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Meloni A, De Luca A, Nugara C, Cavallaro C, Cappelletto C, Barison A, Todiere G, Grigoratos C, Novo G, Grigioni F, Emdin M, Sinagra G, Mavrogeni S, Quaia E, Cademartiri F, Pepe A. The additive prognostic value of end-systolic pressure-volume relation by stress CMR in patients with known or suspected coronary artery disease. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024; 40:1341-1351. [PMID: 38676849 DOI: 10.1007/s10554-024-03104-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 04/02/2024] [Indexed: 04/29/2024]
Abstract
PURPOSE The difference between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an afterload-independent index of left ventricular (LV) contractility. We assessed the independent prognostic value of ΔESPVR index by dipyridamole stress-cardiovascular magnetic resonance (CMR) in patients with known/suspected coronary artery disease (CAD). METHODS We considered 196 consecutive patients (62.74 ± 10.66 years, 49 females). Wall motion and perfusion abnormalities at rest and peak stress were analysed. Replacement myocardial fibrosis was detected by late gadolinium enhancement (LGE) technique. The ESPVR was evaluated at rest and peak stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson's method. RESULTS A reduced ΔESPVR index (≤ 0.02 mmHg/mL/m2) was found in 88 (44.9%) patients and it was associated with a lower LV ejection fraction (EF) and with a higher frequency of abnormal stress CMR and myocardial fibrosis. During a mean follow-up of 53.17 ± 28.21 months, 50 (25.5%) cardiac events were recorded: 5 cardiac deaths, 17 revascularizations, one myocardial infarction, 23 hospitalisations for heart failure or unstable angina, and 4 ventricular arrhythmias. According to Cox regression analysis, diabetes, family history, LVEF, abnormal stress CMR, myocardial fibrosis, and reduced ΔESPVR were significant univariate prognosticators. In the multivariate analysis the independent predictors were ΔESPVR index ≤ 0.02 mmHg/mL/m2 (hazard ratio-HR = 2.58, P = 0.007), myocardial fibrosis (HR = 2.13, P = 0.036), and diabetes (HR = 2.33, P = 0.012). CONCLUSION ΔESPVR index by stress-CMR was independently associated with cardiac outcomes in patients with known/suspected CAD, in addition to replacement myocardial fibrosis and diabetes. Thus, the assessment of ΔESPVR index may be included into the standard stress-CMR exam to further stratify the patients.
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Affiliation(s)
- Antonella Meloni
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, Pisa, 56124, Italy
- Department of Bioengineering, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Antonio De Luca
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Cinzia Nugara
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
- IRCSS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Camilla Cavallaro
- Cardiovascular Department, University Campus Bio-Medico, Roma, Italy
| | - Chiara Cappelletto
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Andrea Barison
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Giancarlo Todiere
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Chrysanthos Grigoratos
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Giuseppina Novo
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
| | | | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, Trieste, Italy
| | - Sophie Mavrogeni
- Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece
| | - Emilio Quaia
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy
| | - Filippo Cademartiri
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, Pisa, 56124, Italy
| | - Alessia Pepe
- Department of Radiology, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, Pisa, 56124, Italy.
- Institute of Radiology, Department of Medicine, University of Padua, Padua, Italy.
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LVAD as a Bridge to Remission from Advanced Heart Failure: Current Data and Opportunities for Improvement. J Clin Med 2022; 11:jcm11123542. [PMID: 35743611 PMCID: PMC9225013 DOI: 10.3390/jcm11123542] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 02/04/2023] Open
Abstract
Left ventricular assist devices (LVADs) are an established treatment modality for advanced heart failure (HF). It has been shown that through volume and pressure unloading they can lead to significant functional and structural cardiac improvement, allowing LVAD support withdrawal in a subset of patients. In the first part of this review, we discuss the historical background, current evidence on the incidence and assessment of LVAD-mediated cardiac recovery, and out-comes including quality of life after LVAD support withdrawal. In the second part, we discuss current and future opportunities to promote LVAD-mediated reverse remodeling and improve our pathophysiological understanding of HF and recovery for the benefit of the greater HF population.
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Meloni A, De Luca A, Nugara C, Vaccaro M, Cavallaro C, Cappelletto C, Barison A, Todiere G, Grigoratos C, Calvi V, Novo G, Grigioni F, Emdin M, Sinagra G, Pepe A. Pressure-volume relationship by pharmacological stress cardiovascular magnetic resonance. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:853-861. [PMID: 34787731 DOI: 10.1007/s10554-021-02464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 11/02/2021] [Indexed: 11/28/2022]
Abstract
The variation between rest and peak stress end-systolic pressure-volume relation (ΔESPVR) is an index of myocardial contractility, easily obtained during routine stress echocardiography and never tested during dipyridamole stress-cardiac magnetic resonance (CMR). We assessed the ΔESPVR index in patients with known/suspected coronary artery disease (CAD) who underwent dipyridamole stress-CMR. One-hundred consecutive patients (24 females, 63.76 ± 10.17 years) were considered. ESPVR index was evaluated at rest and stress from raw measurement of systolic arterial pressure and end-systolic volume by biplane Simpson's method. The ΔESPVR index showed a good inter-operator reproducibility. Mean ΔESPVR index was 0.48 ± 1.45 mmHg/mL/m2. ΔESPVR index was significantly lower in males than in females. ΔESPVR index was not correlated to rest left ventricular end-diastolic volume index or ejection fraction. Forty-six of 85 patients had myocardial fibrosis detected by the late gadolinium enhancement technique and they showed significantly lower ΔESPVR values. An abnormal stress CMR was found in 25 patients and they showed significantly lower ΔESPVR values. During a mean follow-up of 56.34 ± 30.04 months, 24 cardiovascular events occurred. At receiver-operating characteristic curve analysis, a ΔESPVR < 0.02 mmHg/mL/m2 predicted the presence of future cardiac events with a sensitivity of 0.79 and a specificity of 0.68. The noninvasive assessment of the ΔESPVR index during a dipyridamole stress-CMR exam is feasible and reproducible. The ΔESPVR index was independent from rest LV dimensions and function and can be used for a comparative assessment of patients with different diseases. ΔESPVR index by CMR can be a useful and simple marker for additional prognostic stratification.
