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Lai KY, Lee CY, Chang YC, Liu K, Takeuchi M, Yang LT, Ho YL. Prognostic value of fully-automated left atrial strain in patients with asymptomatic chronic severe aortic regurgitation. Int J Cardiol 2024; 416:132487. [PMID: 39209033 DOI: 10.1016/j.ijcard.2024.132487] [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: 05/06/2024] [Revised: 07/29/2024] [Accepted: 08/23/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND To examine whether left atrial (LA) strain was associated with adverse outcomes in asymptomatic chronic aortic regurgitation (AR). METHODS Asymptomatic patients with ≥moderate-severe AR were retrospectively identified from 2008 through 2022 from a university hospital. Apical 4-chamber left ventricular longitudinal strain (A4C-LVLS), LA reservoir (LASr), conduit (LAScd), and contractile strain (LASct) were measured using fully-automated software. Primary endpoint was all-cause death (ACD); secondary endpoints were heart failure (HF) development or aortic valve surgery (AVS). RESULTS Of 352 patients (59 ± 17 years; 19 % female), the mean LV ejection fraction (LVEF) was 60 ± 8 %. The median follow-up during medical surveillance was 4.7 (interquartile range: 1.8-9.0) years; during which 68 patients died. Multivariable analysis adjusted for covariates showed that larger maximal LA volume index (iLAVmax), lower LASr and LASct were independently associated with ACD (all P ≤ 0.047); A4C-LVLS and LAScd were not (P ≥ 0.15). Besides, iLAVmax, LASr, and LASct provided incremental prognostic value over A4C-LVLS in terms of ACD (all P ≤ 0.048). HF symptoms occurred in 126 patients at a median of 2 years. Multivariable determinants for HF development included larger minimal LAV index, lower LASr and LASct (all P ≤ 0.03). Adjusted spline curves showed LASr <38-40 % and LASct <20-24 % were associated with increased risks of ACD and HF development, respectively. Using abovementioned LASr and LASct cutoffs, adjusted Kaplan-Meier curves risk-stratified patients for ACD successfully (P ≤ 0.02). Lower LASr was also independently associated with AVS (Hazard ratio per 1 % increase: 0.98)(P = 0.02). CONCLUSIONS In patients with asymptomatic AR, fully-automated LASr and LASct were robust markers for outcome determination; these markers may identify those who need timely surgical referral.
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Affiliation(s)
- Kuan-Yu Lai
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chung-Yen Lee
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yu-Ching Chang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kang Liu
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
| | - Li-Tan Yang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan.
| | - Yi-Lwun Ho
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Telehealth Center, National Taiwan University Hospital, Taipei, Taiwan
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He W, Yin L, Liu Q, Zhang Y, Zhao Y, Wang L, You L. Influencing factors and predictive model for left atrial appendage emptying velocity in nonvalvular AF patients. Front Cardiovasc Med 2024; 11:1468379. [PMID: 39364064 PMCID: PMC11446783 DOI: 10.3389/fcvm.2024.1468379] [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: 07/21/2024] [Accepted: 09/03/2024] [Indexed: 10/05/2024] Open
Abstract
Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, significantly increasing the risk of death and stroke. The left atrial appendage (LAA) plays a crucial role in the development of AF. Reduced left atrial appendage emptying velocity (LAAEV) is an important indicator of nonvalvular AF, associated with thrombosis and recurrence after catheter ablation. This study aims to identify factors influencing LAAEV and construct a predictive model for LAAEV in nonvalvular AF patients. Methods This retrospective cohort study included 1,048 nonvalvular AF patients hospitalized at the Second Hospital of Hebei Medical University from January 1, 2015, to December 31, 2021. Patients underwent transthoracic and transesophageal echocardiography and had complete laboratory data. Statistical analyses included binary logistic regression and multiple linear regression to identify independent predictors of reduced LAAEV and construct a predictive model. Results Patients were divided into two groups: reduced LAAEV (<40 cm/s) and normal LAAEV (≥40 cm/s). The reduced LAAEV group included 457 patients (43.61%), with significant differences in age, gender, alcohol consumption, heart failure (HF), ischemic stroke, AF type, resting heart rate, CHA2DS2-VASc score, serum creatinine (SCR), serum uric acid (SUA), estimated glomerular filtration rate (eGFR), glycated hemoglobin (HbA1C), β2 macroglobulin (B2M), left atrial diameter (LAD), and left ventricular ejection fraction (LVEF) compared to the normal LAAEV group. Logistic regression analysis identified age (OR 0.974, 95% CI 0.951-0.997, P = 0.028), HF (OR 0.637, 95% CI 0.427-0.949, P = 0.027), AF type [Persistent AF vs. PAF (OR 0.063, 95% CI 0.041-0.095, P = 0) Long-standing Persistent AF vs. PAF (OR 0.077, 95% CI 0.043-0.139, P = 0)], LAD (OR 0.872, 95% CI 0.836-0.91, P < 0.001), and LVEF (OR 1.057, 95% CI 1.027-1.089, P = 0) as independent predictors of reduced LAAEV. Multiple linear regression analysis included age, AF type, LAD, and LVEF in the final predictive model, explaining 43.5% of the variance in LAAEV (adjusted R² = 0.435). Conclusion Age, HF, type of AF, LAD, and LVEF are independent predictors of reduced LAAEV. The predictive model (LAAEV = 96.567-15.940 × AFtype-1.309 × LAD-0.18 × Age + 37.069 × LVEF) demonstrates good predictive value, aiding in the initial assessment and management of nonvalvular AF patients.
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Affiliation(s)
- Weibin He
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lei Yin
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Qian Liu
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yan Zhang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Yanlei Zhao
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Lianxia Wang
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ling You
- Department of Cardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, China
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Clua-Espuny JL, Gentille-Lorente D, Hernández-Pinilla A, Satué-Gracia EM, Pallejà-Millán M, Martín-Luján FM. [MVP Risk score and new atrial fibrillation diagnosis: Prospective cohort PREFATE study]. Aten Primaria 2024; 57:103071. [PMID: 39265318 DOI: 10.1016/j.aprim.2024.103071] [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: 05/08/2024] [Revised: 07/04/2024] [Accepted: 07/08/2024] [Indexed: 09/14/2024] Open
Abstract
OBJECTIVE To assess the association between electrocardiogram (ECG) patterns according to the MVP ECG risk score (morphology-voltage-P-wave duration) and a diagnosis of Atrial Fibrillation (AF). DESIGN Prospective observational cohort study (1/01/2023-31/12/2024). SITE: Primary care. PARTICIPANTS Randomized sample of 150 patients aged 65-85 years without prior diagnosis of AF, stroke, or current anticoagulant treatment; high risk of future AF; CHA2DS2-VASc ≥2; and ability to use the FibricheckR application (App). MEASUREMENTS At baseline, a standard ECG, MVP risk score assessment, and cardiac rhythm monitoring for 15 days using the FibricheckR App were performed. The dependent variables were the presence of P-wave patterns on the electrocardiogram according to MVP risk score and a new diagnosis of AF. RESULTS The diagnosis of AF was confirmed in 14 cases (9.3%, 95% CI 5.6-15.1), 3 men and 11 women. In 3 cases, the arrhythmia was diagnosed on the baseline ECG, and in 11 cases by Holter after being reported as possible AF by the FibricheckR App. A higher prevalence of atypical advanced interatrial block (A-AIB) (p 0.007) was detected among participants with AF, as well as the prevalence of P-wave <0.1mV. (p=0.006). All new diagnoses of AF were made at scores ≥4 in the MVP risk score. CONCLUSIONS Using scales for identifying ECG patterns in high-risk subjects in primary care can facilitate the diagnosis of unknown AF.
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Affiliation(s)
- Josep L Clua-Espuny
- Servicio de Atención Primaria Terres de l'Ebre. Institut Català de la Salut. CAP Temple, Tortosa, España.
| | - Delicia Gentille-Lorente
- Servicio de Cardiología, Hospital Virgen de la Cinta de Tortosa. Institut Català de la Salut, Tortosa, España
| | - Alba Hernández-Pinilla
- Servicio de Atención Primaria Camp de Tarragona, Institut Català de la Salut, Tarragona, España
| | - Eva Maria Satué-Gracia
- Unitat de Suport a la Recerca, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, España
| | - Meritxell Pallejà-Millán
- Unitat de Suport a la Recerca, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Reus, España
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Goette A, Corradi D, Dobrev D, Aguinaga L, Cabrera JA, Chugh SS, de Groot JR, Soulat-Dufour L, Fenelon G, Hatem SN, Jalife J, Lin YJ, Lip GYH, Marcus GM, Murray KT, Pak HN, Schotten U, Takahashi N, Yamaguchi T, Zoghbi WA, Nattel S, Mont L, Akar JG, Akoum N, Althoff T, Diaz JC, Guichard JB, Jadidi A, Kalman J, Lim H, Teixeira RA. Atrial cardiomyopathy revisited-evolution of a concept: a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS). Europace 2024; 26:euae204. [PMID: 39077825 PMCID: PMC11431804 DOI: 10.1093/europace/euae204] [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: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 07/31/2024] Open
Abstract
AIMS The concept of "atrial cardiomyopathy" (AtCM) had been percolating through the literature since its first mention in 1972. Since then, publications using the term were sporadic until the decision was made to convene an expert working group with representation from four multinational arrhythmia organizations to prepare a consensus document on atrial cardiomyopathy in 2016 (EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication). Subsequently, publications on AtCM have increased progressively. METHODS AND RESULTS The present consensus document elaborates the 2016 AtCM document further to implement a simple AtCM staging system (AtCM stages 1-3) by integrating biomarkers, atrial geometry, and electrophysiological changes. However, the proposed AtCM staging needs clinical validation. Importantly, it is clearly stated that the presence of AtCM might serve as a substrate for the development of atrial fibrillation (AF) and AF may accelerates AtCM substantially, but AtCM per se needs to be viewed as a separate entity. CONCLUSION Thus, the present document serves as a clinical consensus statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asian Pacific Heart Rhythm Society (APHRS), and the Latin American Heart Rhythm Society (LAHRS) to contribute to the evolution of the AtCM concept.
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Affiliation(s)
- Andreas Goette
- Department of Cardiology and Intensive Care Medicine, St. Vincenz-Hospital Paderborn, Am Busdorf 2, 33098 Paderborn, Germany
- MAESTRIA Consortium at AFNET, Münster, Germany
- Otto-von-Guericke University, Medical Faculty, Magdeburg, Germany
| | - Domenico Corradi
- Department of Medicine and Surgery, Unit of Pathology; Center of Excellence for Toxicological Research (CERT), University of Parma, Parma, Italy
| | - Dobromir Dobrev
- Institute of Pharmacology, University Duisburg-Essen, Essen, Germany
- Montréal Heart Institute, Université de Montréal, 5000 Belanger St. E., Montréal, Québec H1T1C8, Canada
- Department of Integrative Physiology, Baylor College of Medicine, Houston, TX, USA
| | - Luis Aguinaga
- Director Centro Integral de Arritmias Tucumán, Presidente Sociedad de Cardiología de Tucumàn, Ex-PRESIDENTE DE SOLAECE (LAHRS), Sociedad Latinoamericana de EstimulaciónCardíaca y Electrofisiología, Argentina
| | - Jose-Angel Cabrera
- Hospital Universitario QuirónSalud, Madrid, Spain
- European University of Madrid, Madrid, Spain
| | - Sumeet S Chugh
- Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA, USA
| | - Joris R de Groot
- Department of Cardiology; Cardiovascular Sciences, Heart Failure and Arrhythmias, University of Amsterdam, Amsterdam, The Netherlands
| | - Laurie Soulat-Dufour
- Department of Cardiology, Saint Antoine and Tenon Hospital, AP-HP, Unité INSERM UMRS 1166 Unité de recherche sur les maladies cardiovasculaires et métaboliques, Institut Hospitalo-Universitaire, Institut de Cardiométabolisme et Nutrition (ICAN), Sorbonne Université, Paris, France
| | | | - Stephane N Hatem
- Department of Cardiology, Assistance Publique-Hôpitaux de Paris, Pitié-Salpêtrière Hospital; Sorbonne University; INSERM UMR_S1166; Institute of Cardiometabolism and Nutrition-ICAN, Paris, France
| | - Jose Jalife
- Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III, 28029 Madrid, Spain
| | - Yenn-Jiang Lin
- Cardiovascular Center, Taipei Veterans General Hospital, and Faculty of Medicine National Yang-Ming University Taipei, Taiwan
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Gregory M Marcus
- Electrophysiology Section, Division of Cardiology, University of California, San Francisco, USA
| | - Katherine T Murray
- Department of Medicine, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Pharmacology, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hui-Nam Pak
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Ulrich Schotten
- MAESTRIA Consortium at AFNET, Münster, Germany
- Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University and Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University and Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Naohiko Takahashi
- Department of Cardiology and Clinical Examination, Faculty of Medicine, Oita University, Japan
| | - Takanori Yamaguchi
- Department of Cardiovascular Medicine, Saga University, 5-1-1 Nabeshima, Saga 849-8501, Japan
| | - William A Zoghbi
- Department of Cardiology, Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
| | - Stanley Nattel
- McGill University, 3655 Promenade Sir-William-Osler, Montréal, Québec H3G1Y6, Canada
- West German Heart and Vascular Center, Institute of Pharmacology, University Duisburg, Essen, Germany
| | - Lluis Mont
- Hospital Clinic, Universitat Barcelona, Barcelona, Spain
| | - Joseph G Akar
- Director, Cardiac Electrophysiology, Professor of Medicine, Yale School of Medicine
| | | | - Till Althoff
- Hospital Clinic, Universitat Barcelona, Barcelona, Spain
| | | | - Jean-Baptiste Guichard
- Hospital Clínic de Barcelona, IDIBAPS, CIBERCV, Catalonia, Spain
- CHU de Saint-Étienne, SAINBIOSE-INSERM U1059, France
| | - Amir Jadidi
- Faculty of Medicine, University of Freiburg i.Br., Germany
- Department of Cardiology, Heart Center Lucerne - Lucerne Cantonal Hospital, Lucerne, Switzerland
| | - Jonathan Kalman
- University of Melbourne & Director of Heart Rhythm Services, Royal Melbourne Hospital, Melbourne, Victoria 3050, Australia
| | - Han Lim
- Austin and Northern Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ricardo Alkmim Teixeira
- Hospital Renascentista, R. Salvador dos Santos Nora 76, Santa Doroteia - Pouso Alegre (Minas Gerais), 37553-628 Brazil
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Smiseth OA, Rider O, Cvijic M, Valkovič L, Remme EW, Voigt JU. Myocardial Strain Imaging: Theory, Current Practice, and the Future. JACC Cardiovasc Imaging 2024:S1936-878X(24)00301-2. [PMID: 39269417 DOI: 10.1016/j.jcmg.2024.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 07/01/2024] [Accepted: 07/03/2024] [Indexed: 09/15/2024]
Abstract
Myocardial strain imaging by echocardiography or cardiac magnetic resonance (CMR) is a powerful method to diagnose cardiac disease. Strain imaging provides measures of myocardial shortening, thickening, and lengthening and can be applied to any cardiac chamber. Left ventricular (LV) global longitudinal strain by speckle-tracking echocardiography is the most widely used clinical strain parameter. Several CMR-based modalities are available and are ready to be implemented clinically. Clinical applications of strain include global longitudinal strain as a more sensitive method than ejection fraction for diagnosing mild systolic dysfunction. This applies to patients suspected of having heart failure with normal LV ejection fraction, to early systolic dysfunction in valvular disease, and when monitoring myocardial function during cancer chemotherapy. Segmental LV strain maps provide diagnostic clues in specific cardiomyopathies, when evaluating LV dyssynchrony and ischemic dysfunction. Strain imaging is a promising modality to quantify right ventricular function. Left atrial strain may be used to evaluate LV diastolic function and filling pressure.
