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Zhang L, Li S, Liu B, Wang J, Mu Y, Zhou X, Liu H. Prognostic Factors and Survival of Chinese Patients with Cardiac Amyloidosis. DISEASE MARKERS 2023; 2023:3070017. [PMID: 37228893 PMCID: PMC10205418 DOI: 10.1155/2023/3070017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 09/14/2022] [Accepted: 09/21/2022] [Indexed: 05/27/2023]
Abstract
Purpose To identify the survival and prognostic factors for cardiac amyloidosis (CA) in Chinese patients. Methods This was a prospective cohort study of 72 patients diagnosed with CA and admitted to the PLA General Hospital between November 2017 and April 2021. Demographic, clinical, laboratory, electrocardiographic, conventional ultrasound, endocardial LS during LV systole (LV ENDO LSsys), and myocardial strain data were recorded. Survival was assessed. All-cause mortality was the endpoint. Follow-up was censored on September 30, 2021. Results The mean follow-up was 17.1 ± 12.9 months. Among the 72 patients, 39 died, 23 survived, and 10 were lost to follow-up. Mean survival for all patients was 24.7 ± 2.2 months. Mean survival was 32.7 ± 2.4 months among patients with NYHA class II, 26.6 ± 3.4 months for NYHA class III, and 5.8 ± 1.1 months for NYHA class IV. The multivariate Cox proportional hazard regression model showed that NYHA class (HR = 3.42, 95% CI: 1.36-8.65, P = 0.002), log-proBNP level (HR = 1.40, 95% CI: 1.17-5.83, P = 0.03), and ENDO LSsys of the LV basal level (HR = 1.25, 95% CI: 1.05-1.95, P = 0.004) were independent prognostic factors for CA. Conclusion NYHA class, proBNP level, and ENDO LSsys of the LV basal level were independently associated with the survival of patients with CA.
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Affiliation(s)
- Lu Zhang
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Sulei Li
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Bohan Liu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Jing Wang
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Yang Mu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Xuan Zhou
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
| | - Hongbin Liu
- Department of Cardiology, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese PLA General Hospital, Beijing, China
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2
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Role of Echocardiography in Diabetic Cardiomyopathy: From Mechanisms to Clinical Practice. J Cardiovasc Dev Dis 2023; 10:jcdd10020046. [PMID: 36826542 PMCID: PMC9959745 DOI: 10.3390/jcdd10020046] [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: 10/14/2022] [Revised: 01/17/2023] [Accepted: 01/25/2023] [Indexed: 01/28/2023] Open
Abstract
It has been well established that diabetes mellitus (DM) is considered as a core risk factor for the development of cardiovascular diseases. However, what is less appreciated is the fact that DM may affect cardiac function irrespective of cardiac pathologies to which it contributes, such as coronary artery disease and hypertension. Although echocardiography provides accurate and reproducible diagnostic and prognostic data in patients with DM, its use in these patients is still underappreciated, resulting in progression of DM-related heart failure in many patients. Hence, in the present review, we aimed to discuss the role of echocardiography in the contemporary management of diabetic cardiomyopathy (DCM), as well as the role of emerging echocardiographic techniques, which may contribute to earlier diagnosis and more appropriate management of this complication of DM. In order to improve outcomes, focus must be placed on early diagnosis of this condition using a combination of echocardiography and emerging biomarkers, but perhaps the more important thing is to change perspective when it comes to the clinical importance of DCM.