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Affiliation(s)
- Antonella Meloni
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy
| | - Antonio De Luca
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste, Trieste, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Cinzia Nugara
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
- IRCSS Centro Neurolesi Bonino Pulejo, Messina, Italy
| | - Maria Vaccaro
- Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Camilla Cavallaro
- Cardiovascular Department, University Campus Bio-Medico, Roma, Italy
| | - Chiara Cappelletto
- Cardiovascular Department, Azienda Sanitaria Universitaria di Trieste, Trieste, Italy
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Andrea Barison
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Giancarlo Todiere
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Chrysanthos Grigoratos
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
| | - Valeria Calvi
- Division of Cardiology, Policlinico Vittorio Emanuele Hospital, University of Catania, Catania, Italy
| | - Giuseppina Novo
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
| | | | - Michele Emdin
- Division of Cardiology and Cardiovascular Medicine, Fondazione G. Monasterio CNR-Regione Toscana, Pisa, Italy
- Institute of Life Sciences, Scuola Superiore Sant'Anna, Pisa, Italy
| | - Gianfranco Sinagra
- Department of Medical Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Division of Cardiology, University Hospital "P. Giaccone", University of Palermo, Palermo, Italy
| | - Alessia Pepe
- Magnetic Resonance Imaging Unit, Fondazione G. Monasterio CNR-Regione Toscana, Via Moruzzi, 1, 56124, Pisa, Italy.
- Department of Medicine, Institute of Radiology, University of Padua, Padua, Italy.
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Pugliese NR, Fabiani I, Mandoli GE, Guarini G, Galeotti GG, Miccoli M, Lombardo A, Simioniuc A, Bigalli G, Pedrinelli R, Dini FL. Echo-derived peak cardiac power output-to-left ventricular mass with cardiopulmonary exercise testing predicts outcome in patients with heart failure and depressed systolic function. Eur Heart J Cardiovasc Imaging 2020; 20:700-708. [PMID: 30476026 DOI: 10.1093/ehjci/jey172] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 09/26/2018] [Accepted: 10/18/2018] [Indexed: 12/20/2022] Open
Abstract
AIMS Peak cardiac power output-to-mass (CPOM) represents a measure of the rate at which cardiac work is delivered respect to the potential energy stored in left ventricular (LV) mass. We studied the value of CPOM and cardiopulmonary exercise test (CPET) in risk stratification of patients with heart failure (HF). MATERIALS AND RESULTS We studied 159 patients with chronic HF (mean rest LV ejection fraction 30%) undergoing CPET and exercise stress echocardiography. CPOM was calculated as the product of a constant (K = 2.22 × 10-1) with cardiac output (CO) and the mean blood pressure (MBP), divided by LV mass (M), and expressed in the unit of W/100 g: CPOM = [K × CO (L/min) × MBP (mmHg)]/LVM(g). Patients were followed-up for the primary endpoint, including all-cause death, ventricular assist device implantation, and heart transplantation, and the secondary endpoint that comprised hospitalization for HF. In multivariate Cox regression analyses, peak CPOM was selected as the most powerful independent predictor of both primary and secondary endpoint [hazard ratio (HR) 0.004, 95% confidence interval (CI) 0.004-0.3; P = 0.002 and HR 0.09, 95% CI 0.02-0.55; P = 0.009]. Sixty-month survival free from the combined endpoint was 85% in those exhibiting oxygen consumption (VO2) > 14 mL/min/kg and peak CPOM > 0.6 W/100 g. Peak VO2 ≤ 14 mL/min/kg provided incremental prognostic value over demographic and clinical variables, brain natriuretic peptide, and resting echocardiographic parameters (χ2 from 58 to 64; P = 0.04), that was further increased by peak CPOM ≤ 0.6 W/100 g (χ2 77; P < 0.001). CONCLUSION Peak CPOM and peak VO2 showed independent and incremental prognostic values in patients with chronic HF.