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Affiliation(s)
- Otto A Smiseth
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway.
| | - Oliver Rider
- Oxford Centre for Clinical Magnetic Resonance Research, RDM Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom
| | - Marta Cvijic
- Department of Cardiology, University Medical Centre Ljubljana, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Ladislav Valkovič
- Oxford Centre for Clinical Magnetic Resonance Research, RDM Cardiovascular Medicine, University of Oxford, Oxford, United Kingdom; Department of Imaging Methods, Institute of Measurement Science, Slovak Academy of Sciences, Bratislava, Slovakia
| | - Espen W Remme
- Institute for Surgical Research, Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway; The Intervention Center, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven-University of Leuven, Leuven, Belgium
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Borde DP, Joshi S, Agrawal A, Bhavsar D, Joshi P, Apsingkar P. Left Atrial Strain to Predict Postoperative Atrial Fibrillation in Patients Undergoing Off-pump Coronary Artery Bypass Graft. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00508-1. [PMID: 39218763 DOI: 10.1053/j.jvca.2024.07.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 07/22/2024] [Accepted: 07/26/2024] [Indexed: 09/04/2024]
Abstract
OBJECTIVE Postoperative atrial fibrillation (POAF) is associated with increased morbidity, mortality, and length of hospital stay. The objective of this study was to assess the utility of left atrial strain (LAS) to predict POAF in patients undergoing off-pump coronary artery bypass grafting (OPCABG). DESIGN Retrospective observational study. SETTING Tertiary care hospital. PARTICIPANTS 103 patients undergoing OPCABG. INTERVENTIONS None. MEASUREMENTS AND RESULTS In addition to comprehensive transthoracic echocardiography, LAS was measured for reservoir (R), conduction (CD), and contraction (CT) components. POAF was defined as new electrocardiographic evidence of AF requiring treatment. Logistic regression was done to assess factors associated with POAF. The diagnostic accuracy of variables in predicting POAF was assessed by receiver operating characteristic analysis. POAF was documented in 24 (23.3%) patients. There was no difference in ejection fraction, average global longitudinal strain, or proportion of left ventricular diastolic dysfunction grades between patients with POAF and patients without POAF. All three components of LAS: LAS R (19.2 ± 4.7 v 23.5 ± 4.8, p < 0.001), LAS CD (8.9 ± 3.7 v 12.3 ± 4.8, p = 0.1), and LAS CT (10.3 ± 3.9 v 12.1 ± 4.1, p = 0.04), were significantly lower among patients with POAF compared with patients without POAF, respectively. According to univariate analysis, all components of LAS were statistically significant predictors of POAF. In multivariate analysis, only age (odds ratio = 1.08, p = 0.025) and LAS R (odds ratio = 0.84, p = 0.004) were independently associated with POAF. LAS R was a better predictor of POAF, with an area under the curve (AUC) of 0.758, than LAS CD (AUC = 0.67) and LAS CT (AUC = 0.62). LAS R had an optimal cutoff of 23% with sensitivity of 95.8% (confidence interval: 78.9-99.9%) and specificity of 49.4% (37.9-60.9%) to predict POAF. CONCLUSIONS LAS R is a significant predictor of POAF, and its use can be recommended for screening of OPCABG patients at high risk of POAF.
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Affiliation(s)
- Deepak Prakash Borde
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India.
| | - Shreedhar Joshi
- Department of Cardiac Anesthesia, Narayana Institute of Cardiovascular Sciences Bangalore, Karnataka, India
| | - Ashish Agrawal
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
| | - Deepak Bhavsar
- Department of Cardiac Surgery, Seth Nandlal Dhoot Hospital, Aurangabad, Maharashtra, India
| | - Pooja Joshi
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
| | - Pramod Apsingkar
- Department of Cardiac Anesthesia, Ozone Anesthesia Group, Aurangabad, Maharashtra, India
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Mangia M, D'Andrea E, Cecchetto A, Beccari R, Mele D, Nistri S. Current and Clinically Relevant Echocardiographic Parameters to Analyze Left Atrial Function. J Cardiovasc Dev Dis 2024; 11:241. [PMID: 39195149 DOI: 10.3390/jcdd11080241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 07/28/2024] [Accepted: 07/31/2024] [Indexed: 08/29/2024] Open
Abstract
The evaluation of the left atrial (LA) size using the LA volume index (LAVI) is clinically relevant due to its prognostic significance in various conditions. Nonetheless, adding a LA function assessment to the LAVI provides further clinical and prognostic information in different cardiovascular (CV) diseases. The assessment of LA function by echocardiography primarily includes volumetric measurements (LA ejection fraction [LAEF]), tissue Doppler imaging (TDI) (mitral annular late diastolic velocity [a']), and speckle-tracking methods, such as LA longitudinal reservoir strain (LA strain). This review analyzes and discusses the current medical evidence and potential clinical usefulness of these different methods to analyze LA function.
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Affiliation(s)
- Mario Mangia
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Emilio D'Andrea
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Antonella Cecchetto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Riccardo Beccari
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Donato Mele
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
| | - Stefano Nistri
- Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padua, 35128 Padova, Italy
- Cardiology Service, CMSR Veneto Medica, 36077 Altavilla Vicentina, Italy
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8
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Wang Y, Zhang Y, Yao G, Tang H, Chen L, Yin L, Zhu T, Yuan J, Han W, Yang J, Shu X, Yang Y, Wei Y, Guo Y, Ren W, Gao D, Lu G, Wu J, Yin H, Mu Y, Tian J, Yuan L, Ma X, Dai H, Ding Y, Ding M, Zhou Q, Wang H, Xu D, Zhang M, Zhang Y. Echocardiographic Measurements in Normal Chinese Adults (EMINCA) II focusing on left ventricular and left atrial size and function by three-dimensional echocardiography. Front Med 2024; 18:649-663. [PMID: 38761357 DOI: 10.1007/s11684-023-1045-3] [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: 05/16/2023] [Accepted: 10/23/2023] [Indexed: 05/20/2024]
Abstract
Current guidelines encourage large studies in a diverse population to establish normal reference ranges for three-dimensional (3D) echocardiography for different ethnic groups. This study was designed to establish the normal values of 3D-left ventricular (LV) and left atrial (LA) volume and function in a nationwide, population-based cohort of healthy Han Chinese adults. A total of 1117 healthy volunteers aged 18-89 years were enrolled from 28 collaborating laboratories in China. Two sets of 3D echocardiographic instruments were used, and full-volume echocardiographic images were recorded and transmitted to a core laboratory for image analysis with a vendor-independent off-line workstation. Finally, 866 volunteers (mean age of 48.4 years, 402 men) were qualified for final analysis. Most parameters exhibited substantial differences between different sex and age groups, even after indexation by body surface area. The normal ranges of 3D-LV and 3D-LA volume and function differed from those recommended by the American Society of Echocardiography and the European Association of Cardiovascular Imaging guidelines, presented by the World Alliance Societies of Echocardiography (WASE) study, and from the 2D values in the EMINCA study. The normal reference values of 3D echocardiography-derived LV and LA volume and function were established for the first time in healthy Han Chinese adults. Normal ranges of 3D-LV and 3D-LA echocardiographic measurements stratified with sex, age, and race should be recommended for clinical applications.
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Affiliation(s)
- Yingbin Wang
- State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yu Zhang
- State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Guihua Yao
- State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China
- Department of Cardiology, Qilu Hospital of Shandong University (Qingdao), Qingdao, 266000, China
| | - Hong Tang
- Department of Ultrasonography, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Lixin Chen
- Department of Ultrasonography, Shenzhen People's Hospital/The Second Clinical Medical College of Jinan University, Shenzhen, 518020, China
| | - Lixue Yin
- Department of Ultrasonography, Electronic Science and Technology University of China, The Affiliated Sichuan Provincial People's Hospital, Chengdu, 610072, China
| | - Tiangang Zhu
- Department of Cardiology, Peking University People's Hospital, Beijing, 100044, China
| | - Jianjun Yuan
- Department of Ultrasonography, Henan Provincial People's Hospital, Zhengzhou, 463599, China
| | - Wei Han
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Harbin, 150007, China
| | - Jun Yang
- Department of Echocardiology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, China
| | - Xianhong Shu
- Department of Echocardiology, Zhongshan Hospital, Fudan University, Shanghai, 200032, China
| | - Ya Yang
- Department of Echocardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Yulin Wei
- Department of Cardiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, 510120, China
| | - Yanli Guo
- Department of Ultrasonography, The Southwest Hospital of AMU, Chongqing, 400038, China
| | - Weidong Ren
- Department of Ultrasonography, Shengjing Hospital of China Medical University, Shenyang, 110136, China
| | - Dongmei Gao
- Department of Ultrasonography, China-Japan Union hospital of Jilin University, Changchun, 130033, China
| | - Guilin Lu
- Department of Ultrasonography, First Affiliated Hospital, School of Medicine, Shihezi University, Shihezi, 832000, China
| | - Ji Wu
- Department of Ultrasonography, The First Affiliated Hospital of Guangxi Medical University, Nanning, 537406, China
| | - Hongning Yin
- Department of Echocardiology, The Second Hospital of Hebei Medical University, Shijiazhuang, 050061, China
| | - Yuming Mu
- Department of Ultrasonography, The First Affiliated Hospital of Xinjiang Medical University, Urumqi, 830054, China
| | - Jiawei Tian
- Department of Ultrasonography, The Second Affiliated Hospital of Harbin Medical University, Harbin, 150088, China
| | - Lijun Yuan
- Department of Ultrasonography, Tangdu Hospital of Air Force Medical University of PLA, Xi'an, 710038, China
| | - Xiaojing Ma
- Department of Ultrasonography, Wuhan Asia Heart Hospital, Wuhan, 430022, China
| | - Hongyan Dai
- Department of Cardiology, Qingdao Municipal Hospital, Qingdao, 266071, China
| | - Yunchuan Ding
- Department of Ultrasonography, Yan'an Hospital Affiliated to Kunming Medical University, Kunming, 650051, China
| | - Mingyan Ding
- Department of Ultrasonography, The People's Hospital of Liaoning Province, Shenyang, 110067, China
| | - Qing Zhou
- Department of Ultrasonography, Renmin Hospital of Wuhan University/ Hubei General Hospital, Wuhan, 430060, China
| | - Hao Wang
- Department of Ultrasonography, Fuwai Hospital/Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Di Xu
- Department of Ultrasonography, Jiangsu Province Hospital, Nanjing, 210029, China
| | - Mei Zhang
- State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
| | - Yun Zhang
- State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, 250012, China.