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3
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Lisi M, Cameli M, Mandoli GE, Pastore MC, Righini FM, D'Ascenzi F, Focardi M, Rubboli A, Mondillo S, Henein MY. Detection of myocardial fibrosis by speckle-tracking echocardiography: from prediction to clinical applications. Heart Fail Rev 2022; 27:1857-1867. [PMID: 35043264 DOI: 10.1007/s10741-022-10214-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 12/11/2022]
Abstract
Myocardial fibrosis (MF) represents the underlying pathologic condition of many cardiac disease, leading to cardiac dysfunction and heart failure (HF). Biopsy studies have shown the presence of MF in patients with decompensating HF despite apparently normal cardiac function. In fact, basic indices of left ventricular (LV) function, such as LV ejection fraction (EF), fail to recognize subtle LV dysfunction caused by MF. Cardiac magnetic resonance (CMR) with late gadolinium enhancement (LGE) is currently recognized as the gold standard imaging investigation for the detection of focal and diffuse cardiac chambers MF; however, its use is limited by its availability and the use of contrast agents, while echocardiography remains the first level cardiac imaging technique due to its low cost, portability and high accessibility. Advanced echocardiographic techniques, above all speckle-tracking echocardiography (STE), have demonstrated reliability for early detection of structural myocardial abnormalities and for the prediction of prognosis in acute and chronic HF. Myocardial strain of both ventricles and also left atrium has been shown to correlate with the degree of MF, providing useful prognostic information in several diseases, such as HF, cardiomyopathies and valvular heart disease. This paper aims to provide an overview of the pathophysiology of MF and the clinical application of STE for the prediction of left and right heart chambers MF in HF patients.
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Affiliation(s)
- Matteo Lisi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy.
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Viale Randi 5, 48121, Ravenna, Italy.
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden.
| | - Matteo Cameli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Giulia Elena Mandoli
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Maria Concetta Pastore
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
- University of Eastern Piedmont, Maggiore Della Carità Hospital, Novara, Italy
| | - Francesca Maria Righini
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Marta Focardi
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Andrea Rubboli
- Department of Cardiovascular Disease - AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Viale Randi 5, 48121, Ravenna, Italy
| | - Sergio Mondillo
- Department of Medical Biotechnologies, Division of Cardiology, University of Siena, Siena, Italy
| | - Michael Y Henein
- Department of Public Health and Clinical Medicine, Umeå University and Heart Centre, Umeå, Sweden
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Akashi N, Tsukui T, Yamamoto K, Seguchi M, Taniguchi Y, Sakakura K, Wada H, Momomura SI, Fujita H. Comparison of clinical outcomes and left ventricular remodeling after ST-elevation myocardial infarction between patients with and without diabetes mellitus. Heart Vessels 2021; 36:1445-1456. [PMID: 33715109 PMCID: PMC8379135 DOI: 10.1007/s00380-021-01827-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/05/2021] [Indexed: 11/17/2022]
Abstract
Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) is generally thought to be an adaptive but compromising phenomenon particularly in patients with diabetes mellitus (DM). However, whether the extent of LVR is associated with poor prognostic outcome with or without DM after STEMI in the modern era of reperfusion therapy has not been elucidated. This was a single-center retrospective observational study. Altogether, 243 patients who were diagnosed as having STEMI between January 2016 and March 2019, and examined with echocardiography at baseline (at the time of index admission) and mid-term (from 6 to 11 months after index admission) follow-up were included and divided into the DM (n = 98) and non-DM groups (n = 145). The primary outcome was major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, heart failure (HF) hospitalization, and non-fatal myocardial infarction. The median follow-up duration was 621 days (interquartile range: 304–963 days). The DM group was significantly increased the rate of MACEs (P = 0.020) and HF hospitalization (P = 0.037) compared with the non-DM group, despite of less LVR. Multivariate Cox regression analyses revealed that the patients with DM after STEMI were significantly associated with MACEs (Hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.20–6.47, P = 0.017) and HF hospitalization (HR 3.62, 95% CI 1.19–11.02, P = 0.023) after controlling known clinical risk factors. LVR were also significantly associated with MACEs (HR 2.44, 95% CI 1.03–5.78, P = 0.044) and HF hospitalization (HR 3.76, 95% CI 1.15–12.32, P = 0.029). The patients with both DM and LVR had worse clinical outcomes including MACEs and HF hospitalization, suggesting that it is particularly critical to minimize LVR after STEMI in patients with DM.
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Affiliation(s)
- Naoyuki Akashi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-ku, Saitama, 330-8503, Japan.
