for MV apparatus size and morphology and to determine how they vary across age, sex, and race groups using data from the World Alliance Societies of Echocardiography Normal Values Study. METHODS Three-dimensional volumetric data sets obtained on transthoracic echocardiography in 748 normal subjects (51% men) were analyzed using commercial MV analysis software (TomTec Imaging Systems) to determine annular and leaflet dimensions and areas. The subjects were divided into groups by sex (378 men and 370 women) and age (18 to 40 years [n = 266], 41 to 65 years [n = 249], and >65 years [n = 233]) to identify sex- and age-related differences. In addition, differences among black, white, and Asian populations were studied. Inter- and intraobserver variability was assessed in a subset of 30 subjects and expressed as mean absolute difference between pairs of repeated measurements. RESULTS Compared with women, men had larger annular size measurements, larger tenting size parameters, and larger leaflet length and area. Compared with the black and white populations, the Asian population showed significantly smaller mitral annular size. Although many of the age, sex, and race differences in MV parameters were statistically significant, they were comparable with or smaller than the corresponding measurement variability. Indexing to body surface area and height did not eliminate these differences consistently, suggesting that parameters may need to be indexed according to their dimensionality. CONCLUSIONS This analysis of the World Alliance Societies of Echocardiography data provides normative values of mitral apparatus size and morphology. Although sex- and age-related differences were noted, they need to be interpreted with caution in view of the associated measurement variability.
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Affiliation(s)
| | | | | | | | - Tatsuya Miyoshi
- MedStar Health Research Institute, Washington, District of Columbia
| | | | | | | | | | | | | | | | | | | | | | - Denisa Muraru
- Instituto Auxologico Italiano, IRCCS, San Luca Hospital and University of Milano-Bicocca, Milan, Italy
| | | | | | | | - Ricardo Ronderos
- Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina
| | | | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | | | - Mei Zhang
- Qilu Hospital of Shandong University, Jinan, China
| | | | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
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19
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Lee SJ, Kim H, Oh BK, Choi HI, Sung KC, Kang J, Lee MY, Lee JY. Association between metabolic syndrome and left ventricular geometric change including diastolic dysfunction. Clin Cardiol 2022; 45:767-777. [PMID: 35502633 PMCID: PMC9286337 DOI: 10.1002/clc.23838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 04/16/2022] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND We investigated the association between individual components of metabolic syndrome (MetS) and left ventricular (LV) geometric changes, including diastolic dysfunction, in a large cohort of healthy individuals. METHODS Overall, 148 461 adults who underwent echocardiography during a health-screening program were enrolled. Geographic characteristics on echocardiography and several markers of LV relaxation function were identified according to individual MetS components. Univariate linear regression analysis and a multivariate regression model adjusted for factors known to influence LV relaxation function were conducted. RESULTS The prevalence of LV diastolic dysfunction (LVDD) was higher in the MetS group than in the non-MetS group (0.56% vs. 0.27%, p < .001). In univariate and multivariate analyses, E/A ratio, e' velocity, and left atrial volume index were significantly associated with each component of MetS and covariates (all p ≤ .001). In the age- and sex-adjusted model, MetS was significantly associated with LVDD (odds ratio [95% confidence interval], 1.350 [1.103, 1.652]). However, subjects with more MetS components did not have a significantly higher risk of LVDD. As the analysis was stratified by sex, the multivariate regression model showed that MetS was significantly associated with LVDD only in men (1.3 [1.00, 1.68]) with higher risk in more MetS component (p for trend < .001). In particular, triglyceride (TG) and waist circumference (WC) among MetS components were significantly associated with LVDD in men. CONCLUSIONS MetS was associated with the risk of LVDD, especially in men, with a dose-dependent association between an increasing number of components of MetS and LVDD. TG and WC were independent risk factors for LVDD in men.