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9
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Kane GC. The True Foundation of Medicine Is the Understanding of the Disease: Gaining Insights Into the Pathophysiology of Heart Failure With Preserved Ejection Fraction. J Am Soc Echocardiogr 2024; 37:769-771. [PMID: 38857851 DOI: 10.1016/j.echo.2024.06.001] [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: 06/05/2024] [Accepted: 06/05/2024] [Indexed: 06/12/2024]
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10
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Larsen BS, Biering-Sørensen T, Olsen FJ. Ischemic stroke and the emerging role of left atrial function. Expert Rev Cardiovasc Ther 2024; 22:289-300. [PMID: 38943632 DOI: 10.1080/14779072.2024.2370814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 06/18/2024] [Indexed: 07/01/2024]
Abstract
INTRODUCTION Ischemic stroke is a leading cause of morbidity and mortality worldwide. Emerging evidence suggests that left atrial (LA) dysfunction could play a role in the pathophysiology of ischemic stroke, as a possible contributor and as a predictive biomarker. AREAS COVERED This narrative review details the intricate relationship between LA function, atrial fibrillation (AF), and ischemic stroke. We discuss imaging techniques used to assess LA function, the mechanisms by which impaired LA function may contribute to stroke, and its potential as a prognostic marker of stroke. EXPERT OPINION There is a lack of evidence-based treatments of LA dysfunction in both primary and secondary stroke prevention. This is partly due to the lack of a practical clinical definition and unanswered questions concerning the clinical implications of LA dysfunction in patients without AF. Until such questions are resolved, addressing well-known cardiovascular risk factors, like hypertension and obesity, should be prioritized for preventing AF and ischemic stroke. These risk factors are closely tied to atrial remodeling, emphasizing the importance of targeting primary modifiable factors for preventing future morbidity and mortality.
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Affiliation(s)
- Bjørn Strøier Larsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
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11
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Barilli M, Mandoli GE, Sisti N, Dokollari A, Ghionzoli N, Soliman-Aboumarie H, D’Ascenzi F, Focardi M, Cavigli L, Pastore MC, Cameli M. Potential Role of Left Atrial Strain to Predict Atrial Fibrillation Recurrence after Catheter Ablation Therapy: A Clinical and Systematic Review. J Cardiovasc Dev Dis 2024; 11:203. [PMID: 39057623 PMCID: PMC11277505 DOI: 10.3390/jcdd11070203] [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: 03/15/2024] [Revised: 06/20/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Pulmonary vein isolation (PVI) with catheter ablation (CA) represents an effective therapy for atrial fibrillation (AF). Unfortunately, it is still not exempt from severe complications. The balance of risks and benefits should be assessed, and a patient-tailored approach is desirable. So far, several clinical and cardiac imaging parameters have been evaluated to investigate pre- and post-procedural features that could help clinicians in the selection of patients at high risk of a poor outcome after CA. This clinical and systematic review analyses the potential role of new LA parameters, such as LA reservoir strain, to predict AF recurrence after CA therapy. Notably, LA reservoir strain gains substantial clinical importance in patients with paroxysmal AF and when a low CHADS2-VASc score is retrieved. LA reservoir strain provides data concerning the risk of AF recurrence after PVI and, thus, in the management of long-term medical therapy in this patient's group.
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Affiliation(s)
- Maria Barilli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Nicolò Sisti
- Cardiology Unit, Electrophysiology Section, Gualdo Tadino Hospital, 06024 Gubbio, Italy
| | - Aleksander Dokollari
- Department of Cardiothoracic Surgery Research, Lankenau Institute for Medical Research, Wynnewood, PA 19096, USA
| | - Nicolò Ghionzoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Hatem Soliman-Aboumarie
- Department of Anaesthetics and Cardiothoracic Critical Care, Harefield Hospital, Hill End Road, Uxbridge UB9 6JH, UK;
| | - Flavio D’Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Luna Cavigli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Policlinico “Le Scotte”, 53100 Siena, Italy (M.F.); (M.C.P.)
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12
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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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13
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Isaac M, Kumar SA, Petroski GF, Shinn A, Mehra A, Gomez CR. Assessing left atrial size and pump function in ischemic stroke patients: Is cardiac MRI superior to transthoracic echocardiography? J Stroke Cerebrovasc Dis 2024; 33:107674. [PMID: 38484943 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107674] [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: 11/07/2023] [Revised: 02/22/2024] [Accepted: 03/04/2024] [Indexed: 03/23/2024] Open
Abstract
OBJECTIVES Current guidelines recommend transthoracic echocardiography (TTE) following an ischemic stroke as the primary technique to identify cardiac abnormalities associated with an increased risk of cerebral embolism. It is unclear whether cardiac magnetic resonance imaging (cMRI), a technique shown to provide increased imaging resolution, may also enhance the cardiac assessment of ischemic stroke patients. We compared cMRI with TTE in the evaluation of Left Atrial (LA) size and pump function in a cohort of 44 patients with ischemic stroke. MATERIALS AND METHODS The biplane method was utilized to acquire LA diameters as well as area measurements in both TTE and cMRI. We calculated LA volume (LAV), LAV index (LAVI), LA Global Longitudinal Strain (GLS) and LA pump function. Results were compared using paired two sample for means t-test. Lin's concordance correlation coefficient (CCC) and Bland-Altman methods quantified the agreement of measurements obtained by TTE and cMRI. RESULTS LAVI measurements by cMRI were significantly larger (34.97 v. 28.81; p = 0.001) than by TTE. The concordance correlation demonstrated only a weak agreement between LA size measured by cMRI and TTE (ρc = 0.397; p= 0.001, 95% CI 0.16 - 0.59), and the Bland-Altman plot demonstrated that LAVI measured by cMRI averaged 6.3 ml/m2 larger magnitude than those obtained by TTE. CONCLUSIONS Using TTE alone leads to an underestimation of LA abnormalities important in the evaluation of ischemic stroke patients. Nearly one in every five ischemic stroke patients evaluated based on the current guidelines may have a missed potential source of cardiac embolism.
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Affiliation(s)
| | | | | | - Alex Shinn
- The Division of Cardiology, Department of Medicine
| | - Ashir Mehra
- The Comprehensive Stroke Center, and University of Missouri Columbia, Columbia, Missouri, USA.
| | - Camilo R Gomez
- The Comprehensive Stroke Center, and University of Missouri Columbia, Columbia, Missouri, USA
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14
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Solberg MG, Enger S, Berge T, Rønningen PS, Aagaard EN, Pervez MO, Orstad EB, Kvisvik B, Lyngbakken MN, Røsjø H, Steine K, Tveit A. Left atrial function in middle-aged men and women with and without paroxysmal atrial fibrillation: Data from the Akershus Cardiac Examination (ACE) 1950 study. Echocardiography 2024; 41:e15852. [PMID: 38837738 DOI: 10.1111/echo.15852] [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: 04/05/2024] [Revised: 05/13/2024] [Accepted: 05/20/2024] [Indexed: 06/07/2024] Open
Abstract
PURPOSE To assess left atrial (LA) function in individuals with known paroxysmal atrial fibrillation (AF) compared with healthy and nonhealthy individuals without atrial fibrillation. METHODS The Akershus Cardiac Examination 1950 Study included 3,706 individuals all born in 1950. LA strain assessment of reservoir (LASr), conduit (LAScd) and contractile (LASct) functions were performed in all participants by investigators blinded to clinical data. Participants with cardiovascular disease, obesity, diabetes, pulmonary or renal disease were defined as nonhealthy, and those without as healthy. Patients with paroxysmal AF were identified through medical history and ECG documentation. RESULTS LA strain assessment was feasible in 3,229 (87%) of the participants (50% women). The healthy group (n = 758) had significantly higher LASr and LAScd than the nonhealthy (n = 2,376), but LASct was similar between the groups. Participants with paroxysmal AF had significantly lower values of all strain parameters than the other groups. Multivariable logistic regression showed a significantly reduced probability of having AF per standard deviation increase in LASr and LASct. A nonlinear restricted cubic spline model fitted better with the association of LASr with paroxysmal AF than the linear model, and LA strain values below the population mean associated with an increased probability of having AF, but for values above the population mean no such association was present. CONCLUSION Compared to participants without AF, those with known paroxysmal AF had significantly lower values of all LA strain parameters during sinus rhythm. Lower values of LA strain were associated with a significantly increased probability of having AF.
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Affiliation(s)
- Magnar G Solberg
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Steve Enger
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Trygve Berge
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Peter S Rønningen
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
| | - Erika N Aagaard
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Mohammad Osman Pervez
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Eivind B Orstad
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Brede Kvisvik
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Magnus N Lyngbakken
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Helge Røsjø
- K. G. Jebsen Center for Cardiac Biomarkers, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Division of Research and Innovation, Akershus University Hospital, Lørenskog, Norway
| | - Kjetil Steine
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Cardiology, Division of Medicine, Akershus University Hospital, Lørenskog, Norway
| | - Arnljot Tveit
- Department of Medical Research, Bærum Hospital, Vestre Viken Hospital Trust, Gjettum, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Clark A, Ferkh A, Vandenberg J, Elhindi J, Thomas L. Altered left atrial metrics in patients with cryptogenic stroke: A systematic review and meta-analysis. Eur J Clin Invest 2024; 54:e14175. [PMID: 38308431 DOI: 10.1111/eci.14175] [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: 10/29/2023] [Revised: 01/14/2024] [Accepted: 01/22/2024] [Indexed: 02/04/2024]
Abstract
BACKGROUND There is no defined cause for cryptogenic stroke/embolic stroke of undetermined source (CS-ESUS). As atrial fibrillation (AF) develops in a significant proportion of these patients, it has been suggested that left atrial (LA) myopathy may predispose to CS-ESUS. We investigated alterations in echocardiographic measures of LA size and function in patients with CS-ESUS. METHODS A systematic literature review and meta-analysis was performed. PubMed, EMBASE, Cochrane Library, Web of Science and SCOPUS were searched for articles published between 1 January 1990 and 10 February 2023. All observational studies of adult CS-ESUS patients with LA volume or function measurements performed by transthoracic echocardiogram were included. Individual random effects meta-analyses were performed on LA measurements in the CS-ESUS patients using subgroup analysis of comparator groups. RESULTS We included 29 articles with 3927 CS-ESUS patients. Analysis of weighted mean differences showed CS-ESUS patients had altered LA structure and function parameters, with a larger maximum indexed LA volume, reduced LA emptying fraction and/or LA reservoir strain, compared to healthy controls and noncardioembolic stroke patients. Conversely, CS-ESUS patients had a smaller left atrium with better function, compared to cardioembolic stroke patients and CS-ESUS patients who subsequently developed atrial fibrillation. CONCLUSIONS LA volume and function are altered in CS-ESUS patients compared to healthy controls and other stroke aetiologies. An underlying atrial myopathy in a subset of CS-ESUS patients may be involved in both thrombogenesis and dysrhythmia (specifically AF). While LA functional assessment is not currently recommended following stroke, it may offer an opportunity for recurrent stroke risk stratification.
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Affiliation(s)
- Amy Clark
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Aaisha Ferkh
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
| | - Jamie Vandenberg
- Mark Cowley Lidwill Research Program in Cardiac Electrophysiology, Victor Chang Cardiac Research Institute, Darlinghurst, New South Wales, Australia
- School of Clinical Medicine, UNSW Sydney, Darlinghurst, New South Wales, Australia
| | - James Elhindi
- WSLHD Research and Education Network, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
- Westmead Clinical School, University of Sydney, Camperdown, Sydney, New South Wales, Australia
- South West Clinical School, University of New South Wales, Kensington, New South Wales, Australia
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16
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Addetia K, Lang RM. Unfolding the Mysteries of the Truly Forgotten Chamber. J Am Soc Echocardiogr 2024; 37:506-507. [PMID: 38423399 DOI: 10.1016/j.echo.2024.02.007] [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: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 03/02/2024]
Affiliation(s)
- Karima Addetia
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Roberto M Lang
- Section of Cardiology, Department of Medicine, University of Chicago, Chicago, Illinois.
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17
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Ellis C, Ingram TE, Kite C, Taylor SR, Howard E, Pike JL, Lee E, Buckley JP. Effects of a Transoceanic Rowing Challenge on Cardiorespiratory Function and Muscle Fitness. Int J Sports Med 2024; 45:349-358. [PMID: 37931909 DOI: 10.1055/a-2205-1849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Abstract
Ultra-endurance sports and exercise events are becoming increasingly popular for older age groups. We aimed to evaluate changes in cardiac function and physical fitness in males aged 50-60 years who completed a 50-day transoceanic rowing challenge. This case account of four self-selected males included electro- and echo-cardiography (ECG, echo), cardiorespiratory and muscular fitness measures recorded nine months prior to and three weeks after a transatlantic team-rowing challenge. No clinically significant changes to myocardial function were found over the course of the study. The training and race created expected functional changes to left ventricular and atrial function; the former associated with training, the latter likely due to dehydration, both resolving towards baseline within three weeks post-event. From race-start to finish all rowers lost 8.4-15.6 kg of body mass. Absolute cardiorespiratory power and muscular strength were lower three weeks post-race compared to pre-race, but cardiorespiratory exercise economy improved in this same period. A structured program of moderate-vigorous aerobic endurance and muscular training for>6 months, followed by 50-days of transoceanic rowing in older males proved not to cause any observable acute or potential long-term risks to cardiovascular health. Pre-event screening, fitness testing, and appropriate training is recommended, especially in older participants where age itself is an increasingly significant risk factor.