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Three-Dimensional Echocardiography in Evaluating LA Volumes and Functions in Diabetic Normotensive Patients without Symptomatic Cardiovascular Disease. Int J Vasc Med 2020; 2020:5923702. [PMID: 32922998 PMCID: PMC7453258 DOI: 10.1155/2020/5923702] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Revised: 06/18/2020] [Accepted: 07/08/2020] [Indexed: 11/17/2022] Open
Abstract
Background Cardiovascular complications are the most serious threat to diabetic patients. Associated metabolic and microvascular changes are the main cause of cardiac function affection, and the earliest cardiac change is diastolic dysfunction. Assessment of LA function changes is a key to determine early heart damage of diabetic patients. Objectives To evaluate the effect of diabetes mellitus on left atrial volumes and functions by using real-time 3-dimensional echocardiography in normotensive patients free from cardiovascular disease. Methods The study included 110 individuals, 50 controls and 60 patients with diabetes mellitus, 30 patients with type 1 diabetes mellitus and 30 patients with type 2 diabetes mellitus. 2-dimensional echocardiography was used to assess the LA maximum volume and LA phasic volumes, and LA maximum volume indexed to body surface area were measured by 3D echocardiography. LA functions (LA total stroke volume, LA active stroke volume, and LA active emptying fraction) were obtained from RT3D volumetric analysis. Results The results of the analysis revealed that type 2 diabetes mellitus showed enlarged V max, V min, and LAVi with an increased LA total stroke volume and decreased active emptying fraction, while type 1 diabetics showed only decreased in active emptying fraction. The LA maximum volume indexed to body surface area (LAVi) was significantly higher in type 2 diabetic patients as compared to normal controls which was 23.55 ± 3.37 ml/m2 versus 20.30. Conclusion Patients with type 2 diabetes mellitus have an increased LA volume with impaired compliance and contractility, while patients with type 1 diabetes mellitus have only impaired contractility compared to nondiabetic subjects.
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Bytyci I, Bajraktari G, Fabiani I, Lindqvist P, Poniku A, Pugliese NR, Dini FL, Henein MY. Left atrial compliance index predicts exercise capacity in patients with heart failure and preserved ejection fraction irrespective of right ventricular dysfunction. Echocardiography 2019; 36:1045-1053. [PMID: 31148237 DOI: 10.1111/echo.14377] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2018] [Revised: 04/04/2019] [Accepted: 05/08/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM Predictors of exercise capacity in heart failure (HF) with preserved ejection fraction (HFpEF) remain of difficult determination. The aim of this study was to identify predictors of exercise capacity in a group of patients with HFpEF and right ventricle (RV) dysfunction METHODS: In 143 consecutive patients with HFpEF (age 62 ± 9 years, LV EF ≥45) and 41 controls, a complete echocardiographic study was performed. In addition to conventional measurements, LA compliance was calculated using the formula: [LAV max - LAV min/LAV min × 100]. Exercise capacity was assessed using the six-minute walking test (6-MWT). Tricuspid annular plane systolic excursion (TAPSE) < 1.7 cm was utilized to categorize patients with RV dysfunction (n = 40) from those with maintained RV function (n = 103). RESULTS Patients with RV dysfunction were older (P = 0.002), had higher NYHA class (P = 0.001), higher LV mass index (P = 0.01), reduced septal and lateral MAPSE (all P < 0.001), enlarged LA (P = 0.001) impaired LA compliance index (P < 0.001) and exhibited a more compromised 6-MWT (P = 0.001). LA compliance index correlated more closely with 6-MWT (r = 0.51, P < 0.001) compared with the other LA indices (AP diameter, transverse diameter and volume indexed; r = -0.30, r = -0.35 and r = -0.38, respectively). In multivariate analysis, LA compliance index <60% was 88% sensitive and 61% specific (AUC 0.80, CI = 0.67-0.92 P = 0.001) in predicting exercise capacity. CONCLUSION An impairment in LA compliance was profound in patients with HFpEF and RV dysfunction and seems to be most powerful independent predictor of limited exercise capacity.