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Affiliation(s)
- Seung-Jae Lee
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyunah Kim
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byeong Kil Oh
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyo-In Choi
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ki-Chul Sung
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeonggyu Kang
- Center for Cohort Studies, Total Healthcare Center, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi Yeon Lee
- Division of Biostatistics, Department of R&D Management, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jong-Young Lee
- Division of Cardiology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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20
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Singh A, Sun D, Mor-Avi V, Addetia K, Patel AR, DeCara JM, Ward RP, Lang RM. Can echocardiographic assessment of diastolic function be automated? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:965-974. [PMID: 34882301 DOI: 10.1007/s10554-021-02488-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
Echocardiographic evaluation of left ventricular diastolic function relies on a multi-pronged algorithm, which incorporates Doppler-based and volumetric parameters. Integration of clinical data in diastolic assessment is recommended, though not clearly outlined. We sought to develop an automated tool for diastolic function, compare its performance to human-generated diagnoses and identify the common sources of error. Our software tool is based on the 2016 diastolic guidelines algorithm, which uses 8 parameters as input, with 10 conditions as the logic and 5 possible outputs as final diagnoses. Initially, we prospectively studied 563 patients whose diastolic function was independently evaluated by an expert echocardiographer and by the automated tool. Incongruent cases were further analyzed, after which features of myocardial disease were integrated into a refined version of the software that was tested in an independent cohort of 1106 patients. In the initial analysis, 202/563 grades (36%) were incongruent between the automated and human reads, with the highest rate of discordance for mild and indeterminate categories. In 17% of cases, human diagnoses differed from that dictated by the algorithm due to integration of clinical factors. Follow-up analysis using the refined automated tool did not improve the discordance rate (440/1106; 40%). There was more discordance in cases of: age > 40 years, impaired mitral inflow patterns (E/A < 0.8) and reduced mitral e' values. Further analysis revealed differences in how readers interpreted the interaction between these factors and diastolic function, which could not be incorporated into the automated tool. In conclusion, although assessment of diastolic function relies on an algorithm that can be automated, this algorithm does not include clear guidance on how to incorporate age, or age-related changes in Doppler-based parameters, often resulting in discordant diagnoses. Standardized interpretation of these factors is needed to improve the reproducibility of diastolic function grading by human readers and the accuracy of the automated classification.
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Affiliation(s)
- Amita Singh
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA.
| | - Deyu Sun
- Philips Healthcare, Cambridge, MA, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Amit R Patel
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Jeanne M DeCara
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - R Parker Ward
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
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21
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Wegener A, Kaagaard MD, Gomes LC, Holm AE, Matos LO, Lima KO, Vieira IVM, de Souza RM, Olsen FJ, Marinho CRF, Biering-Sørensen T, Silvestre OM, Brainin P. Reference values for left ventricular dimensions, systolic and diastolic function: a study from the Amazon Basin of Brazil. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:813-822. [PMID: 34807316 DOI: 10.1007/s10554-021-02475-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 11/12/2021] [Indexed: 12/20/2022]
Abstract
Country- and ethnicity-specific reference values for echocardiographic parameters are necessary for decision making. No prior studies have examined reference values in adults from the Amazon Basin of Brazil. We performed echocardiographic examinations in 290 healthy adults (mean age 37 ± 14 years, 40% male) from the Brazilian Amazon. Left ventricular (LV) dimensions and volumes were obtained and indexed to body surface area. We also assessed systolic (LV ejection fraction [LVEF] and global longitudinal strain [GLS]) and diastolic function. LV dimensions and volumes were larger in males compared to females, but after indexation only volumes remained larger (P < 0.001 for all). Parameters of systolic function, were significantly greater in females (LVEF 50 to 68%, GLS - 17 to - 24%) than in males (LVEF 50 to 67%, GLS - 15 to - 23%, P < 0.05). Upper limits of normality for cardiac dimensions (indexed and non-indexed) were markedly higher compared to contemporary guidelines (American Society of Echocardiography) and the Brazilian subgroup in the World Alliance Society of Echocardiography (WASE). Lower limit of normality for LVEF (both sex 50%) and upper limit of normality for the left atrial volume index (LAVI) (male: 31 mL/m2, female: 25 mL/m2) were within normal range but slightly lower compared to guidelines and the WASE study. Other diastolic parameters, including E/A-ratio, E/e' ratio and peak tricuspid regurgitation velocity were compatible with present recommendations. Normal reference ranges of echocardiographic parameters in healthy adults from the Brazilian Amazon Basin may be different compared to international guidelines and data from other regions of Brazil. This applies specifically for LVEF and LAVI.