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Affiliation(s)
- Chris Ellis
- Shrewsbury and Telford Hospital NHS Trust, Cardio Respiratory, Apley Castle Telford, TF16TF, UK
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Thomas E Ingram
- Shrewsbury and Telford Hospital NHS Trust, Cardio Respiratory, Apley Castle Telford, TF16TF, UK
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Chris Kite
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
- School of Health and Society, Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton WV1 1LY, UK
- Warwickshire Institute for the Study of Diabetes, Endocrinology and Metabolism (WISDEM), University Hospitals Coventry and Warwickshire NHS Trust, Coventry CV2 2DX, UK
- Centre for Sport, Exercise and Life Sciences, Research Institute for Health & Wellbeing, Coventry University, Coventry CV1 5FB, UK
| | - Suzan R Taylor
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Elizabeth Howard
- Spire Healthcare Ltd, Perform at St Georges Park, Burton upon Trent, Staffordshire, DE13 9PD, UK
| | - Joanna L Pike
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
| | - Eveline Lee
- Shrewsbury and Telford Hospital NHS Trust, Cardio Respiratory, Apley Castle Telford, TF16TF, UK
| | - John P Buckley
- Chester Medical School, Faculty of Health, Medicine and Society, Health & Exercise Medicine, University Centre, Shrewsbury, The Guildhall, Frankwell, Shrewsbury, SY3 8HQ, UK
- Keele University, School of Allied Health Professions, Keele, Staffordshire, ST5 5BG, UK
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Yafasov M, Olsen FJ, Skaarup KG, Lassen MCH, Johansen ND, Lindgren FL, Jensen GB, Schnohr P, Møgelvang R, Søgaard P, Biering-Sørensen T. Normal values for left atrial strain, volume, and function derived from 3D echocardiography: the Copenhagen City Heart Study. Eur Heart J Cardiovasc Imaging 2024; 25:602-612. [PMID: 38261728 DOI: 10.1093/ehjci/jeae018] [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: 06/26/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/25/2024] Open
Abstract
AIMS 3D echocardiographic (3DE) assessment of the left atrium (LA) is a new modality of potential clinical value. Age- and sex-based normative values are needed to benchmark these parameters for clinical use. METHODS AND RESULTS Of 4466 participants in the 5th Copenhagen City Heart Study, a prospective longitudinal cohort study on the general population, 2082 participants underwent 3DE of the LA. Healthy participants were included to establish normative values for LA strain, volume, and function by 3DE. The effects of age and sex were also evaluated. After excluding participants with comorbidities, 979 healthy participants (median age 44 years, 39.6% males) remained. The median and limits of normality (2.5th and 97.5th percentiles) for functional and volumetric measures were as follows: LA reservoir strain (LASr) 30.8% (18.4-44.2%), LA conduit strain (LAScd) 19.1% (6.8-32.0%), LA contractile strain 11.7% (4.3-22.2%), total LA emptying fraction (LAEF) 61.4% (47.8-71.0%), passive LAEF 37.7% (17.4-53.9%), active LAEF 37.4% (22.2-52.5%), LA minimum volume index (LAVimin) 10.2 (5.9-18.5) mL/m2, and LA maximum volume index (LAVimax) 26.8 (16.5-40.1) mL/m2. All parameters changed significantly with increasing age (P value for all <0.001). Significant sex-specific differences were observed for all parameters except active LAEF and LAVimax. Sex significantly modified the association between age and LASr (P for interaction < 0.001), LAScd (P for interaction < 0.001), LAVimin (P for interaction = 0.037), and total LAEF (P for interaction = 0.034) such that these parameters deteriorated faster with age in females than males. CONCLUSION We present age- and sex-specific reference material including limits of normality for LA strain, volume, and function by 3DE.
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Affiliation(s)
- Marat Yafasov
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Filip Lyng Lindgren
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
| | - Rasmus Møgelvang
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Peter Søgaard
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
- The Copenhagen City Heart Study, Copenhagen University Hospital- Herlev Hospital, Borgmester Ib Juuls Vej 73, opgang 7, 4. etage, M1, 2730 Herlev, Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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19
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Raisi-Estabragh Z, Szabo L, Schuermans A, Salih AM, Chin CWL, Vágó H, Altmann A, Ng FS, Garg P, Pavanello S, Marwick TH, Petersen SE. Noninvasive Techniques for Tracking Biological Aging of the Cardiovascular System: JACC Family Series. JACC Cardiovasc Imaging 2024:S1936-878X(24)00082-2. [PMID: 38597854 DOI: 10.1016/j.jcmg.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 03/01/2024] [Accepted: 03/01/2024] [Indexed: 04/11/2024]
Abstract
Population aging is one of the most important demographic transformations of our time. Increasing the "health span"-the proportion of life spent in good health-is a global priority. Biological aging comprises molecular and cellular modifications over many years, which culminate in gradual physiological decline across multiple organ systems and predispose to age-related illnesses. Cardiovascular disease is a major cause of ill health and premature death in older people. The rate at which biological aging occurs varies across individuals of the same age and is influenced by a wide range of genetic and environmental exposures. The authors review the hallmarks of biological cardiovascular aging and their capture using imaging and other noninvasive techniques and examine how this information may be used to understand aging trajectories, with the aim of guiding individual- and population-level interventions to promote healthy aging.
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Affiliation(s)
- Zahra Raisi-Estabragh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom.
| | - Liliana Szabo
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Art Schuermans
- Faculty of Medicine, KU Leuven, Leuven, Belgium; Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts, USA; Cardiovascular Research Center, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ahmed M Salih
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Department of Population Health Sciences, University of Leicester, Leicester UK; Department of Computer Science, Faculty of Science, University of Zakho, Zakho, Kurdistan Region, Iraq
| | - Calvin W L Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore, Singapore; Cardiovascular Academic Clinical Programme, Duke National University of Singapore Medical School, Singapore, Singapore
| | - Hajnalka Vágó
- Semmelweis University, Heart and Vascular Center, Budapest, Hungary
| | - Andre Altmann
- Centre for Medical Image Computing, Department of Medical Physics and Biomedical Engineering, University College London, London, United Kingdom
| | - Fu Siong Ng
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Pankaj Garg
- University of East Anglia, Norwich Medical School, Norwich, United Kingdom; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom
| | - Sofia Pavanello
- Occupational Medicine, Department of Cardio-Thoraco-Vascular Sciences and Public Health, University of Padua, Padua, Italy; Padua Hospital, Occupational Medicine Unit, Padua, Italy; University Center for Space Studies and Activities "Giuseppe Colombo" - CISAS, University of Padua, Padua, Italy
| | | | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, United Kingdom; Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom; Health Data Research UK, London, United Kingdom
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20
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Fridolfsson C, Thegerström J, Åkesson K, Engvall J, Blomstrand P. Lower left atrial function in young individuals with type 1 diabetes mellitus compared to healthy controls: an echocardiographic study. Sci Rep 2024; 14:3982. [PMID: 38368449 PMCID: PMC10874446 DOI: 10.1038/s41598-024-54597-6] [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: 10/02/2023] [Accepted: 02/14/2024] [Indexed: 02/19/2024] Open
Abstract
In adulthood, individuals with type 1 diabetes mellitus may develop a condition of heart failure with preserved ejection fraction. However, subclinical changes to the heart in diabetes are likely to occur prior to the clinical presentation. This cross-sectional study aimed to compare left atrial function by echocardiography between 43 individuals with type 1 diabetes and 43 healthy controls, aged 10-30 years. All participants underwent echocardiography and 2D speckle tracking measurements for left atrial phase function parameters. Physical capacity was assessed by exercise test on a bicycle. Results showed that participants with type 1 diabetes had significantly lower left atrial function parameters than healthy controls (p < 0.05). There was a significant negative correlation between HbA1c means and reservoir and conduit strain (p < 0.05) and individuals with BMI < 30 showed a lower left atrial stiffness (p < 0.05). Individuals with type 1 diabetes and a higher physical capacity did not differ from their healthy peers. Results indicate that lower HbA1c levels, BMI < 30 and a higher physical capacity are favourable in terms of left atrial function in children and young adults with type 1 diabetes mellitus. Left atrial strain by echocardiography might become a new important tool in assessing heart function in T1DM.
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Affiliation(s)
- Cecilia Fridolfsson
- Department of Clinical Physiology in Kalmar, Region Kalmar County, Kalmar, Sweden.
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden.
| | - Johanna Thegerström
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Paediatrics in Kalmar, Region Kalmar County, Kalmar, Sweden
- Faculty of Health and Life Sciences (FHL), Linnaeus University, Kalmar, Sweden
| | - Karin Åkesson
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Pediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Jan Engvall
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, Linköping University Hospital, Linköping, Sweden
| | - Peter Blomstrand
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Natural Sciences and Biomedicine, School of Health and Welfare, Jönköping University, Jönköping, Sweden
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21
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Kuznetsova T, Daels Y, Ntalianis E, Santana EJ, Sabovčik F, Haddad F, Cauwenberghs N. Clinical and biochemical predictors of longitudinal changes in left atrial structure and function: A general population study. Echocardiography 2024; 41:e15780. [PMID: 38372342 DOI: 10.1111/echo.15780] [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: 10/11/2023] [Revised: 01/11/2024] [Accepted: 01/28/2024] [Indexed: 02/20/2024] Open
Abstract
PURPOSE There is a need for better understanding the factors that modulate left atrial (LA) dysfunction. Therefore, we determined associations of clinical and biochemical biomarkers with serial changes in echocardiographic indexes of LA function in the general population. METHODS We measured LA maximal and minimal volume indexes (LAVImax and LAVImin) by echocardiography and LA reservoir strain (LARS) by two-dimensional speckle-tracking in 627 participants (mean age 50.8 years, 51.2% women) at baseline and after 4.8 years. RESULTS During follow-up, LARS decreased significantly in men (-.90%, P = .033) but not in women (-.23%, P = .60). In stepwise regression analysis, stronger decrease in LARS over time was associated with male sex, a higher age, body mass index (BMI), mean arterial pressure (MAP) and serum insulin at baseline and with a greater increase in BMI and MAP over time (P ≤ .018). Similarly, an increased risk of developing or retaining abnormal LARS was observed in older participants, in subjects with a higher baseline BMI, MAP, heart rate (HR), troponin T and ΔMAP, and in those who used β-blockers at baseline. Both LAVImax and LAVImin increased significantly over time (P ≤ .0007). This increase was associated with a higher baseline age, pulse pressure and a lower HR at baseline and a greater increase in pulse pressure over time (P ≤ .029). Higher serum insulin and D-dimer were independently associated with a stronger increase in LAVImin (P ≤ .0034). CONCLUSION Subclinical worsening in LA dysfunction was associated with older age, hypertension, obesity, insulin resistance and troponin T levels. Cardiovascular risk management strategies may delay LA deterioration.
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Affiliation(s)
- Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Yne Daels
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Evangelos Ntalianis
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Everton J Santana
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
| | - Francois Haddad
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, California, USA
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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22
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Bashir Z, Chen EW, Wang S, Shu L, Goldstein ED, Rana M, Kala N, Dai X, Mandel D, Has P, Xie M, Wang T, Dickey JB, Poppas A, Simmons J, Song C, Yaghi S, Haines P. Left atrial strain, embolic stroke of undetermined source, and atrial fibrillation detection. Echocardiography 2024; 41:e15738. [PMID: 38284672 DOI: 10.1111/echo.15738] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND Atrial cardiopathy is a proposed mechanism of embolic stroke of undetermined source (ESUS). Left atrial (LA) strain may identify early atrial cardiopathy prior to structural changes. We aim to study the associations between LA strain, ESUS, and atrial fibrillation (AF) detection in ESUS. METHODS The study population included patients with ESUS and noncardioembolic (NCE) stroke presenting to the Rhode Island Hospital Stroke Center between January 2016 and June 2017 who underwent transthoracic echocardiography. Speckle tracking echocardiography (STE) was used to measure the three phases of LA strain (reservoir, conduit, and contractile). Binary logistic regression analysis was performed to determine the associations between LA strain and stroke subtype (ESUS vs. NCE) as well as follow-up detection of AF in ESUS patients. RESULTS We identified 656 patients, 307 with ESUS and 349 with NCE. In binary logistic regression, the lowest tertiles of LA reservoir (adjusted OR 1.944, 95% CI 1.266-2.986, p = .002), contractile (aOR 1.568, 95% CI 1.035-2.374, p = .034), and conduit strain (aOR 2.288, 95% CI 1.448-3.613, p = .001) were more likely to be significantly associated with ESUS compared to NCE stroke. Among all ESUS patients, the lowest tertiles of LA reservoir strain (OR 2.534, 95% CI 1.029-6.236, p = .043), contractile strain (OR 2.828, 95% CI 1.158-6.903, p = .022), and conduit strain (OR 2.614, 95% CI 1.003-6.815, p = .049) were significantly associated with subsequent detection of AF. CONCLUSION Reduced LA strain is associated with ESUS occurrence and AF detection in ESUS patients. Therefore, quantification of LA strain in ESUS patients may improve risk stratification and guide secondary prevention strategies.