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Affiliation(s)
- Nicola Riccardo Pugliese
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Iacopo Fabiani
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Giulia Elena Mandoli
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Giacinta Guarini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Gian Giacomo Galeotti
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Mario Miccoli
- Department of Clinical and Experimental Medicine, University of Pisa, Via Paradisa, 2, Pisa, Italy
| | - Alberto Lombardo
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Anca Simioniuc
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Giovanni Bigalli
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Roberto Pedrinelli
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
| | - Frank L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Azienda Universitaria-Ospedaliera Pisana, Via Paradisa, 2, Pisa, Italy
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Tayal U, Wage R, Newsome S, Manivarmane R, Izgi C, Muthumala A, Dungu JN, Assomull R, Hatipoglu S, Halliday BP, Lota AS, Ware JS, Gregson J, Frenneaux M, Cook SA, Pennell DJ, Scott AD, Cleland JG, Prasad SK. Predictors of left ventricular remodelling in patients with dilated cardiomyopathy – a cardiovascular magnetic resonance study. Eur J Heart Fail 2020; 22:1160-1170. [DOI: 10.1002/ejhf.1734] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/05/2019] [Accepted: 11/29/2019] [Indexed: 01/28/2023] Open
Affiliation(s)
- Upasana Tayal
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Ricardo Wage
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Simon Newsome
- Department of Medical Statistics London School of Hygiene and Tropical Medicine London UK
| | | | - Cemil Izgi
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Amal Muthumala
- North Middlesex University Hospital and St Bartholomew's Hospital London UK
| | | | | | - Suzan Hatipoglu
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Brian P. Halliday
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Amrit S. Lota
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - James S. Ware
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
- MRC London Institute of Medical Sciences London UK
| | - John Gregson
- Department of Medical Statistics London School of Hygiene and Tropical Medicine London UK
| | - Michael Frenneaux
- National Heart Lung Institute Imperial College London UK
- University of East Anglia Norwich UK
| | | | - Dudley J. Pennell
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Andrew D. Scott
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - John G.F. Cleland
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
| | - Sanjay K. Prasad
- National Heart Lung Institute Imperial College London UK
- Cardiovascular Magnetic Resonance Unit Royal Brompton Hospital London UK
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6
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Relación presión/volumen en el laboratorio de ecocardiografía de estrés. ¿Cómo influye el tamaño del ventrículo izquierdo (dimensión diastólica del ventrículo izquierdo)? Rev Esp Cardiol 2017. [DOI: 10.1016/j.recesp.2016.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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7
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Holmager P, Egstrup M, Gustafsson I, Schou M, Dahl JS, Rasmussen LM, Møller JE, Tuxen C, Faber J, Kistorp C. Galectin-3 and fibulin-1 in systolic heart failure - relation to glucose metabolism and left ventricular contractile reserve. BMC Cardiovasc Disord 2017; 17:22. [PMID: 28068900 PMCID: PMC5223321 DOI: 10.1186/s12872-016-0437-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 12/07/2016] [Indexed: 02/08/2023] Open
Abstract
Background Heart failure (HF) patients with diabetes (DM) have an adverse prognosis and reduced functional capacity, which could be associated with cardiac fibrosis, increased chamber stiffness and reduced left ventricular (LV) contractile reserve. Galectin-3 (Gal-3) and fibulin-1 are circulating biomarkers potentially reflecting cardiac fibrosis. We hypothesize that plasma levels of Gal-3 and fibulin-1 are elevated in HF patients with DM and are associated with reduced LV contractile reserve in these patients. Methods A total of 155 patients with HF with reduced ejection fraction underwent a low-dose dobutamine echocardiography and blood sampling for biomarker measurements. Patients were classified according to history of DM and an oral glucose tolerance test (OGTT) as: normal glucose tolerance (NGT) (n = 70), impaired glucose tolerance (IGT) (n = 25) and DM (n = 60). Results Galectin-3 levels were elevated in DM patients as compared to non-diabetic patients (P = 0.02), while higher fibulin-1 levels were observed in HF patients with IGF and DM (P = 0.07). Reduced LV contractile reserve was associated with increasing Gal-3 levels (β = −0.19, P = 0.03) although, this association was attenuated after adjustment for estimated glomerular filtration rate (P = 0.66). Fibulin-1 was not associated with LV contractile reserve (P = 0.71). Conclusions Galectin-3 and fibulin-1 levels were elevated in HF patients with impaired glucose metabolism. However, reduced LV contractile reserve among HF patients with DM does not to have an independent impact on plasma Gal-3 and fibulin-1 levels.
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Affiliation(s)
- Pernille Holmager
- Department of Medicine, Endocrine Unit, Herlev University Hospital, Herlev, Denmark. .,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark. .,Department of Endocrinology, Herlev Hospital, Herlev, Denmark.
| | - Michael Egstrup
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Ida Gustafsson
- Department of Cardiology, Hvidovre University Hospital, Hvidovre, Denmark
| | - Morten Schou
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark.,Department of Cardiology, Herlev University Hospital, Herlev, Denmark
| | - Jordi S Dahl
- Department of Cardiology and Cardiothoracic Surgery, Odense University Hospital, Odense, Denmark
| | - Lars Melholt Rasmussen
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark.,Centre of Individualized Medicine in Arterial Diseases, Odense University Hospital, Odense, Denmark
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Christian Tuxen
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jens Faber
- Department of Medicine, Endocrine Unit, Herlev University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
| | - Caroline Kistorp
- Department of Medicine, Endocrine Unit, Herlev University Hospital, Herlev, Denmark.,Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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8
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Bombardini T, Mulieri LA, Salvadori S, Costantino MF, Scali MC, Marzilli M, Picano E. Pressure-volume Relationship in the Stress-echocardiography Laboratory: Does (Left Ventricular End-diastolic) Size Matter? ACTA ACUST UNITED AC 2016; 70:96-104. [PMID: 27475497 DOI: 10.1016/j.rec.2016.04.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 04/19/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND OBJECTIVES The variation between rest and peak stress end-systolic pressure-volume relation is an afterload-independent index of left ventricular contractility. Whether and to what extent it depends on end-diastolic volume remains unclear. The aim of this study was to assess the dependence of the delta rest-stress end-systolic pressure-volume relation on end-diastolic volume in patients with negative stress echo and all ranges of resting left ventricular function. METHODS We analyzed interpretable data obtained in 891 patients (593 men, age 63 ± 12 years) with ejection fraction 47% ± 12%: 338 were normal or near-normal or hypertensive; 229 patients had coronary artery disease; and 324 patients had ischemic or nonischemic dilated cardiomyopathy. They were studied with exercise (n = 172), dipyridamole (n = 482) or dobutamine (n = 237) stress echocardiography. The end-systolic pressure-volume relation was evaluated at rest and peak stress from raw measurement of systolic arterial pressure by cuff sphygmomanometer and end-systolic volume by biplane Simpson rule 2-dimensional echocardiography. RESULTS Absolute values of delta rest-stress end-systolic pressure-volume relation were higher for exercise and dobutamine than for dipyridamole. In the overall population, an inverse relationship between end-systolic pressure-volume relation and end-diastolic volume was present at rest (r2 = 0.69, P < .001) and peak stress (r2 = 0.56, P < .001), but was absent if the delta rest-stress end-systolic pressure-volume relation was considered (r2 = 0.13). CONCLUSIONS Left ventricular end-diastolic volume does not affect the rest-stress changes in end-systolic pressure-volume relation in either normal or abnormal left ventricles during physical or pharmacological stress.