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Affiliation(s)
- Alma Wegener
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Molly D Kaagaard
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Laura Cordeiro Gomes
- Department of Parasitology, Institute of Biomedical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anna Engell Holm
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Luan O Matos
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Karine O Lima
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Isabelle V M Vieira
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Rodrigo Medeiros de Souza
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil
| | - Flemming Javier Olsen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | | | - Tor Biering-Sørensen
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Faculty of Biomedical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Odilson M Silvestre
- Health and Sport Science Center, Federal University of Acre, Rio Branco, Acre, Brazil
| | - Philip Brainin
- Multidisciplinary Center, Federal University of Acre, Câmpus Floresta, Cruzeiro do Sul, Acre, Brazil.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
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22
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Miyoshi T, Tanaka H. Standardization of normal values for cardiac chamber size in echocardiography. J Med Ultrason (2001) 2022; 49:21-33. [PMID: 34787741 DOI: 10.1007/s10396-021-01147-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/09/2021] [Indexed: 10/19/2022]
Abstract
Echocardiography is used worldwide to evaluate cardiac size and function. To determine what values are abnormal, it is essential to establish normal reference values for echocardiography. The current guidelines for chamber quantification specify normative values for cardiac chambers and recommend that gender and body size be taken into account. However, these normative data were established using databases for which a variety of measurement methods were used and the majority of subjects consisted of Whites in Europe and the United States. However, several regional studies from other countries suggest that cardiac size varies globally. To overcome these limitations, the Normal Reference Ranges for Echocardiography study and the World Alliance of Societies of Echocardiography Normal Values study have recently been conducted to examine similarities and differences in cardiac chamber size and to establish normal reference values while taking worldwide diversity into account. The results from these studies have demonstrated that standardization of normal reference values for cardiac size is important. This review article aims to summarize the current status of normative echocardiographic values for cardiac chamber size.
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Affiliation(s)
- Tatsuya Miyoshi
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Ohno-Higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
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23
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Morais H, Feijão A, De Victória Pereira S. Values of left ventricular diastolic function assessed by left atrial volumes and Doppler echocardiography in healthy Angolans: Effect of age and gender: A pilot study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2021; 49:791-798. [PMID: 34212397 DOI: 10.1002/jcu.23034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/07/2021] [Accepted: 06/21/2021] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Studies about the reference values of conventional and tissue Doppler echocardiography in African populations are limited. OBJECTIVES To evaluate the effect of aging and gender in left ventricular diastolic function assessed by conventional and tissue Doppler echocardiography in healthy Angolans. METHODS Cross-sectional study involving healthy adult participants attending a diagnostic center in Luanda, Angola. Two-dimensional transthoracic B-mode and Doppler echocardiography were performed according to the Guidelines of the American Society of Echocardiography and the European Association of Cardiovascular Imaging. RESULTS A total of 103 men (47.5%) (mean age: 39.5 ± 10.8) and 114 women (52.5%) (mean age: 43.0 ± 12.5 years) were included. Women were older (p = 0.025) and showed smaller body surface area (p < 0.001) than men. Mitral E velocity and E/e' ratio were higher in women than in men. While DT of mitral E velocity was longer in men than in women (p = 0.041), E velocity, E/A ratio, and average e' velocity showed a negative significant correlation with increasing age (r - 0.33; p ≤ 0.001; r - 0.48; p ≤ 0.001 and r - 0.41; p ≤ 0.0001, respectively). Conversely, A wave velocity showed a significant positive correlation with age (r 0.47; p < 0.001). CONCLUSIONS In a healthy Angolan adult population, the variables of left ventricular diastolic function declined with age, reflecting a normal aging process. This must be taken into account when assessing diastolic function at different age categories.
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Affiliation(s)
- Humberto Morais
- Department of Cardiology, Hospital Militar Principal/Instituto Superior, Luanda, Angola
| | - Ana Feijão
- Department of Cardiology, Luanda Medical Center, Luanda, Angola
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24
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Crousillat DR, Wood MJ. Echocardiography in Women: How Are Mars and Venus Different? Curr Cardiol Rep 2021; 23:149. [PMID: 34427784 DOI: 10.1007/s11886-021-01562-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/14/2021] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Sex is an important determinant of cardiac structure and function. We review key sex differences in universal echocardiographic parameters and discuss the clinical implications of using sex-specific algorithms to increase the diagnostic accuracy of echocardiography and improve the timely treatment of common cardiovascular disorders, and the unique role of echocardiography in pregnancy and the evaluation of ischemic heart disease. RECENT FINDINGS Emerging echocardiographic findings have begun to define important sex-based differences in chamber size and ventricular function. We advocate for additional research and the consideration of sex-specific algorithms in future expert consensus guidelines for the diagnosis and treatment of valvular heart disease, heart failure, and thoracic aortic disease. Echocardiography is an essential diagnostic tool in our armamentarium of imaging modalities for the sex-specific diagnosis and guidance of treatment for a broad spectrum of cardiovascular disorders.