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Affiliation(s)
- Zubair Bashir
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Edward W Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, USA
| | - Shuyuan Wang
- Department of Ultrasound, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liqi Shu
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Eric D Goldstein
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Maheen Rana
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Narendra Kala
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Xing Dai
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Daniel Mandel
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Phinnara Has
- Lifespan Biostatistics, Epidemiology and Research Design, Rhode Island Hospital, Providence, Rhode Island, USA
| | - Mingxing Xie
- Department of Ultrasound, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tao Wang
- Stanford Cardiovascular Institute, Stanford University, Palo Alto, California, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcestor, Massachusetts, USA
| | - Athena Poppas
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - James Simmons
- Department of Pulmonary, Critical Care, and Sleep Medicine, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Christopher Song
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Shadi Yaghi
- Department of Neurology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Philip Haines
- Department of Cardiology, Alpert Medical School of Brown University, Providence, Rhode Island, USA
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23
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Buendía-Fuentes F, Lozano-Edo S, Jover-Pastor P, Sánchez-Martínez JC, Martínez-Sole J, Rodríguez-Serrano M, Aguero J, Arnau-Vives MA, Osa-Sáez A, Martínez-Dolz LV, Rueda J. Left atrial strain in adults after the arterial switch operation for transposition of the great arteries. Echocardiography 2024; 41:e15750. [PMID: 38284674 DOI: 10.1111/echo.15750] [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: 07/17/2023] [Revised: 11/16/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
BACKGROUND No study has focused on left atrial (LA) function assessed by echocardiography in adult patients with simple D-TGA after arterial switch operation (ASO). We aimed to describe LA strain parameters in these patients. METHODS A prospective cohort study including 42 adult patients with simple D-TGA after ASO and 33 aged-matched controls. Phasic LA and LV global longitudinal strain (GLS) were obtained by transthoracic 2D-speckle tracking echocardiography (STE). Volumetric and functional analysis of LA and LV were also evaluated by 2D and 3D analysis. A multivariable model was performed to investigate the variables that best differentiate patients with D-TGA from healthy controls. RESULTS LA strain parameters in D-TGA patients were within the normal range described for healthy subjects. However, the three LA strain parameters (Reservoir, Conduit, and Contraction) were lower in patients (LASr: 31.13 ± 7.67 vs. 49.71 ± 8.38; LAS cd: -22.91 ± 5.69 vs. -34.55 ± 6.54; LASct: -8.14 ± 4.93 vs. -15.15 ± 6.07, p < .001 for all three comparisons). LA volumes were similar between patients and controls. LV-GLS remained significantly lower in the D-TGA group than in controls (-17.29 ± 2.68 vs. -21.98 ± 1.84, p < .001). D-TGA patients had evidence of worse LV ejection fraction measured by the Teichholz method (63.38 ± 8.23 vs. 69.28 ± 5.92, p = .001) and 3D analysis (57.97% ± 4.16 vs. 60.67 ± 3.39, p = .011) and diastolic dysfunction as compared to healthy controls. LV-GLS and conduit LAS were the variables best differentiating patients with D-TGA from healthy controls. CONCLUSIONS LA strain is impaired in young adults with simple D-TGA late after the ASO, probably in agreement with some degree of LV dysfunction previously described.
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Affiliation(s)
- Francisco Buendía-Fuentes
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Silvia Lozano-Edo
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - Pablo Jover-Pastor
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Julia Martínez-Sole
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | | | - Jaume Aguero
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Miguel A Arnau-Vives
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Ana Osa-Sáez
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Luis V Martínez-Dolz
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
| | - Joaquín Rueda
- Cardiology Department, Hospital Universitari i Politecnic La Fe, Valencia, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain
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24
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Gherbesi E, Gianstefani S, Angeli F, Ryabenko K, Bergamaschi L, Armillotta M, Guerra E, Tuttolomondo D, Gaibazzi N, Squeri A, Spaziani C, Pizzi C, Carugo S. Myocardial strain of the left ventricle by speckle tracking echocardiography: From physics to clinical practice. Echocardiography 2024; 41:e15753. [PMID: 38284665 DOI: 10.1111/echo.15753] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 12/21/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024] Open
Abstract
Speckle tracking echocardiography (STE) is a reliable imaging technique of recognized clinical value in several settings. This method uses the motion of ultrasound backscatter speckles within echocardiographic images to derive myocardial velocities and deformation parameters, providing crucial insights on several cardiac pathological and physiological processes. Its feasibility, reproducibility, and accuracy have been widely demonstrated, being myocardial strain of the various chambers inserted in diagnostic algorithms and guidelines for various pathologies. The most important parameters are Global longitudinal strain (GLS), Left atrium (LA) reservoir strain, and Global Work Index (GWI): based on large studies the average of the lower limit of normality are -16%, 23%, and 1442 mmHg%, respectively. For GWI, it should be pointed out that myocardial work relies primarily on non-invasive measurements of blood pressure and segmental strain, both of which exhibit high variability, and thus, this variability constitutes a significant limitation of this parameter. In this review, we describe the principal aspects of the theory behind the use of myocardial strain, from cardiac mechanics to image acquisition techniques, outlining its limitation, and its principal clinical applications: in particular, GLS have a role in determine subclinical myocardial dysfunction (in cardiomyopathies, cardiotoxicity, target organ damage in ambulatory patients with arterial hypertension) and LA strain in determine the risk of AF, specifically in ambulatory patients with arterial hypertension.
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Affiliation(s)
- Elisa Gherbesi
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Silvia Gianstefani
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Francesco Angeli
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Khrystyna Ryabenko
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Luca Bergamaschi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Matteo Armillotta
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Emiliano Guerra
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico Di Modena, Modena, Italy
| | - Domenico Tuttolomondo
- Cardiology Division, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Nicola Gaibazzi
- Cardiology Division, Parma University Hospital, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Angelo Squeri
- Maria Cecilia Hospital, GVM Care and Research, Cotignola, Ravenna, Italy
| | - Cristina Spaziani
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Carmine Pizzi
- Cardiology Unit, IRCCS Azienda Ospedaliera-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences - DIMEC - Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
- Department of Clinical Sciences and Community Health, University of Milano, Milano, Italy
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25
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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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26
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Flachskampf FA. New Echocardiographic Reference Values: Why They Are Welcome. JACC Cardiovasc Imaging 2023; 16:1532-1535. [PMID: 37921724 DOI: 10.1016/j.jcmg.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/07/2023] [Indexed: 11/04/2023]
Affiliation(s)
- Frank A Flachskampf
- Divisions of Clinical Physiology and Cardiology, Uppsala University Clinic, and the Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
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27
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Aurigemma GP, Gentile BA, Dickey JB, Fitzgibbons TP, Tighe DA, Kakouros N, Kovell LC, Gottbrecht MF, Narvaez-Guerra O, Qureshi W, Gerson DS, Parker MW. Insights Into the Standard Echocardiographic Views From Multimodality Imaging: Ventricles, Pericardium, Valves, and Atria. J Am Soc Echocardiogr 2023; 36:1266-1289. [PMID: 37549797 DOI: 10.1016/j.echo.2023.07.011] [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: 12/17/2022] [Revised: 07/19/2023] [Accepted: 07/20/2023] [Indexed: 08/09/2023]
Abstract
The widespread use of cardiac computed tomography and cardiac magnetic resonance imaging in patients undergoing echocardiography presents an opportunity to correlate the images side by side. Accordingly, the aim of this report is to review aspects of the standard echocardiographic examination alongside similarly oriented images from the two tomographic imaging modalities. It is hoped that this exercise will enhance understanding of the structures depicted by echocardiography as they relate to other structures in the thorax. In addition to reviewing basic cardiac anatomy, the authors take advantage of these correlations with computed tomography and cardiac magnetic resonance imaging to better understand the issue of foreshortening, a common pitfall in transthoracic echocardiography. The authors also highlight an important role that three-dimensional echocardiography can potentially play in the future, especially as advances in image processing permit higher fidelity multiplanar reconstruction images.
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Affiliation(s)
- Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts.
| | - Bryon A Gentile
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Timothy P Fitzgibbons
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Dennis A Tighe
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Nikolaos Kakouros
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Lara C Kovell
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Matthew F Gottbrecht
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Offdan Narvaez-Guerra
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Waqas Qureshi
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - David S Gerson
- Department of Radiology, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
| | - Matthew W Parker
- Division of Cardiovascular Medicine, Department of Medicine, UMass Chan Medical School and UMass Memorial Healthcare, Worcester, Massachusetts
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28
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Nyberg J, Jakobsen EO, Østvik A, Holte E, Stølen S, Lovstakken L, Grenne B, Dalen H. Echocardiographic Reference Ranges of Global Longitudinal Strain for All Cardiac Chambers Using Guideline-Directed Dedicated Views. JACC Cardiovasc Imaging 2023; 16:1516-1531. [PMID: 37921718 DOI: 10.1016/j.jcmg.2023.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Myocardial deformation by echocardiographic strain imaging is a key measurement in cardiology, providing valuable diagnostic and prognostic information. Reference ranges for strain should be established from large healthy populations with minimal methodologic biases and variability. OBJECTIVES The aim of this study was to establish echocardiographic reference ranges, including lower normal limits of global strains for all 4 cardiac chambers, by guideline-directed dedicated views from a large healthy population and to evaluate the influence of subject-specific characteristics on strain. METHODS In total, 1,329 healthy participants from HUNT4Echo, the echocardiographic substudy of the 4th wave of the Trøndelag Health Study, were included. Echocardiographic recordings specific for each chamber were optimized according to current recommendations. Two experienced sonographers recorded all echocardiograms using GE HealthCare Vivid E95 scanners. Analyses were performed by experts using GE HealthCare EchoPAC. RESULTS The reference ranges for left ventricular (LV) global longitudinal strain and right ventricular free-wall strain were -24% to -16% and -35% to -17%, respectively. Correspondingly, left atrial (LA) and right atrial (RA) reservoir strains were 17% to 49% and 17% to 59%. All strains showed lower absolute values with higher age, except for LA and RA contractile strains, which were higher. The feasibility for strain was overall good (LV 96%, right ventricular 83%, LA 94%, and RA 87%). All chamber-specific strains were associated with age, and LV strain was associated with sex. CONCLUSIONS Reference ranges of strain for all cardiac chambers were established based on guideline-directed chamber-specific recordings. Age and sex were the most important factors influencing reference ranges and should be considered when using strain echocardiography.
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Affiliation(s)
- John Nyberg
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Even Olav Jakobsen
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Andreas Østvik
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Medical Image Analysis, Health Research, SINTEF Digital, Trondheim, Norway
| | - Espen Holte
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Stian Stølen
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Lasse Lovstakken
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway
| | - Bjørnar Grenne
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Havard Dalen
- Department of Circulation and Medical Imaging, NTNU-Norwegian University of Science and Technology, Trondheim, Norway; Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway; Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway.
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29
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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: 11] [Impact Index Per Article: 11.0] [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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30
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Ferkh A, Clark A, Thomas L. Left atrial phasic function: physiology, clinical assessment and prognostic value. Heart 2023; 109:1661-1669. [PMID: 36918267 DOI: 10.1136/heartjnl-2022-321609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/02/2023] [Indexed: 03/16/2023] Open
Abstract
Left atrial (LA) phasic function provides significant insights into the pathophysiology of cardiovascular disease. LA function is described in three phases: reservoir (atrial filling, during systole), conduit (passive emptying, during early diastole) and contractile (active emptying, during late diastole). LA phasic function can be evaluated by different imaging modalities, and a variety of techniques including volumetric analysis, deformation (strain) and Doppler methods. LA phasic function (particularly LA reservoir strain) is more sensitive and provides earlier detection of LA dysfunction than alterations in LA volume. LA function parameters have also demonstrated significant diagnostic and prognostic value, particularly in heart failure, atrial fibrillation and stroke. However, there remain barriers to implementation of phasic function parameters in clinical practice and guidelines. This review outlines the physiology of LA phasic function, methods of assessment, and its diagnostic and prognostic utility in varying pathologies.
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Affiliation(s)
- Aaisha Ferkh
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Amy Clark
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
| | - Liza Thomas
- Westmead Clinical School, The University of Sydney, Westmead, New South Wales, Australia
- Department of Cardiology, Westmead Hospital, Westmead, New South Wales, Australia
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31
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Ferkh A, Pathan F, Kizana E, Elhindi J, Singh A, Singulane CC, Miyoshi T, Asch FM, Lang RM, Thomas L. Variations in indexation of left atrial volume across different races. Heliyon 2023; 9:e20334. [PMID: 37810843 PMCID: PMC10550615 DOI: 10.1016/j.heliyon.2023.e20334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 09/11/2023] [Accepted: 09/19/2023] [Indexed: 10/10/2023] Open
Abstract
Background Left atrial volume (LAV) has prognostic value. Guidelines propose indexation to body surface area (BSA), however studies demonstrate this can overcorrect for body size. Limited studies investigate indexation across different ethnicities. We sought to evaluate the effect of ethnicity on indexation. Methods Using data from the World Alliance of Societies of Echocardiography (WASE) cohort, healthy subjects were classified by race as White, Black, Asian, or Other. Biplane LAV was indexed to traditional isometric measurements (BSA, height, weight, ideal body weight (IBW) and IBW derived BSA (IBSA)), as well as previously-derived allometric height exponents (2.7 and 1.72). Additionally, an allometric height exponent for our cohort was derived (linear regression of the logarithmic transformation of LAV = a(height)b) as 1.87. All indices were then assessed using Spearman correlation, with a good index retaining correlation of LAV/index to raw LAV (r∼1), while avoiding overcorrection by the index (r∼0). Results There were 1366 subjects (White: 524, Black: 149, Asian: 523, Other: 170; median age 44 years, 653 females (47.8%)). In the entire group, BSA, IBSA, height1.87 and height1.72 performed well with retaining correlation to raw LAV (r > 0.9 for all), and minimising overcorrection to body size (r < 0.1 for all). On race-specific analysis, BSA overcorrected for body size in the White population (r = 0.128). Height1.72 minimised overcorrection for body size in all populations (r ≤ 0.1 for all races). Conclusion Despite a cohort with normal BMI, there was still disparity in LAV indexation with BSA across races. Allometric height indexation, particularly using height1.72, is a possible solution, although further validation studies in BMI extremes are required.