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Affiliation(s)
- Tonino Bombardini
- Cardiovascular Medicine Division, Cardiothoracic and Vascular Department, University of Pisa, Italy.
| | - Louis A Mulieri
- Department of Molecular Physiology & Biophysics, University of Vermont, Burlington, Vermont, United States
| | - Stefano Salvadori
- Epidemiology and Health Services Research Department, Institute of Clinical Physiology, National Research Council of Italy (CNR), Pisa, Italy
| | | | - Maria Chiara Scali
- Cardiovascular Medicine Division, Cardiothoracic and Vascular Department, University of Pisa, Italy
| | - Mario Marzilli
- Cardiovascular Medicine Division, Cardiothoracic and Vascular Department, University of Pisa, Italy
| | - Eugenio Picano
- Nazarbayev University School of Medicine, Astana, Kazakhstan
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9
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To ACY, Benatti RD, Sato K, Grimm RA, Thomas JD, Wilkoff BL, Agler D, Popović ZB. Strain-time curve analysis by speckle tracking echocardiography in cardiac resynchronization therapy: Insight into the pathophysiology of responders vs. non-responders. Cardiovasc Ultrasound 2016; 14:14. [PMID: 27090784 PMCID: PMC4835914 DOI: 10.1186/s12947-016-0057-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 04/08/2016] [Indexed: 11/17/2022] Open
Abstract
Background Patients with non-ischemic heart failure etiology and left bundle branch block (LBBB) show better response to cardiac resynchronization therapy (CRT). While these patients have the most pronounced left ventricular (LV) dyssynchrony, LV dyssynchrony assessment often fails to predict outcome. We hypothesized that patients with favorable outcome from CRT can be identified by a characteristic strain distribution pattern. Methods From 313 patients who underwent CRT between 2003 and 2006, we identified 10 patients who were CRT non-responders (no LV end-systolic volume [LVESV] reduction) with non-ischemic cardiomyopathy and LBBB and compared with randomly selected CRT responders (n = 10; LVESV reduction ≥15 %). Longitudinal strain (εlong) data were obtained by speckle tracking echocardiography before and after (9 ± 5 months) CRT implantation and standardized segmental εlong-time curves were obtained by averaging individual patients. Results In responders, ejection fraction (EF) increased from 25 ± 9 to 40 ± 11 % (p = 0.002), while in non-responders, EF was unchanged (20 ± 8 to 21 ± 5 %, p = 0.57). Global εlong was significantly lower in non-responders at pre CRT (p = 0.02) and only improved in responders (p = 0.04) after CRT. Pre CRT septal εlong -time curves in both groups showed early septal contraction with mid-systolic decrease, while lateral εlong showed early stretch followed by vigorous mid to late contraction. Restoration of contraction synchrony was observed in both groups, though non-responder remained low amplitude of εlong. Conclusions CRT non-responders with LBBB and non-ischemic etiology showed a similar improvement of εlong pattern with responders after CRT implantation, while amplitude of εlong remained unchanged. Lower εlong in the non-responders may account for their poor response to CRT.
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Affiliation(s)
- Andrew C Y To
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.,Department of Cardiology, North Shore Hospital, 124 Shakespeare Rd, Takapuna, Auckland, New Zealand
| | - Rodolfo D Benatti
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Kimi Sato
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Richard A Grimm
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - James D Thomas
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Bruce L Wilkoff
- Section of Electrophysiology, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Deborah Agler
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA
| | - Zoran B Popović
- Section of Cardiovascular Imaging, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, USA.