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Affiliation(s)
- Daniela R Crousillat
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Blake 256, Boston, MA, 02114, USA
| | - Malissa J Wood
- Division of Cardiology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street Blake 256, Boston, MA, 02114, USA.
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25
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Singh A, Carvalho Singulane C, Miyoshi T, Prado AD, Addetia K, Bellino M, Daimon M, Gutierrez Fajardo P, Kasliwal RR, Kirkpatrick JN, Monaghan MJ, Muraru D, Ogunyankin KO, Park SW, Ronderos RE, Sadeghpour A, Scalia GM, Takeuchi M, Tsang W, Tucay ES, Tude Rodrigues AC, Vivekanandan A, Zhang Y, Schreckenberg M, Blankenhagen M, Degel M, Hitschrich N, Mor-Avi V, Asch FM, Lang RM. Normal Values of Left Atrial Size and Function and the Impact of Age: Results of the World Alliance Societies of Echocardiography Study. J Am Soc Echocardiogr 2021; 35:154-164.e3. [PMID: 34416309 DOI: 10.1016/j.echo.2021.08.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 08/06/2021] [Accepted: 08/10/2021] [Indexed: 01/09/2023]
Abstract
BACKGROUND Left atrial (LA) evaluation includes volumetric and functional parameters with an abundance of diagnostic and prognostic implications. Solid normal reference ranges are compulsory for accurate interpretation in individual patients, but previous studies have yielded mixed conclusions regarding the effects of age, sex, and/or race. The present report from the World Alliance Societies of Echocardiography study focuses on two-dimensional (2D) and three-dimensional (3D) measures of LA structure and function, with subgroup analysis by age, sex, and race. METHODS Transthoracic 2D and 3D echocardiographic images were obtained in 1,765 healthy individuals (901 men, 864 women) evenly distributed among age subgroups: 18 to 40 years (n = 745), 41 to 65 years (n = 618), and >65 years (n = 402); the racial distribution was 38.4% white, 39.9% Asian, and 9.7% black. Images were analyzed using dedicated LA analysis software to measure LA volumes and phasic function from 3D volume and 2D strain curves. RESULTS Three-dimensional maximum and minimum LA volumes adjusted for body surface area were nearly identical for men and women, but women demonstrated higher 3D total and passive emptying fractions (EFs). Two-dimensional reservoir strain was similar for both sexes. Age was associated with an incremental rise in LA volumes alongside characteristic shifts in functional indices. Total 2D EF and reservoir and conduit strain varied inversely with age, counteracted by higher booster strain, with a greater magnitude of effect in women. Active 3D EF was significantly higher, while total and passive EFs decreased with age. Interracial differences were noted in LA volumes, without substantial differences in functional indices. CONCLUSION Although similar normal values for LA volumes and strain can be applied to both sexes, meaningful differences in LA size occur with aging. Indices of function also shift with age, with a compensatory rise in booster function, which may serve to counteract observed lower total and passive EFs. Defining age-associated normal values may help differentiate age-associated "healthy" LA aging from pathologic processes.