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Affiliation(s)
- Ibadete Bytyci
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Gani Bajraktari
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Kosovo
| | - Iacopo Fabiani
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Per Lindqvist
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
| | - Afrim Poniku
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
- St George University London, London, UK
| | | | - Frank L Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Pisa, Italy
| | - Michael Y Henein
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
- St George University London, London, UK
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7
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Badran HM, Faheem N, Soliman M, Hamdy M, Yacoub M. Comparison of vector velocity imaging and three-dimensional speckle tracking echocardiography for assessment of left ventricular longitudinal strain in hypertrophic cardiomyopathy. Glob Cardiol Sci Pract 2019; 2019:6. [PMID: 31024948 PMCID: PMC6472697 DOI: 10.21542/gcsp.2019.6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Vector velocity imaging (VVI) is a two-dimensional wall motion tracking method that can measure cardiac mechanics in hypertrophic cardiomyopathy (HCM). 3D-speckle tracking echocardiography (3D-STE) has been proven to be superior to conventional measures in assessment of LV function. The aim of this study was to compare the two technologies in the assessment of LV longitudinal strain (LS) in HCM patients. Methods: A total of 50 patients with HCM were investigated using VVI and 3D-STE in same setting. 3D-STE allows obtaining longitudinal, circumferential, radial and area strains (AS). Values of longitudinal strain (LS) and AS by 3D-STE were compared to VVI- derived analyses. Thereafter, VVI-LS values were correlated with LV phenotype. Last, the variability of VVI versus 3DE strain measurements as well as recorded time of analysis was assessed. Results: The absolute value of 3D-STE LS and AS is significantly higher than VVI-LS (P < 0.0001). VVI provided complete longitudinal LV strain information, similar to 3D-STE. There is excellent agreement between the two technologies-derived values, however, a greater number of segments could be analyzed using VVI (94.7%), compared with 3DE (62.1%). Despite VVI being more time consuming, VVI-LS is more correlated to LV mass index, mitral regurgitation severity and functional class when compared with 3D-STE LS and AS. Conclusions: VVI is a feasible modality for assessing LV longitudinal strain. Although VVI agreed well with 3D-STE for most of regional and global LS, a better correlation was found between VVI-LS and HCM phenotype. It is hypothesized that this discrepancy originates from the inferior imaging quality using 3D tracking algorithms.
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Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department, Menoufiya University, Egypt.,The BAHCM National Program, Egypt.,Aswan Heart Center, Aswan, Egypt
| | - Naglaa Faheem
- Cardiology Department, Menoufiya University, Egypt.,The BAHCM National Program, Egypt
| | | | | | - Magdi Yacoub
- The BAHCM National Program, Egypt.,Aswan Heart Center, Aswan, Egypt.,Imperial College, London, UK
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Kang SJ, Ha J, Hwang SJ, Kim HJ. Long Term Outcomes of Left Atrial Reservoir Function in Children with a History of Kawasaki Disease. J Cardiovasc Ultrasound 2018; 26:26-32. [PMID: 29629021 PMCID: PMC5881081 DOI: 10.4250/jcu.2018.26.1.26] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 12/27/2017] [Accepted: 02/26/2018] [Indexed: 12/18/2022] Open
Abstract
Background Decreased left atrial (LA) reservoir function is reported to be associated with elevated left ventricular (LV) end diastolic pressure and LV diastolic dysfunction. Echocardiographic parameters that reflect LA reservoir function include LA total emptying fraction [(maximum LA volume - minimum LA volume) / maximum LA volume], peak LA longitudinal strain (PLALS) at systole, and LA stiffness index (E/E´/PLALS). We aimed to investigate the long-term outcomes of LV diastolic function in children with a history of Kawasaki disease (KD) (KDHx group) by assessing LA reservoir function. Methods Retrospectively, echocardiograms performed at a mean follow-up period of 5 years after the acute phase of KD in 24 children in the KDHx group were compared to those from 20 normal control subjects. LA total emptying fraction, PLALS, LA stiffness index, LV peak longitudinal systolic strain (ε), and strain rate (SR) were evaluated with conventional echocardiographic parameters. Results The mean age at long term follow-up echocardiography in children in the KDHx group was 6.8 years. Five children (20.8%) had coronary artery lesions (CALs) in the acute stage of KD. No children showed CALs at a mean follow-up period of 5 years after the acute phase of KD. There were no significant differences in the conventional echocardiographic parameters and in LA total emptying fraction, PLALS, LA stiffness index, LV peak longitudinal systolic ε, and SR, between the children in the KDHx and control group. Conclusion LV diastolic function assessed by LA reservoir function parameters at long-term follow-up in children in the KDHx group appears to be favorable.