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Bombardini T, Zoppè M, Ciampi Q, Cortigiani L, Agricola E, Salvadori S, Loni T, Pratali L, Picano E. Myocardial contractility in the stress echo lab: from pathophysiological toy to clinical tool. Cardiovasc Ultrasound 2013; 11:41. [PMID: 24246005 PMCID: PMC3875530 DOI: 10.1186/1476-7120-11-41] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Accepted: 11/15/2013] [Indexed: 11/10/2022] Open
Abstract
Up-regulation of Ca2+ entry through Ca2+ channels by high rates of beating is involved in the frequency-dependent regulation of contractility: this process is crucial in adaptation to exercise and stress and is universally known as force-frequency relation (FFR). Disturbances in calcium handling play a central role in the disturbed contractile function in myocardial failure. Measurements of twitch tension in isolated left-ventricular strips from explanted cardiomyopathic hearts compared with non-failing hearts show flat or biphasic FFR, while it is up-sloping in normal hearts. Starting in 2003 we introduced the FFR measurement in the stress echo lab using the end-systolic pressure (ESP)/End-systolic volume index (ESVi) ratio (the Suga index) at increasing heart rates. We studied a total of 2,031 patients reported in peer-reviewed journals: 483 during exercise, 34 with pacing, 850 with dobutamine and 664 during dipyridamole stress echo. We demonstrated the feasibility of FFR in the stress echo lab, the clinical usefulness of FFR for diagnosing latent contractile dysfunction in apparently normal hearts, and residual contractile reserve in dilated idiopathic and ischemic cardiomyopathy. In 400 patients with left ventricular dysfunction (ejection fraction 30 ± 9%) with negative stress echocardiography results, event-free survival was higher (p < 0.001) in patients with ΔESPVR (the difference between peak and rest end-systolic pressure-volume ratio, ESPVR) ≥ 0.4 mmHg/mL/m2. The prognostic stratification of patients was better with FFR, beyond the standard LV ejection fraction evaluation, also in the particular settings of severe mitral regurgitation or diabetics without stress-induced ischemia. In the particular setting of selection of heart transplant donors, the stress echo FFR was able to correctly select 34 marginal donor hearts efficiently transplanted in emergency recipients. Starting in 2007, we introduced an operator-independent cutaneous sensor to monitor the FFR: the force is quantified as the sensed pre-ejection myocardial vibration amplitude. We demonstrated that the sensor-derived force changes at increasing heart rates are highly related with both max dP/dt in animal models, and with the stress echo FFR in 220 humans, opening a new window for pervasive cardiac heart failure monitoring in telemedicine systems.
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Affiliation(s)
- Tonino Bombardini
- CNR, Institute of Clinical Physiology, Area della Ricerca, Pisa 56124, Italy.
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11
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End-systolic elastance and ventricular-arterial coupling reserve predict cardiac events in patients with negative stress echocardiography. BIOMED RESEARCH INTERNATIONAL 2013; 2013:235194. [PMID: 24024185 PMCID: PMC3760182 DOI: 10.1155/2013/235194] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Accepted: 07/01/2013] [Indexed: 11/18/2022]
Abstract
Background. A maximal negative stress echo identifies a low-risk subset for coronary events. However, the potentially prognostically relevant information on cardiovascular hemodynamics for heart-failure-related events is unsettled. Aim of this study was to assess the prognostic value of stress-induced variation in cardiovascular hemodynamics in patients with negative stress echocardiography. Methods. We enrolled 891 patients (593 males mean age 63 ± 12, ejection fraction 48 ± 17%), with negative (exercise 172, dipyridamole 482, and dobutamine 237) stress echocardiography result. During stress we assessed left ventricular end-systolic elastance index (ELVI), ventricular arterial coupling (VAC) indexed by the ratio of the ELVI to arterial elastance index (EaI), systemic vascular resistance (SVR), and pressure-volume area (PVA). Changes from rest to peak stress (reserve) were tested as predictors of main outcome measures: combined death and heart failure hospitalization. Results. During a median followup of 19 months (interquartile range 8–36), 50 deaths and 84 hospitalization occurred. Receiver-operating-characteristic curves identified as best predictors ELVI reserve for exercise (AUC = 0.871) and dobutamine (AUC = 0.848) and VAC reserve (AUC = 0.696) for dipyridamole. Conclusions. Patients with negative stress echocardiography may experience an adverse outcome, which can be identified by assessment of ELVI reserve and VAC reserve during stress echo.
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Otasevic P, Tasic N, Vidakovic R, Boskovic S, Radak D, Djukanovic B, Angelkov L, Kostic N, Caparevic Z, Vasiljevic-Pokrajcic Z. Feasibility of semi-quantitative assessment of left ventricular contractile reserve in dilated cardiomyopathy. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:405-409. [PMID: 22407437 DOI: 10.1002/jcu.21903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 01/27/2012] [Indexed: 05/31/2023]
Abstract
BACKGROUND We and others have shown previously that left ventricular (LV) contractile reserve assessed quantitatively by high-dose dobutamine stress-echocardiography (DSE) has prognostic implications in patients with dilated cardiomyopathy. PURPOSE To assess the feasibility of semi-quantitative assessment of LV contractile reserve by differently skilled operators in patients with dilated cardiomyopathy. METHODS High-dose DSE was performed in 63 consecutive patients, mean age 50 ± 10 years and ejection fraction (EF) 19 ± 8%. LVEF was calculated 1) using Simpson's biplane formula, and 2) semi-quantitatively (5% increments) by novice and experienced echocardiographers, and by a DSE expert. Patients were considered to have preserved LV contractile reserve if LVEF dobutamine-induced change was ≥5%. RESULTS Twenty-seven (45.8%) patients died during the 5-year follow-up. The feasibility of the assessment was 89%, 94%, and 98% for novice and experienced readers and DSE expert, respectively. Kaplan-Meier analysis showed that LV contractile reserve assessed semi-quantitatively by DSE expert and experienced reader achieved the best prognostic separation (log rank 19.63 and 18.99, respectively, p < 0.001 for both), followed by quantitative assessment (log rank 9.76, p = 0.0018) and assessment by novice reader (log rank 8.76, p = 0.012). Areas under the curves were similar for quantitative and semi-quantitative assessment of LV contractile reserve. CONCLUSIONS Our data indicate that semi-quantitative assessment of LV contractile reserve is feasible by differently skilled operators.