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Affiliation(s)
- Aaisha Ferkh
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney, Camperdown, Sydney, NSW, Australia
| | - Faraz Pathan
- Department of Cardiology, Nepean Hospital, Nepean, NSW, Australia
| | - Eddy Kizana
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney, Camperdown, Sydney, NSW, Australia
| | - James Elhindi
- University of Sydney, Camperdown, Sydney, NSW, Australia
| | | | | | | | | | | | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
- University of Sydney, Camperdown, Sydney, NSW, Australia
- University of New South Wales, Kensington, NSW, Australia
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32
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Zhang MJ, Gyberg DJ, Healy CL, Zhang N, Liu H, Dudley SC, O’Connell TD. Atrial Myopathy Quantified by Speckle-tracking Echocardiography in Mice. Circ Cardiovasc Imaging 2023; 16:e015735. [PMID: 37795649 PMCID: PMC10591948 DOI: 10.1161/circimaging.123.015735] [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: 05/25/2023] [Accepted: 08/17/2023] [Indexed: 10/06/2023]
Abstract
BACKGROUND Emerging evidence suggests that atrial myopathy may be the underlying pathophysiology that explains adverse cardiovascular outcomes in heart failure (HF) and atrial fibrillation. Lower left atrial (LA) function (strain) is a key biomarker of atrial myopathy, but murine LA strain has not been described, thus limiting translational investigation. Therefore, the objective of this study was to characterize LA function by speckle-tracking echocardiography in mouse models of atrial myopathy. METHODS We used 3 models of atrial myopathy in wild-type male and female C57Bl6/J mice: (1) aged 16 to 17 months, (2) Ang II (angiotensin II) infusion, and (3) high-fat diet+Nω-nitro-L-arginine methyl ester (HF with preserved ejection fraction, HFpEF). LA reservoir, conduit, and contractile strain were measured using speckle-tracking echocardiography from a modified parasternal long-axis window. Left ventricular systolic and diastolic function, and global longitudinal strain were also measured. Transesophageal rapid atrial pacing was used to induce atrial fibrillation. RESULTS LA reservoir, conduit, and contractile strain were significantly reduced in aged, Ang II and HFpEF mice compared with young controls. There were no sex-based interactions. Left ventricular diastolic function and global longitudinal strain were lower in aged, Ang II and HFpEF, but left ventricular ejection fraction was unchanged. Atrial fibrillation inducibility was low in young mice (5%), moderately higher in aged mice (20%), and high in Ang II (75%) and HFpEF (83%) mice. CONCLUSIONS Using speckle-tracking echocardiography, we observed reduced LA function in established mouse models of atrial myopathy with concurrent atrial fibrillation inducibility, thus providing the field with a timely and clinically relevant platform for understanding the pathophysiology and discovery of novel treatment targets for atrial myopathy.
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Affiliation(s)
- Michael J. Zhang
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN
| | - Dylan J. Gyberg
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
| | - Chastity L. Healy
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
| | - Naixin Zhang
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
| | - Hong Liu
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN
| | - Samuel C. Dudley
- Department of Medicine, Cardiovascular Division, University of Minnesota, Minneapolis, MN
- Lillehei Heart Institute, University of Minnesota, Minneapolis, MN
| | - Timothy D. O’Connell
- Department of Integrative Biology and Physiology, University of Minnesota, Minneapolis, MN
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33
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Vandroux D, Houehanou YC, Magne J, Saka D, Sonou A, Amidou S, Houinato D, Preux PM, Aboyans V, Lacroix P. Normal reference values of cardiac chamber sizes and functional parameters in a beninese community population: the TAHES study. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1729-1739. [PMID: 37354384 DOI: 10.1007/s10554-023-02892-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/30/2023] [Indexed: 06/26/2023]
Abstract
Reported ranges of normal values for echocardiographic measurements are mostly issued from studies performed in Caucasians. This study is a part of TAHES, a population-based prospective cohort study in Benin and aims to establish normal reference values for echocardiographic cardiac chambers dimensions and Doppler parameters in a Sub-Saharan African population. We included 486 healthy (non-diabetic, non-obese and normotensive) individuals (202 men and 284 women, age 37[30-47] years, BSA 1.58 (1.47-1.67) m2). End-diastolic interventricular septal wall thickness, left ventricular (LV) internal diameter, posterior wall thicknesses, and systolic LV internal diameter were respectively at 10[9-12], 45[43-49], 9[8-11], 29[26-34] mm for male and 9[7-10], 43[41-46], 8[7-], 29[27-32] mm for females. LV mass was significantly greater in males even after normalization for the body surface area (98[85-117] vs. 82[71-96] g/m2). Upper limits of BSA-indexed LV mass were 145 g/m2 for males and 124 g/m2 for females. The allometric exponent that described the LV mass-Height relationship were 2.5 in both sexes but 1.2 for males and 1.8 for females separately. E-wave velocity was 0.79 [0.65-0.90] cm/sec in males and 0.88 [0.78-0.99]cm/sec in females (p < 0.0001) but without significant gender differences in E/A ratio (limits: 0.75 and 2.1). The e'-wave velocity (lower limit = 8 cm/sec) decreased and E/e' ratio (Upper limit = 9) increased with aging. Upper limit of BSA-indexed left atrium volume was 38 mL/m2 for both sexes. In conclusion, normal values from a general population in West Africa differ from those established in Caucasian populations with greater LV mass and wall thicknesses.
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Affiliation(s)
- David Vandroux
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France.
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France.
- Cardio-surgical Intensive Care Unit, CHU Limoges, 2 Avenue Martin Luther King, Limoges, 87042, France.
| | - Yessito Corine Houehanou
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
- Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Julien Magne
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Cardiology, CHU Limoges, Limoges, France
| | - Dominique Saka
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
- Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Arnaud Sonou
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
- Cardiology Unit, CNHU Cotonou, Cotonou, Bénin
| | - Salmane Amidou
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
| | - Dismand Houinato
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Faculty of Health Sciences, Laboratory of Chronic and Neurologic Diseases Epidemiology, University of Abomey-Calavi, Cotonou, Bénin
| | - Pierre Marie Preux
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
| | - Victor Aboyans
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Department of Cardiology, CHU Limoges, Limoges, France
| | - Philippe Lacroix
- Inserm U1094, IRD U270, Univ. Limoges, CHU Limoges, Limoges, 87042, France
- EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, Institute of Epidemiology and Tropical Neurology, OmegaHealth, Limoges, France
- Vascular Medicine Unit, CHU Limoges, Limoges, France
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Takagi T, Hosomi T. Peak atrial longitudinal strain represents atrial fibrillation burden in daily practice: clinical implication of routine left atrial strain measurements. J Echocardiogr 2023; 21:113-121. [PMID: 36564608 DOI: 10.1007/s12574-022-00595-4] [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: 02/08/2022] [Revised: 12/07/2022] [Accepted: 12/14/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Usefulness of left atrial (LA) strain measurements using speckle tracking echocardiography has been reported in various clinical settings. However, clinical implication of routine LA strain measurements in daily practice remains unclear. The purpose of this study was to evaluate clinical utility of routine LA strain measurements in daily practice. METHODS From January 6, 2020 to December 28, 2021, 338 consecutive patients underwent echocardiography in Takagi Cardiology Clinic, and all comers were enrolled to the study. Echocardiographic measurements including peak atrial longitudinal strain (PALS) measurement using speckle tracking echocardiography were attempted in all patients. RESULTS PALS was obtained in 335 patients (age 71 ± 16 years, male 43%, hypertensive 74%), and mean value was 22.3 ± 11.5%. PALS was progressively impaired with worsening atrial fibrillation (AF) burden. PALS in patients without AF, in patients with history of AF (paroxysmal AF &/or ablation therapy), and in patients with AF onsite were 26.8 ± 9.8%, 20.3 ± 7.9%, and 8.1 ± 3.3%, respectively (anova p < 0.0001). In patients without history of AF at the time of echocardiography, using cut-off value of 15.0% (i.e., mean + 2SD of PALS in AF patients), Kaplan-Meier analysis revealed that impaired PALS was associated with increased new-onset AF during follow-up period (log-rank p < 0.0001). CONCLUSION In daily practice, PALS represents AF burden. Furthermore, impaired PALS is associated with increased new-onset AF. Therefore, routine LA strain measurements using speckle tracking echocardiography will be useful in risk stratification of AF in daily practice.
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Affiliation(s)
- Tsutomu Takagi
- Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan.
| | - Takeshi Hosomi
- Takagi Cardiology Clinic, Mibu Kayogosho-cho 3-3, Nakagyo-ku, Kyoto, 604-8811, Japan
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Harada T, Kagami K, Shina T, Sorimachi H, Yuasa N, Saito Y, Naito A, Yoshida K, Kato T, Wada N, Ishii H, Obokata M. Diagnostic value of reduced left atrial compliance during ergometry exercise in heart failure with preserved ejection fraction. Eur J Heart Fail 2023; 25:1293-1303. [PMID: 37062872 DOI: 10.1002/ejhf.2862] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 03/19/2023] [Accepted: 04/08/2023] [Indexed: 04/18/2023] Open
Abstract
AIMS Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging in patients presenting with chronic dyspnoea. We sought to determine the diagnostic value of reduced left atrial (LA) compliance during exercise to diagnose HFpEF. METHODS AND RESULTS Ergometry exercise stress echocardiography was performed in 225 patients with HFpEF and 262 non-heart failure controls (non-cardiac dyspnoea [NCD]) in Protocol 1, where the diagnosis of HFpEF was defined by the HFA-PEFF algorithm. In Protocol 2, the diagnosis of HFpEF was ascertained by exercise right heart catheterization in 67 participants (49 HFpEF and 18 NCD). Speckle-tracking echocardiography was performed at rest and during exercise to determine LA compliance (ratio of LA reservoir strain to E/e'). As compared with NCD, patients with HFpEF demonstrated decreased LA reservoir strain and compliance at rest, and these differences further increased during exercise in Protocol 1. Exercise LA compliance discriminated HFpEF from NCD (area under the curve 0.87, p < 0.0001), with a superior diagnostic ability to exercise E/e' ratio (DeLong p = 0.005). Exercise LA compliance demonstrated incremental diagnostic value over clinical factors (age, systemic hypertension, and atrial fibrillation) and resting LA compliance (χ2 212.4 vs. 166.2, p < 0.0001). These findings were confirmed in Protocol 2. CONCLUSION Left atrial compliance during exercise demonstrated superior diagnostic ability to exercise E/e' ratio, with incremental diagnostic value over the resting LA compliance. Exercise LA compliance may enhance the diagnosis of HFpEF among patients with dyspnoea.
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Affiliation(s)
- Tomonari Harada
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kazuki Kagami
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
- Division of Cardiovascular Medicine, National Defense Medical College, Saitama, Japan
| | - Takayuki Shina
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hidemi Sorimachi
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Naoki Yuasa
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuki Saito
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan
| | - Ayami Naito
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
- Division of Cardiovascular Medicine, National Defense Medical College, Saitama, Japan
| | - Kuniko Yoshida
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Toshimitsu Kato
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Naoki Wada
- Department of Rehabilitation Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
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Świątczak M, Rozwadowska K, Sikorska K, Młodziński K, Świątczak A, Raczak G, Daniłowicz-Szymanowicz L. The potential impact of hereditary hemochromatosis on the heart considering the disease stage and patient age-the role of echocardiography. Front Cardiovasc Med 2023; 10:1202961. [PMID: 37496670 PMCID: PMC10368456 DOI: 10.3389/fcvm.2023.1202961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023] Open
Abstract
Background Hereditary hemochromatosis (HH) is a genetic disease that leads to increased iron accumulation in several organs. Cardiomyocytes are highly susceptible to this damage owing to their high iron uptake, and cardiovascular complications account for 1/3 of the deaths in the natural course of HH. Additionally, excess iron intake and associated oxidative stress may accelerate the aging of the cardiovascular system, regardless of the age of patients with HH. We aimed to investigate the role of standard and speckle-tracking echocardiography (STE) in revealing heart differences in patients with HH considering the disease stage and the patient age. Methodology Consecutive patients with HH (n = 58) without heart pathologies (except hypertension) and 29 age- and sex-matched healthy individuals underwent echocardiography. Patients were compared according to the time since HH diagnosis (the recently diagnosed HH group [31 patients] with diagnosed HH for less than 6 months and had no more than one venesection; the medium group [11 patients] with diagnosed HH between 6 and 24 months; and the long-lasting group [16 patients] with diagnosed HH for more than 2 years) and the quartile contribution of their age. Results Standard echocardiography revealed differences in diastolic parameters between patients with HH and controls, which were the most prominent between healthy and long-lasting HH patients. Regarding systolic function, left ventricular ejection fraction was lower in HH patients, with the most evident differences between the healthy and recently diagnosed HH patients. STE revealed additional differences in systolic parameters, with LV rotation the worst in recently diagnosed patients and its increase in patients with medium and long-lasting HH. Significantly worse peak systolic longitudinal strain values were observed in all patients with HH. Analyses of the results according to the age quartiles of patients with HH revealed that some changes ocurred earlier than expected according to age. Conclusions Echocardiography can reveal possible heart damage in HH patients at different stages of the disease and highlight potential features of accelerated myocardial aging in these patients.