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Affiliation(s)
- Soo Jung Kang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Jihyun Ha
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Seo Jung Hwang
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Hyo Jin Kim
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
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9
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Yu L, Zhou Q, Peng Q, Yang Z. Left ventricular function of patients with pregnancy-induced hypertension evaluated using velocity vector imaging echocardiography and N-terminal pro-brain natriuretic peptide. Echocardiography 2018; 35:459-466. [PMID: 29430691 DOI: 10.1111/echo.13817] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE To investigate whether acute and transient pressure overload in patients with pregnancy-induced hypertension (PIH) affects left ventricular (LV) systolic function. METHODS From pregnancy to 3 months after delivery, 82 patients were analyzed: 27, 25, and 30 with gestational hypertension, preeclampsia, and the healthy control group, respectively. Conventional echocardiography and velocity vector imaging (VVI) were performed, and blood levels of N-terminal pro-brain natriuretic peptide (NT-pro-BNP) were analyzed. RESULTS Compared with the control group, patients with gestational hypertension had significantly lower mean LV peak global longitudinal strain. Importantly, during both pregnancy and after delivery, patients with preeclampsia had significantly lower global longitudinal, circumferential, and radial strain compared with the control group. The NT-pro-BNP levels were significantly higher in patients with PIH compared with normotensive pregnancies, and this situation continued for 3 months after delivery in women with preeclampsia. CONCLUSIONS In pregnancies complicated by pregnancy-induced hypertension, especially preeclampsia, the systolic function is impaired and NT-pro-BNP levels are elevated compared with normal pregnancy. Velocity vector imaging (VVI) is more sensitive than left ventricular ejection fraction to evaluate heart function in patients with PIH.
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Affiliation(s)
- Li Yu
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qichang Zhou
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Qinghai Peng
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
| | - Zurong Yang
- Department of Ultrasound Diagnosis, Second Xiangya Hospital of Central South University, Changsha, China
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10
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Abstract
The left atrium has an important role in modulating left ventricular filling and is an important biomarker of cardiovascular disease and adverse cardiovascular outcomes. While previously left atrial (LA) size was utilised, the role of LA function as a biomarker is increasingly being evaluated, both independently and also in combination with LA size. Strain analysis has been utilised for evaluation of LA function and can be measured throughout the cardiac cycle, thereby enabling the evaluation of LA reservoir, conduit and contractile function. Strain evaluates myocardial deformation while strain rate examines the rate of change in strain. This review will focus on the various types of strain analysis for evaluation of LA function, alterations in LA strain in physiological and pathologic states that alter LA function and finally evaluate its utility as a prognostic marker.
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Affiliation(s)
- Gary C H Gan
- Department of Cardiology, Blacktown Hospital, Blacktown, NSW, Australia.,University of New South Wales, Sydney, Australia
| | | | - Anita Boyd
- University of Sydney, Sydney, NSW, Australia.,Westmead Private Cardiology, Westmead, NSW, Australia
| | - Liza Thomas
- University of New South Wales, Sydney, Australia.,University of Sydney, Sydney, NSW, Australia.,Department of Cardiology, Westmead Hospital, Westmead, NSW, Australia
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11
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Kang SJ, Kwon YW, Hwang SJ, Kim HJ, Jin BK, Yon DK. Clinical Utility of Left Atrial Strain in Children in the Acute Phase of Kawasaki Disease. J Am Soc Echocardiogr 2018; 31:323-332. [PMID: 29305035 DOI: 10.1016/j.echo.2017.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Indexed: 01/11/2023]
Abstract
BACKGROUND We aimed to evaluate the diagnostic utility of peak left atrial longitudinal strain (PALS) during left ventricular (LV) systole to differentiate children in the acute phase of Kawasaki disease (aKD) from controls. We also aimed to compare the diagnostic utility of PALS with those of conventional echocardiographic indices of diastolic function. METHODS Retrospectively measured PALS, LV longitudinal peak systolic strain, and strain rate obtained via velocity vector imaging were compared in a derivation cohort comprising 95 aKD and 67 controls. The utility of PALS in differentiating aKD from controls was compared with those of E/E', E/A, and maximum left atrial volume index (LAVImax). Derived cutoffs from receiver operating characteristic curves were validated in a separate validation cohort comprising 37 aKD and 19 controls. RESULTS In the derivation cohort, PALS was significantly decreased in aKD as compared with in controls. For differentiating aKD from controls, PALS outperformed E/E', E/A, and LAVImax. However, cutoffs of PALS (≤40% and ≤39%, before and after adjusting for the presence of significant mitral regurgitation and LV systolic dysfunction, respectively), like those of E/E', E/A, and LAVImax, showed low sensitivity and poor discriminative ability for differentiating aKD from controls. In the validation cohort, for differentiating aKD from controls, both cutoffs of PALS showed low sensitivity, like those of E/E', E/A, and LAVImax. CONCLUSION In aKD, impaired left atrial reservoir function could be detected as decreased PALS. For differentiating aKD from controls, PALS outperforms E/E', E/A, and LAVImax. However, like E/E', E/A, and LAVImax, PALS as a single parameter is limited in its clinical utility to differentiate aKD from controls because of its low sensitivity and poor discriminative ability.