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Affiliation(s)
- Petar Otasevic
- Dr Aleksandar D. Popovic Cardiovascular Research Center, Dedinje Cardiovascular Institute and Belgrade University Medical School, Belgrade, Serbia
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13
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Egstrup M, Kistorp CN, Schou M, Høfsten DE, Møller JE, Tuxen CD, Gustafsson I. Abnormal glucose metabolism is associated with reduced left ventricular contractile reserve and exercise intolerance in patients with chronic heart failure. Eur Heart J Cardiovasc Imaging 2012; 14:349-57. [PMID: 22898711 DOI: 10.1093/ehjci/jes165] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
AIMS To investigate the associations between glucose metabolism, left ventricular (LV) contractile reserve, and exercise capacity in patients with chronic systolic heart failure (HF). METHODS AND RESULTS From an outpatient HF clinic, 161 patients with systolic HF were included (mean age 70 ± 10 years, 69% male, 59% had ischaemic heart disease, mean LV ejection fraction (LVEF) 37 ± 9%). Thirty-four (21%) patients had known diabetes mellitus (DM). Oral glucose tolerance testing (OGTT) classified patients without a prior DM diagnosis as normal glucose tolerance (NGT), impaired glucose tolerance or new DM. All patients completed low-dose dobutamine echocardiography (LDDE) and 154 patients a 6-min walking distance test (6MWD). Compared with patients with NGT, patients with known DM had lower resting LVEF (33.4 vs. 39.1%, P < 0.05) and higher E/e' (13.9 vs. 11.4, P < 0.05). During LDDE, an increase in LVEF could be observed in all glycemic groups (mean 8.2% absolute increase), but the contractile reserve was lower in patients with known DM (-5.4%, P = 0.001) and new DM (-3.5%, P = 0.035) compared to patients with NGT. 6MWD was lower in known DM (349 m) and new DM (379 m) compared with NGT (467 m) (P < 0.001). Differences in clinical variables, resting echocardiographic parameters or contractile reserve, did not explain the exercise intolerance related to diabetes. CONCLUSION Diabetes, known or newly detected by OGTT, is independently associated with reduced LV contractile reserve and exercise intolerance in outpatients with systolic HF. These findings may offer one explanation for the excess mortality related to diabetes in HF.
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Affiliation(s)
- M Egstrup
- Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Nordre Fasanvej 59, Frederiksberg 2000, Denmark
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14
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Ciampi Q, Pratali L, Porta MD, Petruzziello B, Manganiello V, Villari B, Picano E, Sicari R. Tissue Doppler systolic velocity change during dobutamine stress echocardiography predicts contractile reserve and exercise tolerance in patients with heart failure. Eur Heart J Cardiovasc Imaging 2012; 14:102-9. [DOI: 10.1093/ehjci/jes096] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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15
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Young AA, Crossman DJ, Ruygrok PN, Cannell MB. Mapping system for coregistration of cardiac mri and ex vivo tissue sampling. J Magn Reson Imaging 2011; 34:1065-71. [DOI: 10.1002/jmri.22714] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2010] [Accepted: 06/08/2011] [Indexed: 11/11/2022] Open
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16
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The concept of ventricular reserve in heart failure and pulmonary hypertension: an old metric that brings us one step closer in our quest for prediction. Curr Opin Cardiol 2011; 26:123-31. [PMID: 21297465 DOI: 10.1097/hco.0b013e3283437485] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Ventricular reserve is emerging a strong predictor of outcome in heart failure and cardiovascular disease. Ventricular reserve is the term used to describe the extent of increase or change in ventricular function that occurs during exercise or pharmacological stress (typically with dobutamine). RECENT FINDINGS The interest in ventricular reserve lies in its ability to assess viability in coronary artery disease, to predict clinical outcome and response to therapy in patients with heart failure and to screen patients for early cardiovascular disease. SUMMARY In this paper, we will review the emerging role of ventricular reserve in heart failure and pulmonary hypertension. We will also explore the mechanisms involved in the pathophysiology of impaired ventricular reserve and discuss future directions of research in the field.
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Ciampi Q, Pratali L, Citro R, Villari B, Picano E, Sicari R. Clinical and prognostic role of pressure-volume relationship in the identification of responders to cardiac resynchronization therapy. Am Heart J 2010; 160:906-14. [PMID: 21095279 DOI: 10.1016/j.ahj.2010.07.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 07/13/2010] [Indexed: 11/26/2022]
Abstract
BACKGROUND The identification of responders remains challenging in cardiac resynchronization therapy (CRT). Pressure-volume relationship (PVR) is a method to evaluate left ventricular myocardial contractility during stress. The aim of the study was to assess the role of PVR to identify responders to CRT. METHODS Seventy-two patients (57% with ischemic etiology) referred to CRT: ejection fraction ≤ 35%, New York Heart Association ≥ III and QRS duration ≥ 120 milliseconds, underwent dobutamine stress echocardiography (up to 40 μg/kg per minute). PVR was defined as systolic cuff pressure/end-systolic volume index difference between rest-peak dobutamine stress echocardiography. Responders were identified by clinical and/or echocardiographic (end-systolic volume decrease ≥ 15%) follow-up criteria. We divided retrospectively the patient population into 2 groups, accordingly to the presence of myocardial contractile reserve that was set at the value of PVR (0.72 mm Hg/mL per square meter) obtained by a receiver operating characteristic analysis. RESULTS During a median follow-up of 12 months, 8 patients (11%) died. Patients with lower PVR, showed higher brain natriuretic peptide levels (853 ± 1211 vs 342 ± 239, P = .044) larger left ventricular end-diastolic (196 ± 82 mL vs 152 ± 39 mL, P = .005) and end-systolic (147 ± 66 vs 112 ± 30 mL, P = .006) volumes. Intraventricular dyssynchrony was similar in the 2 groups (88 ± 45 vs 70 ± 32 milliseconds, P = .175). Patients with higher PVR presented a larger incidence of clinical (86% vs 46% P < .001), and echocardiographic responders to CRT (79% vs 40%, P = .002). Event-free survival was significantly better in patients with higher PVR (log rank = 5.78, P = .01). CONCLUSION Patients with preserved contractility, assessed by PVR during stress echocardiography show a favor clinical outcome and left ventricular reverse remodeling after CRT. In particular, PVR may have a significant clinical role in patients undergoing CRT, providing critical information for risk stratification.