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Affiliation(s)
- Michał Świątczak
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Katarzyna Rozwadowska
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Katarzyna Sikorska
- Department of Tropical Medicine and Epidemiology, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - Krzysztof Młodziński
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Agata Świątczak
- Department of Pediatrics, Hematology and Oncology, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Faculty of Medicine, Medical University of Gdańsk, Gdańsk, Poland
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Zhang MJ, Ji Y, Wang W, Norby FL, Parikh R, Eaton AA, Inciardi RM, Alonso A, Soliman EZ, Mosley TH, Johansen MC, Gottesman RF, Shah AM, Solomon SD, Chen LY. Association of Atrial Fibrillation With Stroke and Dementia Accounting for Left Atrial Function and Size. JACC. ADVANCES 2023; 2:100408. [PMID: 37954510 PMCID: PMC10634508 DOI: 10.1016/j.jacadv.2023.100408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/11/2023] [Accepted: 05/01/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) is associated with higher risks of ischemic stroke (IS) and dementia. Whether alterations in left atrial (LA) function or size-atrial myopathy-confound these associations remains unknown. OBJECTIVES The purpose of this study was to examine the association of prevalent and incident AF with ischemic stroke and dementia in the ARIC (Atherosclerosis Risk In Communities) study, adjusting for LA function and size. METHODS Participants at visit 5 (2011-2013) with echocardiographic LA function (reservoir, conduit, contractile strain, and emptying fraction) and size (maximal, minimal volume index) data, and without prevalent stroke or dementia were followed through 2019. For analysis, we used time-varying Cox regression. RESULTS Among 5,458 participants (1,193 with AF, mean age of 76 years) in the stroke analysis and 5,461 participants (1,205 with AF, mean age of 75 years) in the dementia analysis, 209 participants developed ischemic stroke, and 773 developed dementia over 7.1 years (median). In a demographic and risk factor-adjusted model, AF was significantly associated with ischemic stroke (HR, 1.63; 95% CI: 1.11-2.37) and dementia (HR: 1.38, 95% CI: 1.13-1.70). After additionally adjusting for LA reservoir strain, these associations were attenuated and no longer statistically significant (stroke [HR: 1.33, 95% CI: 0.88-2.00], dementia [HR: 1.15, 95% CI: 0.92-1.43]). Associations with ischemic stroke and dementia were also attenuated and not statistically significant after adjustment for LA contractile strain, emptying fraction, and minimal volume index. CONCLUSIONS AF-ischemic stroke and AF-dementia associations were not statistically significant after adjusting for measures of atrial myopathy. This proof-of-concept analysis does not support AF as an independent risk factor for ischemic stroke and dementia.
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Affiliation(s)
- Michael J. Zhang
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota
| | - Yuekai Ji
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Wendy Wang
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Faye L. Norby
- Department of Cardiology, Center for Cardiac Arrest Prevention, Cedars-Sinai Smidt Heart Institute, Los Angeles, California
| | - Romil Parikh
- Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Anne A. Eaton
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Riccardo M. Inciardi
- Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Institute of Cardiology, University of Brescia, Brescia, Italy
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Elsayed Z. Soliman
- Cardiovascular Medicine Section, Department of Internal Medicine, Epidemiological Cardiology Research Center, Wake Forest School of Medicine, Winston Salem, North Carolina
| | - Thomas H. Mosley
- Division of Geriatrics, Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - Michelle C. Johansen
- Department of Neurology, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Rebecca F. Gottesman
- Stroke Branch, National Institute of Neurological Disorders and Stroke Intramural Research Program, NIH, Bethesda, Maryland
| | - Amil M. Shah
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Scott D. Solomon
- Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Lin Yee Chen
- Cardiovascular Division, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
- Lillehei Heart Institute, University of Minnesota Medical School, Minneapolis, Minnesota
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38
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Ünlü S, Özden Ö, Çelik A. Imaging in Heart Failure with Preserved Ejection Fraction: A Multimodality Imaging Point of View. Card Fail Rev 2023; 9:e04. [PMID: 37387734 PMCID: PMC10301698 DOI: 10.15420/cfr.2022.27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 10/18/2022] [Indexed: 07/01/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is an important global health problem. Despite increased prevalence due to improved diagnostic options, limited improvement has been achieved in cardiac outcomes. HFpEF is an extremely complex syndrome and multimodality imaging is important for diagnosis, identifying its different phenotypes and determining prognosis. Evaluation of left ventricular filling pressures using echocardiographic diastolic function parameters is the first step of imaging in clinical practice. The role of echocardiography is becoming more popular and with the recent developments in deformation imaging, cardiac MRI is extremely important as it can provide tissue characterisation, identify fibrosis and optimal volume measurements of cardiac chambers. Nuclear imaging methods can also be used in the diagnosis of specific diseases, such as cardiac amyloidosis.
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Affiliation(s)
- Serkan Ünlü
- Department of Cardiology, Gazi UniversityAnkara, Turkey
| | - Özge Özden
- Cardiology Department, Memorial Bahçelievler HospitalIstanbul, Turkey
| | - Ahmet Çelik
- Department of Cardiology, Mersin UniversityMersin, Turkey
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39
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Cotella JI, Miyoshi T, Mor-Avi V, Addetia K, Schreckenberg M, Sun D, Slivnick JA, 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, Prado AD, Asch FM, Lang RM. Normative values of the aortic valve area and Doppler measurements using two-dimensional transthoracic echocardiography: results from the Multicentre World Alliance of Societies of Echocardiography Study. Eur Heart J Cardiovasc Imaging 2023; 24:415-423. [PMID: 36331816 DOI: 10.1093/ehjci/jeac220] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 09/28/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022] Open
Abstract
AIMS Aortic valve area (AVA) used for echocardiographic assessment of aortic stenosis (AS) has been traditionally interpreted independently of sex, age and race. As differences in normal values might impact clinical decision-making, we aimed to establish sex-, age- and race-specific normative values for AVA and Doppler parameters using data from the World Alliance Societies of Echocardiography (WASE) Study. METHODS AND RESULTS Two-dimensional transthoracic echocardiographic studies were obtained from 1903 healthy adult subjects (48% women). Measurements of the left ventricular outflow tract (LVOT) diameter and Doppler parameters, including AV and LVOT velocity time integrals (VTIs), AV mean pressure gradient, peak velocity, were obtained according to ASE/EACVI guidelines. AVA was calculated using the continuity equation. Compared with men, women had smaller LVOT diameters and AVA values, and higher AV peak velocities and mean gradients (all P < 0.05). LVOT and AV VTI were significantly higher in women (P < 0.05), and both parameters increased with age in both sexes. AVA differences persisted after indexing to body surface area. According to the current diagnostic criteria, 13.5% of women would have been considered to have mild AS and 1.4% moderate AS. LVOT diameter and AVA were lower in older subjects, both men and women, and were lower in Asians, compared with whites and blacks. CONCLUSION WASE data provide clinically relevant information about significant differences in normal AVA and Doppler parameters according to sex, age, and race. The implementation of this information into clinical practice should involve development of specific normative values for each ethnic group using standardized methodology.
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Affiliation(s)
- Juan I Cotella
- University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | | | - Victor Mor-Avi
- University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Karima Addetia
- University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | | | - Deyu Sun
- University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | - Jeremy A Slivnick
- University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
| | | | | | | | | | | | | | | | | | | | - 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
| | - Anita Sadeghpour
- Rajaie Cardiovascular Medical and Research Center, Tehran, Islamic Republic of Iran
| | | | - Masaaki Takeuchi
- University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Wendy Tsang
- Toronto General Hospital, University of Toronto, Toronto, ON, Canada
| | | | - Mei Zhang
- Qilu Hospital of Shandong University, Jinan, China
| | - Aldo D Prado
- Centro Privado de Cardiología, Tucumán, Argentina
| | | | - Roberto M Lang
- University of Chicago, 5758 S. Maryland Avenue, MC 9067, DCAM 5509, Chicago, IL 60637, USA
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Muacevic A, Adler JR, Kabil H, Raslan M, Mostafa S. Association of Left Atrial Deformation Analysis by Speckle Tracking Echocardiography With Left Atrial Appendage Thrombus in Patients With Primary Valvular Heart Disease. Cureus 2023; 15:e35151. [PMID: 36811128 PMCID: PMC9938794 DOI: 10.7759/cureus.35151] [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] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND This study aimed to investigate the correlation between the functional parameters of the left atrium (LA) derived from deformation imaging, two-dimensional (2D) speckle tracking echocardiography (STE), and tissue Doppler imaging (TDI) strain and strain rate (SR) and the function of the left atrial appendage (LAA) as measured by transesophageal echocardiography (TEE) in patients with primary valvular heart disease. METHODS This cross-sectional research included 200 primary valvular heart disease cases, categorized into Group I (n = 74) with thrombus and Group II (n = 126) without thrombus. All patients were subjected to standard 12 lead electrocardiography, transthoracic echocardiography (TTE), strain and SR imaging of the LA by TDI and 2D speckle tracking, and TEE. RESULTS At a cut-off value of <10.50%, peak atrial longitudinal strain (PALS) is a predictor of thrombus with an area under the curve (AUC) of 0.975 (95% CI: 0.957-0.993), sensitivity of 94.6%, specificity of 93.7%, positive predictive value (PPV) of 89.7%, negative predictive value (NPV) of 96.7%, and accuracy of 94%. At a cut-off value of <0.295 m/s, LAA emptying velocity is a predictor of thrombus with an AUC of 0.967 (95% CI: 0.944-0.989), sensitivity of 94.6%, specificity of 90.5%, PPV of 85.4%, NPV of 96.6%, and accuracy of 92%. The PALS (<10.50%) and LAA velocity (<0.295 m/s) are significant predictors of thrombus (P = 0.001, β = 2.745, SE = 0.804, OR = 15.56, and 95% CI: 3.219-75.245; and P = 0.002, β = 2.499, SE = 0.799, OR = 12.17, and 95% CI: 2.543-58.201, respectively). Peak systolic strain < 12.55% and SR < 1.065/s are insignificant predictors of thrombus (β = 1.167, SE = 0.996, OR = 3.21, and 95% CI: 0.456-22.631; and β = 1.443, SE = 0.929, OR = 4.23, and 95% CI: 0.685-26.141, respectively). CONCLUSIONS Among LA deformation parameters derived from TTE, PALS is the best predictor of reduced LAA emptying velocity and LAA thrombus in primary valvular heart disease, regardless of the rhythm.
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Wu J, Huang X, Huang K, Tian Y, Gao Q, Lin B, Tang Y, Chen X, Su M. Dynamic assessment of the tricuspid annulus in a healthy Asian population: A four-dimensional echocardiography study. Echocardiography 2023; 40:113-127. [PMID: 36647764 PMCID: PMC10107205 DOI: 10.1111/echo.15528] [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: 03/24/2022] [Revised: 09/11/2022] [Accepted: 12/21/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Tricuspid annulus (TA) geometry and function reference values are limited, especially for Asian populations. We aimed to explore TA using four-dimensional echocardiography (4DE) in a healthy Asian population. METHODS A total of 355 healthy Asian volunteers (median age 34 years; 52% males) were prospectively enrolled. TA geometry and function were analyzed using 4DE throughout the cardiac cycle. RESULTS The TA area, perimeter, and dimensions were smallest at end systole (ES) and largest at late diastole (LD). Normal TA parameters at end diastole (ED) in different sex and age groups were obtained. TA areas, perimeters, and dimensions in males were significantly larger than those in females at ED; BSA-indexed perimeters and BSA-indexed dimensions in males were significantly smaller than those in females at ED. TA parameters correlated well with tricuspid valve (TV) tenting, right ventricle (RV), and right atrium (RA) parameters. CONCLUSIONS Reference values of TA parameters were obtained by 4DE in an Asian population. Quantitative data on TA geometry and function are essential for TA pathology and therapeutics.
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Affiliation(s)
- Jian Wu
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Xinyi Huang
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Kunhui Huang
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Yuan Tian
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Qiumei Gao
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Biqin Lin
- Department of Ultrasonography, Xiamen Humanity Hospital, Fujian Medical University, Xiamen, China
| | - Yiruo Tang
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Xu Chen
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
| | - Maolong Su
- Department of Echocardiography, Xiamen Cardiovascular Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Precision Medicine for Cardiovascular Disease, Xiamen, China
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Koutroumpakis E, Niku A, Black CK, Ali A, Sadaf H, Song J, Palaskas N, Iliescu C, Durand JB, Yusuf SW, Lee HC, Buja LM, Deswal A, Banchs J. Evaluation of contemporary echocardiographic and histomorphology parameters in predicting mortality in patients with endomyocardial biopsy-proven cardiac AL amyloidosis. Front Cardiovasc Med 2023; 9:1073804. [PMID: 36762300 PMCID: PMC9902366 DOI: 10.3389/fcvm.2022.1073804] [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: 10/18/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction This study examined the role of echocardiographic and cardiac histomorphology parameters in predicting mortality in patients with cardiac AL amyloidosis. Methods Patients with endomyocardial biopsy-proven cardiac AL amyloidosis treated at MD Anderson Cancer Center between 6/2011 and 6/2020 were identified. Stored echocardiographic images and endomyocardial biopsy samples were processed for myocardial strain analysis and a detailed histomorphology characterization. Results Of 43 patients; 44% were women and 63% white. Median age was 65 years; 51% underwent stem cell transplantation (SCT). Thirty patients (70%) died during follow up (median follow up: 4.1 years). Lower LA strain (<13.5%) and absence of SCT as a time-varying covariate were significantly associated with increased risk of death in the multivariate cox regression analysis. Higher LV mass and lower RV tricuspid annular plane systolic excursion were associated with increased odds of having ≥5% interstitial amyloid deposition on biopsy in the multivariate logistic regression analysis. Conclusion Lower LA strain independently predicted mortality in our cohort, and its performance in the routine assessment of AL amyloidosis may be beneficial. Furthermore, SCT for cardiac AL amyloidosis was associated with improved OS. These findings need to be confirmed by larger studies in the era of contemporary systemic therapies.