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Affiliation(s)
- Soo Jung Kang
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea.
| | - Yoo Won Kwon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Seo Jung Hwang
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Hyo Jin Kim
- Department of Diagnostic Laboratory Medicine, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Bo Kyeong Jin
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
| | - Dong Keon Yon
- Department of Pediatrics, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Republic of Korea
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12
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Bytyçi I, Bajraktari G. Left atrial changes in early stages of heart failure with preserved ejection fraction. Echocardiography 2016; 33:1479-1487. [PMID: 27471047 DOI: 10.1111/echo.13306] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND AND AIM Increased left atrial (LA) mass was introduced as a compensatory mechanism in heart failure (HF) patients. Furthermore, atrial conduction time and LA emptying fraction is are deteriorated in HF with preserved ejection fraction (HFpEF). The aim of this study was to assess the early LA changes in HFpEF patients. METHODS In 79 consecutive patients with HFpEF (age 61±8 years, NYHA class I-III, LV EF ≥45%), a complete 2-dimensional, M-mode, and Doppler echocardiographic study was performed. According to the diastolic dysfunction (DD), patients were divided into three groups: Group I-29 healthy subjects (control group); Group II-HFpEF patients with mild DD; and Group III-HFpEF patients with moderate DD. RESULTS The LV mass was increased (P<.05), septal s', lateral s', septal and lateral MAPSE were decreased (P<.05, for all), E/e' ratio was increased (P<.001), LA mass and minimal volume were increased (P<.001, P<.05), LA emptying fraction was decreased (P<.05), and LA dyssynchrony was deteriorated (P<.05) in patients with mild DD compared to controls. These changes were of the same nature in patients with moderate LV DD. CONCLUSIONS In early stage of DD, in patients with HFpEF, in addition to LV hypertrophy and compromised LV longitudinal systolic function, the LA emptying fraction is reduced, LA mass and LAV min are increased and LA dyssynchrony is significant, despite normal LA dimensions. These findings suggest early LA function deterioration irrespective of normal cavity measurements, hence a need for optimum therapy.
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Affiliation(s)
- Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo.
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Republic of Kosovo
- Medical Faculty, University of Prishtina, Prishtina, Republic of Kosovo
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Moustafa S, Ho TH, Shah P, Murphy K, Nelluri BK, Lee H, Wilansky S, Mookadam F. Predictors of incipient dysfunction of all cardiac chambers after treatment of metastatic renal cell carcinoma by tyrosine kinase inhibitors. JOURNAL OF CLINICAL ULTRASOUND : JCU 2016; 44:221-230. [PMID: 26875513 PMCID: PMC7584378 DOI: 10.1002/jcu.22333] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 10/28/2015] [Accepted: 12/31/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE We aimed to explore the hypothesis that early subclinical cardiac chamber dysfunction secondary to tyrosine kinase inhibitors (TKIs) in patients with metastatic renal cell carcinoma could be signaled by abnormal cardiac mechanics demonstrated by velocity vector imaging. METHODS Echocardiographic images were acquired from the apical views in 23 metastatic renal cell carcinoma patients. All patients had baseline and at least a 3-month follow-up echocardiogram after receiving TKI therapy. Subendocardial borders of all the cardiac chambers were traced to obtain volumetric and deformation indices. RESULTS Mean age was 67 ± 9 years with 92% men. The right ventricle peak systolic global longitudinal strain (GLɛ) and strain rate were significantly lower after TKIs (-23.49 ± 5.1 versus -19.81 ± 5.5, p = 0.002 and -1.52 ± 0.52 versus -1.24 ± 0.35 p = 0.02, respectively). LV GLɛ was not statistically different. Volumetric and deformation indices showed a minimal decrease of the right atrium reservoir and conduit functions, and no significant changes of left atrial function. CONCLUSIONS The right heart exhibited greater strain changes than the left heart after TKI treatment. The implications of these findings and their potential significance warrant further work.