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Ciampi Q, Pratali L, Bombardini T, Della Porta M, Petruzziello B, Villari B, Picano E, Sicari R. Pressure-Volume Relationship During Dobutamine Stress Echocardiography Predicts Exercise Tolerance in Patients with Congestive Heart Failure. J Am Soc Echocardiogr 2010; 23:71-8. [DOI: 10.1016/j.echo.2009.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2009] [Indexed: 11/16/2022]
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19
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Stipac AV, Otasević P, Popović ZB, Cvorović V, Putniković B, Stanković I, Nesković AN. Prognostic significance of contractile reserve assessed by dobutamine-induced changes of Tei index in patients with idiopathic dilated cardiomyopathy. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2009; 11:264-70. [PMID: 19995800 DOI: 10.1093/ejechocard/jep208] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Alja Vlahović Stipac
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, 11080 Belgrade, Serbia.
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Methods from the Theory of Random Heterogeneous Media for Quantifying Myocardial Morphology in Normal and Dilated Hearts. Ann Biomed Eng 2009; 38:308-18. [DOI: 10.1007/s10439-009-9848-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 11/15/2009] [Indexed: 01/08/2023]
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21
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Ciampi Q, Pratali L, Citro R, Piacenti M, Villari B, Picano E. Identification of responders to cardiac resynchronization therapy by contractile reserve during stress echocardiography. Eur J Heart Fail 2009; 11:489-96. [PMID: 19324921 DOI: 10.1093/eurjhf/hfp039] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS The identification of responders to cardiac resynchronization therapy (CRT) remains a challenge. We assessed the role of dyssynchrony (DYS) and contractile reserve (CR) in identifying CRT responders. METHODS AND RESULTS Sixty-nine patients (55% with ischaemic aetiology) referred for CRT (ejection fraction < or =35%, New York Heart Association > or =III, and QRS duration > or =120 ms) underwent baseline evaluation of DYS and dobutamine stress-echo [up to 40 microg/kg/min: CR was defined as a wall motion score index (WMSI) variation > or =0.20]. CRT responders were identified by clinical and/or echocardiographic [end-systolic volume (ESV) decrease > or =15%] follow-up criteria. During a median follow-up of 11 months, 46 patients (66%) were classified as clinical responders. Reverse remodelling was found in 34 of the 59 patients (58%) with echocardiographic follow-up. CR was present in 78% of clinical responders (P = 0.001) and in 69% with reverse remodelling (P = 0.005). DYS was equally present in the two groups. Reverse remodelling was correlated with rest-stress changes in ESV (r = 0.439, P = 0.003) and in WMSI (r = 0.450, P = 0.001), but not with DYS. CR (OR = 6.2, 95% CI = 1.4-27.6, P = 0.015) was the best predictor of response to CRT. CONCLUSION Patients with CR show a favourable clinical and reverse LV remodelling response to CRT. This finding shifts the focus from electrical (dyssynchrony) to the myocardial substrate of functional response.
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Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Viale Principe di Napoli, Benevento, Italy.
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22
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Dini FL, Ghiadoni L, Conti U, Stea F, Buralli S, Taddei S, De Tommasi SM. Coronary flow reserve in idiopathic dilated cardiomyopathy: relation with left ventricular wall stress, natriuretic peptides, and endothelial dysfunction. J Am Soc Echocardiogr 2009; 22:354-60. [PMID: 19269783 DOI: 10.1016/j.echo.2009.01.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Indexed: 10/21/2022]
Abstract
Studies have demonstrated impaired coronary blood flow reserve (CBFR) in idiopathic dilated cardiomyopathy (IDCM). It was the aim of this study to examine the potential underlying mechanisms for CBFR reduction in patients with IDCM by Doppler ultrasound techniques. Forty-eight clinically stable patients with heart failure caused by IDCM (New York Heart Association classes 1-3) were evaluated by echocardiographic and Doppler techniques with the assessments of CBFR and brachial artery flow-mediated dilation (FMD). CBFR was estimated as the hyperemic (dipyridamole: 0.84 mg/kg in 10 minutes, intravenously) to resting coronary diastolic peak velocities ratio. N-terminal pro-brain natriuretic peptide (Nt-pro-BNP) plasma levels were measured at the time of the index echocardiogram. Left ventricular (LV) ejection fraction was 30% +/- 8%, and wall motion score index was 2.0 +/- 0.25. The best correlation with CBFR was found with LV wall thickness-to-cavity radius (r = 0.77, P < .0001). A strong correlation of log-transformed Nt-pro-BNP levels was observed with CBFR (r = -0.64; P < .0001). No significant correlation was documented between CBFR and FMD. The stepwise regression model showed that LV wall thickness-to-cavity radius was the strongest independent predictor of CBFR followed by New York Heart Association class and log-transformed Nt-pro-BNP leading to a cumulative R value of 0.82 (P < .0001). The results of the study indicate that by measuring variables related to LV end-diastolic wall stress, such as LV wall thickness-to-cavity radius and plasma Nt-proBNP, it is possible to have information about CBFR in patients with heart failure secondary to IDCM.
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Affiliation(s)
- Frank Lloyd Dini
- Unità Malattie Cardiovascolari 2, Santa Chiara Hospital, Pisa, Italy.