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Affiliation(s)
- Efstratios Koutroumpakis
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States,*Correspondence: Efstratios Koutroumpakis, , @EKoutroumpakis
| | - Adam Niku
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Christopher K. Black
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Abdelrahman Ali
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Humaira Sadaf
- Department of Pathology and Laboratory Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Juhee Song
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Nicolas Palaskas
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Cezar Iliescu
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jean-Bernard Durand
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Syed Wamique Yusuf
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Hans C. Lee
- Division of Cancer Medicine, Department of Lymphoma-Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - L. Maximilian Buja
- Department of Pathology and Laboratory Medicine, McGovern Medical School at The University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Anita Deswal
- Division of Internal Medicine, Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, TX, United States
| | - Jose Banchs
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, United States
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43
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Nagueh SF, Khan SU. Left Atrial Strain for Assessment of Left Ventricular Diastolic Function: Focus on Populations with Normal LVEF. JACC Cardiovasc Imaging 2022; 16:691-707. [PMID: 36752445 DOI: 10.1016/j.jcmg.2022.10.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 09/13/2022] [Accepted: 10/06/2022] [Indexed: 01/13/2023]
Abstract
Left atrial (LA) strain has emerged as a useful parameter for the assessment of left ventricular (LV) diastolic function and the estimation of LV filling pressures. Some have advocated using LA strain by itself, mainly reservoir strain, as a single stand-alone measurement for this objective. Recent data indicate several challenges for this application in patients with normal left ventricular ejection fraction (LVEF) because of the wide range for normal values and the load dependency of LA strain. Both findings can result in reduced left atrial reservoir strain (LARS) values in normal subjects that overlap those seen in patients with diastolic dysfunction. LARS for the estimation of LV filling pressures is most accurate in patients with depressed LVEF. It is less accurate in patients with normal ejection fraction. In this group of patients, LARS <18% has high specificity for increased LV filling pressures. There are promising data showing the association of LARS with outcome events in patients with normal ejection fraction, and additional data are needed to confirm that it provides incremental information over clinical and other echocardiographic measurements.
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Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA.
| | - Safi U Khan
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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44
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Barbieri A, Albini A, Chiusolo S, Forzati N, Laus V, Maisano A, Muto F, Passiatore M, Stuani M, Torlai Triglia L, Vitolo M, Ziveri V, Boriani G. Three-Dimensional Automated, Machine-Learning-Based Left Heart Chamber Metrics: Associations with Prevalent Vascular Risk Factors and Cardiovascular Diseases. J Clin Med 2022; 11:jcm11247363. [PMID: 36555980 PMCID: PMC9782505 DOI: 10.3390/jcm11247363] [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: 10/16/2022] [Revised: 12/08/2022] [Accepted: 12/09/2022] [Indexed: 12/14/2022] Open
Abstract
Background. Three-dimensional transthoracic echocardiography (3DE) powered by artificial intelligence provides accurate left chamber quantification in good accordance with cardiac magnetic resonance and has the potential to revolutionize our clinical practice. Aims. To evaluate the association and the independent value of dynamic heart model (DHM)-derived left atrial (LA) and left ventricular (LV) metrics with prevalent vascular risk factors (VRFs) and cardiovascular diseases (CVDs) in a large, unselected population. Materials and Methods. We estimated the association of DHM metrics with VRFs (hypertension, diabetes) and CVDs (atrial fibrillation, stroke, ischemic heart disease, cardiomyopathies, >moderate valvular heart disease/prosthesis), stratified by prevalent disease status: participants without VRFs or CVDs (healthy), with at least one VRFs but without CVDs, and with at least one CVDs. Results. We retrospectively included 1069 subjects (median age 62 [IQR 49−74]; 50.6% women). When comparing VRFs with the healthy, significant difference in maximum and minimum indexed atrial volume (LAVi max and LAVi min), left atrial ejection fraction (LAEF), left ventricular mass/left ventricular end-diastolic volume ratio, and left ventricular global function index (LVGFI) were recorded (p < 0.05). In the adjusted logistic regression, LAVi min, LAEF, LV ejection fraction, and LVGFI showed the most robust association (OR 3.03 [95% CI 2.48−3.70], 0.45 [95% CI 0.39−0.51], 0.28 [95% CI 0.22−0.35], and 0.22 [95% CI 0.16−0.28], respectively, with CVDs. Conclusions. The present data suggested that novel 3DE left heart chamber metrics by DHM such as LAEF, LAVi min, and LVGFI can refine our echocardiographic disease discrimination capacity.
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Affiliation(s)
- Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- Correspondence:
| | - Alessandro Albini
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Simona Chiusolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Nicola Forzati
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Vera Laus
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Anna Maisano
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Federico Muto
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Matteo Passiatore
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Marco Stuani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Laura Torlai Triglia
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Marco Vitolo
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
- 2 Clinical and Experimental Medicine Ph.D. Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Valentina Ziveri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41125 Modena, Italy
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45
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Kulka C, Lorbeer R, Askani E, Kellner E, Reisert M, von Krüchten R, Rospleszcz S, Hasic D, Peters A, Bamberg F, Schlett CL. Quantification of Left Atrial Size and Function in Cardiac MR in Correlation to Non-Gated MR and Cardiovascular Risk Factors in Subjects without Cardiovascular Disease: A Population-Based Cohort Study. Tomography 2022; 8:2202-2217. [PMID: 36136881 PMCID: PMC9498662 DOI: 10.3390/tomography8050185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/16/2022] Open
Abstract
Background: In magnetic resonance imaging (MRI), the comparability of gated and non-gated measurements of the left atrial (LA) area and function and their association with cardiovascular risk factors have not been firmly established. Methods: 3-Tesla MRIs were performed on 400 subjects enrolled in the KORA (Cooperative Health Research in the Augsburg Region) MRI study. The LA maximum and minimum sizes were segmented in gated CINE four-chamber sequences (LAmax and LAmin) and non-gated T1 VIBE-Dixon (NGLA). The area-based LA function was defined as LAaf = (LAmax − LAmin)/LAmax. Inter-and intra-reader reliability tests were performed (n = 31). Linear regression analyses were conducted to link LA size and function with cardiovascular risk factors. Results: Data from 378 subjects were included in the analysis (mean age: 56.3 years, 57.7 % male). The measurements were highly reproducible (all intraclass correlation coefficients ≥ 0.98). The average LAmax was 19.6 ± 4.5 cm2, LAmin 11.9 ± 3.5 cm2, NGLA 16.8 ± 4 cm2 and LAaf 40 ± 9%. In regression analysis, hypertension was significantly associated with larger gated LAmax (β = 1.30), LAmin (β = 1.07), and non-gated NGLA (β = 0.94, all p ≤ 0.037). Increasing age was inversely associated with LAaf (β = −1.93, p < 0.001). Conclusion: LA enlargement, as measured in gated and non-gated CMR is associated with hypertension, while the area-based LA function decreases with age.
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Affiliation(s)
- Charlotte Kulka
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilians-University Hospital, 80336 Munich, Germany
| | - Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Centre, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Susanne Rospleszcz
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, 81377 Munich, Germany
| | - Dunja Hasic
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Annette Peters
- Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg, Germany
- Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-University, 81377 Munich, Germany
- German Center for Diabetes Research, München-Neuherberg, 85764 Neuherberg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
| | - Christopher L. Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany
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46
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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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47
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Olsen FJ, Biering-Sørensen T. Validation of Alternative Left Atrial Indexation Methods in Obesity. J Am Soc Echocardiogr 2022; 35:1184-1185. [PMID: 35688306 DOI: 10.1016/j.echo.2022.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Flemming Javier Olsen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Tor Biering-Sørensen
- The Copenhagen City Heart Study, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark; Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark; Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
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48
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Rethinking Left Atrial Enlargement: Identifying Individuals at Risk by Appropriate Scaling. JACC Cardiovasc Imaging 2022; 15:998-1000. [PMID: 35680232 DOI: 10.1016/j.jcmg.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
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49
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Figliozzi S, Georgiopoulos G, Pateras K, Sianis A, Previtero M, Tondi L, Petropoulos Ι, Bragato RM, Papachristidis A, Condorelli G, Takeuchi M. Normal ranges of left atrial volumes and ejection fraction by 3D echocardiography in adults: a systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1329-1340. [PMID: 34994882 DOI: 10.1007/s10554-021-02520-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 12/30/2021] [Indexed: 11/05/2022]
Abstract
Increased sizes and dysfunction of the left atrium have been related to adverse outcomes. 3D-echocardiography is more accurate than 2D-echocardiography in estimating LA volumes and ejection fraction. However, the use of 3DE for LA analysis is limited by the absence of established reference values. We performed a systematic review and meta-analysis to provide reference ranges of LA maximum and minimum volumes indexed for body surface area (LAVi max and LAVi min, respectively), and LA-EF assessed by 3DE in healthy adults. Data search was conducted from inception through September 15, 2021, using the following Medical Subject Heading terms: left atrial/atrium, three-dimensional/3D echocardiography. The study protocol was registered in the PROSPERO database (CRD42021252428). 15 studies including 4,226 healthy adults (51% males) and reporting 3DE values of LAVi max, LAVi min and LA-EF were selected. LAVi max, LAVi min and LA-EF mean and reference values were equal to 25.18 ml/m2 (95% CI 23.10, 27.26), 11.10 ml/m2 (10.01, 12.18) and 55.94% (51.92, 59.96), respectively. No influential studies were identified. Pooled estimates per age group- and sex were also estimated. By meta-regression analyses, we identified variability in LA volumes and LA-EF depending on participants' age, ethnicity and number of heart cycles at 3D multi-beat acquisition. At individual patient data analysis conducted on 374 subjects, a software effect on LA-EF was shown. This systematic review and meta-analysis provides reference values of LAVi max, LAVi min and LA-EF assessed by 3DE in healthy adults, encouraging 3DE evaluation of the LA evaluation in daily practice.
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Affiliation(s)
- Stefano Figliozzi
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy.
| | - Georgios Georgiopoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Kostantinos Pateras
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
- Faculty of Public Health, University of Thessaly, Volos, Greece
| | - Alexandros Sianis
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Lara Tondi
- Multimodality Imaging Section IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ιoannis Petropoulos
- Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Renato Maria Bragato
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
| | | | - Gianluigi Condorelli
- Clinical Echocardiography Diagnostic Service, Cardio Center, Humanitas Research Hospital IRCCS, Via Alessandro Manzoni, 56, 20089, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, MI, Italy
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health, School of Medicine, Kitakyushu, Japan
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50
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Rønningen PS, Berge T, Solberg MG, Enger S, Pervez MO, Orstad EB, Kvisvik B, Aagaard EN, Lyngbakken MN, Ariansen I, Røsjø H, Steine K, Tveit A. Impact of Blood Pressure in the Early 40s on Left Atrial Volumes in the Mid-60s: Data From the ACE 1950 Study. J Am Heart Assoc 2022; 11:e023738. [PMID: 35621203 PMCID: PMC9238725 DOI: 10.1161/jaha.121.023738] [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] [Indexed: 11/18/2022]
Abstract
Background Echocardiographic measures of left atrial volumes are powerful predictors of cardiovascular events and important for assessing diastolic dysfunction. Despite this, there is limited knowledge of factors influencing left atrial remodeling. In particular, the impact of blood pressure in those in their early 40s on left atrial volumes later in life has not been sufficiently elucidated. Methods and Results We linked data from individuals born in 1950 who participated in the Age 40 Program, and the ACE (Akershus Cardiac Examination) 1950 Study. We divided the study population into quartiles of systolic blood pressure in their early 40s and assessed the proportion of individuals with an enlarged left atrium in their mid‐60s. The associations between blood pressure and left atrial volumes were assessed in linear regression analyses. Of the 2591 individuals included in this study, 1302 (50.3%) were women, and the mean age in the Age 40 Program was 40.1±0.3 years. Systolic blood pressure was 128.1±13.6 mm Hg and diastolic blood pressure was 78.3±9.5 mm Hg. Mean age in the ACE 1950 Study was 64.0±0.6 years. The proportion of individuals with an enlarged left atrium increased across the quartiles of systolic blood pressure (P=0.001). Systolic blood pressure was independently associated with left atrial volumes; the end‐systolic volume was 0.09 mL (95% CI, 0.04–0.14 mL) larger per 1‐mm Hg higher systolic blood pressure. Conclusions Our findings suggest that increased blood pressure in those in their early 40s is relevant for left atrial remodeling later in life. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01555411.
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Affiliation(s)
- Peter Selmer Rønningen
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Trygve Berge
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway
| | - Magnar Gangås Solberg
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Steve Enger
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway
| | - Mohammad Osman Pervez
- Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Eivind Bjørkan Orstad
- Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Brede Kvisvik
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Erika Nerdrum Aagaard
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Magnus Nakrem Lyngbakken
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Inger Ariansen
- Deparment of Chronic Diseases and Ageing Norwegian Institute of Public Health Oslo Norway
| | - Helge Røsjø
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division for Research and Innovation Akershus University Hospital Lørenskog Norway
| | - Kjetil Steine
- Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway.,Division of Medicine Department of Cardiology Akershus University Hospital Lørenskog Norway
| | - Arnljot Tveit
- Department of Medical Research Bærum HospitalVestre Viken Hospital Trust Gjettum Norway.,Faculty of Medicine Institute of Clinical Medicine University of Oslo Oslo Norway
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