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Affiliation(s)
- Sherif Moustafa
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ
| | - Thai H Ho
- Division of Hematology/Oncology, Department of Medicine, Mayo Clinic, Arizona, AZ
| | - Parth Shah
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ
| | - Katie Murphy
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ
| | - Bhargava K Nelluri
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ
| | - Howard Lee
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ
| | - Susan Wilansky
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ
| | - Farouk Mookadam
- Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Arizona, AZ
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Left ventricular longitudinal systolic dysfunction is associated with right atrial dyssynchrony in heart failure with preserved ejection fraction. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2016. [DOI: 10.1016/j.repce.2015.11.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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15
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Bytyçi I, Haliti E, Berisha G, Tishukaj A, Shatri F, Bajraktari G. Left ventricular longitudinal systolic dysfunction is associated with right atrial dyssynchrony in heart failure with preserved ejection fraction. Rev Port Cardiol 2016; 35:207-14. [PMID: 26992745 DOI: 10.1016/j.repc.2015.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2015] [Accepted: 11/21/2015] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE We aimed in this study to assess the role of longitudinal left ventricular (LV) systolic function in heart failure with preserved ejection fraction (HFpEF) in delayed intra- and interatrial conduction time. METHODS In 85 consecutive patients with HFpEF (age 60±11 years, ejection fraction [EF] ≥45%), a complete M-mode echocardiographic and tissue Doppler imaging (TDI) study was performed. The times from the onset of the P wave on the ECG to the beginning of the A' wave (PA) from the lateral and septal mitral and tricuspid annuli on TDI were recorded. The difference between these intervals gave the intra- and interatrial dyssynchrony. Based on mitral annular plane systolic excursion (MAPSE), patients were classified as having HFpEF with impaired (MAPSE ≤1.2 cm) or normal (MAPSE >1.2 cm) longitudinal systolic function. RESULTS Patients with impaired MAPSE were older (p<0.001), had higher LV mass index (p<0.001), greater left atrial (LA) minimum volume (p=0.007), reduced left atrial EF (p<0.001), higher E/e' ratio (p=0.002), reduced lateral and septal e' wave (p=0.005 and p=0.006, respectively), prolonged tricuspid PA' (p=0.03) and significantly increased right atrial (RA) dyssynchrony (p=0.001) compared with normal MAPSE. MAPSE correlated with RA dyssynchrony (r=-0.40, p<0.001) but not with interatrial and LA dyssynchrony. CONCLUSION In patients with HFpEF and impaired MAPSE, RA dyssynchrony is increased, compared to those with normal MAPSE. As patients with RA dyssynchrony are at higher risk for arrhythmia, assessment of this dyssynchrony may help to improve treatment, as well as to predict outcome in these patients.
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Affiliation(s)
- Ibadete Bytyçi
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo.