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23
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Ciampi Q, Villari B. Role of echocardiography in diagnosis and risk stratification in heart failure with left ventricular systolic dysfunction. Cardiovasc Ultrasound 2007; 5:34. [PMID: 17910744 PMCID: PMC2064911 DOI: 10.1186/1476-7120-5-34] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 10/02/2007] [Indexed: 01/13/2023] Open
Abstract
Heart failure (HF) is a complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood. Echocardiography represents the "gold standard" in the assessment of LV systolic dysfunction and in the recognition of systolic heart failure, since dilatation of the LV results in alteration of intracardiac geometry and hemodynamics leading to increased morbidity and mortality. The functional mitral regurgitation is a consequence of adverse LV remodelling that occurs with a structurally normal valve and it is a marker of adverse prognosis. Diastolic dysfunction plays a major role in signs and symptoms of HF and in the risk stratification, and provides prognostic information independently in HF patients and impaired systolic function. Ultrasound lung comets are a simple echographic sign of extravascular lung water, more frequently associated with left ventricular diastolic and/or systolic dysfunction, which can integrate the clinical and pathophysiological information provided by conventional echocardiography and provide a useful information for prognostic stratification of HF patients. Contractile reserve is defined as the difference between values of an index of left ventricular contractility during peak stress and its baseline values and the presence of myocardial viability predicts a favorable outcome. A non-invasive echocardiographic method for the evaluation of force-frequency relationship has been proposed to assess the changes in contractility during stress echo. In conclusion, in HF patients, the evaluation of systolic, diastolic function and myocardial contractile reserve plays a fundamental role in the risk stratification. The highest risk is present in HF patients with a heart that is weak, big, noisy, stiff and wet.
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Affiliation(s)
- Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
| | - Bruno Villari
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
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Otasevic P, Popovic ZB, Vasiljevic JD, Pratali L, Vlahovic-Stipac A, Boskovic SD, Tasic N, Neskovic AN. Head-to-head comparison of indices of left ventricular contractile reserve assessed by high-dose dobutamine stress echocardiography in idiopathic dilated cardiomyopathy: five-year follow up. Heart 2006; 92:1253-8. [PMID: 16449519 PMCID: PMC1861177 DOI: 10.1136/hrt.2005.073999] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare head to head the indices of left ventricular contractile reserve assessed by high-dose dobutamine in the five-year prognosis of patients with idiopathic dilated cardiomyopathy. DESIGN AND SETTING Prospective study in a tertiary care centre. PATIENTS 63 consecutive patients with idiopathic dilated cardiomyopathy. INTERVENTIONS High-dose dobutamine stress echocardiography was performed in progressive stages lasting 5 min each. Wall motion score index, ejection fraction, cardiac power output and end systolic pressure to volume ratio were evaluated as indices of left ventricular contractility. MAIN OUTCOME MEASURE Five-year cardiac mortality. RESULTS During the follow up of 59 patients, 27 (45.8%) died of cardiac causes. According to Kaplan-Meier and receiver operating characteristic analyses all indices of contractile reserve differentiated patients with respect to cardiac death. Wall motion score index achieved the best separation (log rank 21.75, p < 0.0001, area under the curve 0.84), followed by change in ejection fraction (log rank 11.25, p = 0.0008, area under the curve 0.79), end systolic pressure to volume ratio (log rank 14.32, p = 0.0002, area under the curve 0.75) and cardiac power output (log rank 9.84, p = 0.0017, area under the curve 0.71). Cox's regression model identified wall motion score index as the only independent predictor of cardiac death. CONCLUSIONS These data show that all examined indices of left ventricular contractile reserve are predictive of five-year prognosis, but change in wall motion score index may have the greatest prognostic potential.
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Affiliation(s)
- P Otasevic
- Dr Aleksandar D Popovic Cardiovascular Research Center, Dedinje Cardiovascular Institute, Milana Tepića 1, 11040 Belgrade, Serbia and Montenegro.
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25
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Neskovic AN, Otasevic P. Stress-echocardiography in idiopathic dilated cardiomyopathy: instructions for use. Cardiovasc Ultrasound 2005; 3:3. [PMID: 15705202 PMCID: PMC550672 DOI: 10.1186/1476-7120-3-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2005] [Accepted: 02/10/2005] [Indexed: 11/10/2022] Open
Abstract
A number of studies have suggested that stress-echocardiography may be used for prognostic stratification in patients with idiopathic dilated cardiomyopathy. There is no consensus on which protocol or which measurements of left ventricular contractile reserve to use. The most frequently used protocol is low-dose dobutamine stress-echocardiography, and most commonly used measures of left ventricular systolic performance are ejection fraction, wall motion score index and cardiac power output.Stress-echocardiography has been shown to predict improvement in cardiac function in patients with recently diagnosed dilated cardiomyopathy, as well as to predict which patients will benefit from the treatment with beta-blockers. Most importantly, stress-echocardiography can identify patients with worse prognosis in terms of cardiac death and need for transplantation. Additionally, contractile reserve is closely correlated with maximal oxygen consumption and can even be used for further stratification in patients with maximal oxygen consumption between 10 and 14 ml/kg/min. Future studies are needed for head-to-head comparison of various protocols in an attempt to make standardization in the assessment of patients with dilated cardiomyopathy.
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Affiliation(s)
- Aleksandar N Neskovic
- Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade, Serbia and Montenegro
- Belgrade University Medical School, Belgrade, Serbia and Montenegro
| | - Petar Otasevic
- Cardiovascular Research Center, Dedinje Cardiovascular Institute, Belgrade, Serbia and Montenegro
- Belgrade University Medical School, Belgrade, Serbia and Montenegro
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