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Affiliation(s)
| | | | - Tatsuya Miyoshi
- MedStar Health Research Institute, Washington, District of Columbia
| | - Aldo D Prado
- Centro Privado de Cardiologia, Tucumán, Argentina
| | | | | | | | | | | | | | | | - Denisa Muraru
- University of Milano-Bicocca and Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | | | - Seung Woo Park
- Samsung Medical Center/Sungkyunkwan University School of Medicine, Seoul, Korea
| | | | - Anita Sadeghpour
- Rajaie Cardiovascular Medical Center, Iran University of Medical Sciences, Tehran, Iran
| | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Yun Zhang
- Qilu Hospital of Shandong University, Jinan, China
| | | | | | - Markus Degel
- TomTec Imaging Systems, Unterschleissheim, Germany
| | | | | | - Federico M Asch
- MedStar Health Research Institute, Washington, District of Columbia
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26
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Sugimoto T, Dohi K. Current status and issues regarding reference values for echocardiography: a short review. J Med Ultrason (2001) 2021; 49:17-19. [PMID: 34185191 DOI: 10.1007/s10396-021-01108-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
In general, the reference values of diagnostic test parameters are specified based on the values of 95% confidence intervals of those parameters measured in healthy subjects. As heart size varies according to sex, there are sex-related differences in the reference values of echocardiographic parameters. There have been attempts to minimize the variability in the reference values of echocardiographic parameters worldwide by correcting for age-related, sex-related, and body size-related differences. This short review describes the current status and issues regarding the reference values of echocardiographic parameters and discusses the findings of research aimed at resolving these issues.
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Affiliation(s)
- Tadafumi Sugimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan.
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, 2-174 Edobashi, Tsu, 514-8507, Japan
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27
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Letnes JM, Eriksen-Volnes T, Nes B, Wisløff U, Salvesen Ø, Dalen H. Variability of echocardiographic measures of left ventricular diastolic function. The HUNT study. Echocardiography 2021; 38:901-908. [PMID: 33960012 DOI: 10.1111/echo.15073] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 04/10/2021] [Accepted: 04/24/2021] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE Investigate variability related to image acquisition and reading process for echocardiographic measures of left ventricular (LV) diastolic function, and its influence on classification of LV diastolic dysfunction (LVDD). METHODS Forty participants (19 women) mean age 62 (28-88) years underwent echocardiographic examinations twice by different echocardiographers and blinded analyses by four readers in a cross-sectional design. Measurements included quantification of two- (2D) and three-dimensional (3D) recordings of the left atrium (LA) (maximal) volume (LAVmax ) and spectral Doppler blood flow and tissue velocities for assessment of LV diastolic function. Variability and reproducibility measures were calculated using variance component analyses and Kappa statistics. RESULTS Image acquisition influenced variability more than image reading (mean 24% and 4% of variance, respectively), but variability from image reading was especially important for 2D LAVmax (16% of variance) compared to 4% for 3D LAVmax , which was reflected in better agreement for 3D measures. The variability of measures used in classification of LVDD had clinical significance, and agreement across the four raters in classification using current recommendations was only fair (Kappa 0.42), but the agreement improved when using 3D LAVmax (Kappa 0.58). Agreement and reliability measures were reported for all measures. CONCLUSION Performing a new image acquisition influenced variability more than a introducing a new image reader, but there were differences across the different measures. LAVmax by 3D is superior to 2D with respect to lower variability. The variability of diastolic measures influences the reliability of LVDD classification, and this should be taken into account in the everyday clinic.
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Affiliation(s)
- Jon Magne Letnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Torfinn Eriksen-Volnes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Bjarne Nes
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway
| | - Ulrik Wisløff
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
| | - Øyvind Salvesen
- Unit of Applied Clinical Research, Department of Public Health and Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olavs University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
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28
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Setti M, Benfari G, Mele D, Rossi A, Ballo P, Galderisi M, Henein M, Nistri S. Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms-A Primary Care Study. Diagnostics (Basel) 2020; 10:diagnostics10100850. [PMID: 33092136 PMCID: PMC7589762 DOI: 10.3390/diagnostics10100850] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 10/16/2020] [Accepted: 10/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a’ emerges as a simple and effective approach to this aim.
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Affiliation(s)
- Martina Setti
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Giovanni Benfari
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Donato Mele
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy;
| | - Andrea Rossi
- Division of Cardiology, Department of Medicine, University of Verona, 37126 Verona, Italy; (M.S.); (G.B.); (A.R.)
| | - Piercarlo Ballo
- Santa Maria Annunziata Hospital, Cardiology Unit, 50012 Florence, Italy;
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, 80131 Naples, Italy;
| | - Michael Henein
- Institute of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden;
| | - Stefano Nistri
- CMSR Veneto Medica-Cardiology Service, 36077 Altavilla Vicentina (VI), Italy
- Correspondence: ; Tel.: +39-0444225111
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