| | - Edmond Haliti
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Gëzim Berisha
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Arbërie Tishukaj
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Faik Shatri
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
| | - Gani Bajraktari
- Clinic of Cardiology, University Clinical Centre of Kosova, Prishtina, Kosovo
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Wang Y, Hou D, Ma R, Ding G, Yin L, Zhang M. Early Detection of Left Atrial Energy Loss and Mechanics Abnormalities in Diabetic Patients with Normal Left Atrial Size: A Study Combining Vector Flow Mapping and Tissue Tracking Echocardiography. Med Sci Monit 2016; 22:958-68. [PMID: 27005947 PMCID: PMC4807740 DOI: 10.12659/msm.897385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Whether left atrial (LA) functional abnormalities already exist when the LA is of normal size is unknown. The aim of this study was to explore LA energy loss and mechanics changes using vector flow mapping (VFM) and two-dimensional tissue tracking (2DTT) echocardiography in patients with diabetes and normal LA size. Material/Methods This study included 47 normotensive patients with diabetes and 45 controls. The following indexes were measured: LA energy loss during systole (LAELs), early diastole (LAELed), and atrial contraction (LAELac); atrial longitudinal strain during systole (SLAs), early diastole (SLAed) and late diastole (SLAac); and peak LA strain rate during systole (SRLAs), early diastole (SRLAed), and atrial contraction (SRLAac). Results The LAELs and LAELed decreased in diabetic patients compared with controls (P=0.002, P<0.01, respectively), whereas the LAELac increased in diabetic patients (P<0.001). The SLAs, SLAed, SRLAs, and SRLAed (all P<0.01) were all lower in diabetic patients than in controls. However, there was no difference in the SLAac and SRLAac between the two groups. Multivariate regression analysis showed that the LAELs, LAELac, and SRLAs were independently associated with HbA1c in the whole study population. Conclusions LA energy loss and deformation mechanics are already impaired in diabetic patients with normal LA size and the long-term parameter of glycemic control was correlated with them. VFM combined with 2DTT might be a promising tool for the early detection of LA dysfunction caused by impaired glucose metabolism.
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Affiliation(s)
- Yi Wang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
| | - Dailun Hou
- Department of Medical Image, Shandong Chest Hospital, Jinan, Shandong, China (mainland)
| | - Rongchuan Ma
- Institute of Ultrasound Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China (mainland)
| | - Geqi Ding
- Institute of Ultrasound Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China (mainland)
| | - Lixue Yin
- Institute of Ultrasound Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, China (mainland)
| | - Mei Zhang
- Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, China (mainland)
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Moustafa S, Murphy K, Nelluri BK, Northfelt D, Shah P, Lee H, Wilansky S, Naqvi TZ, Meyer S, Mookadam F. Temporal Trends of Cardiac Chambers Function with Trastuzumab in Human Epidermal Growth Factor Receptor II-Positive Breast Cancer Patients. Echocardiography 2015; 33:406-15. [DOI: 10.1111/echo.13087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sherif Moustafa
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Katie Murphy
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Bhargava K. Nelluri
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Donald Northfelt
- Division of Hematology/Oncology; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Parth Shah
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Howard Lee
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Susan Wilansky
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Tasneem Z. Naqvi
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Susan Meyer
- Division of Hematology/Oncology; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
| | - Farouk Mookadam
- Division of Cardiovascular Diseases; Department of Medicine; Mayo Clinic Arizona; Scottsdale Arizona
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18
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Assessment of left atrial deformation properties by speckle tracking in patients with systolic heart failure. Egypt Heart J 2015. [DOI: 10.1016/j.ehj.2014.07.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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19
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Bonapace S, Rossi A, Lipari P, Bertolini L, Zenari L, Lanzoni L, Canali G, Molon G, Mantovani A, Zoppini G, Bonora E, Barbieri E, Targher G. Relationship between increased left atrial volume and microvascular complications in patients with type 2 diabetes. J Diabetes Complications 2015; 29:822-8. [PMID: 26050564 DOI: 10.1016/j.jdiacomp.2015.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 10/23/2022]
Abstract
AIMS We assessed whether left atrial volume index (LAVI) was associated with the presence of microvascular complications in patients with type 2 diabetes, and whether this association was independent of hemodynamic and non-hemodynamic factors. METHODS We studied 157 consecutive outpatients with type 2 diabetes with no previous history of ischemic heart disease, chronic heart failure and valvular diseases. A transthoracic echocardiography and myocardial perfusion scintigraphy were performed in all participants. Presence of microvascular complications was also recorded. RESULTS Overall, 51 patients had decreased estimated glomerular filtration rate and/or abnormal albuminuria, 24 had diabetic retinopathy, 22 had lower-extremity sensory neuropathy, and 67 (42.7%) patients had one or more of these microvascular complications (i.e., combined endpoint). After stratifying patients by LAVI, those with LAVI ≥32 ml/m(2) had a greater prevalence of microvascular complication, lower left ventricular (LV) ejection fraction, higher LV mass index and higher E/e' ratio than those with LAVI <32 ml/m(2). Logistic regression analyses revealed that microvascular complications (singly or in combination) were associated with increased LAVI, independently of age, sex, diabetes duration, hemoglobin A1c, hypertension, LV-ejection fraction, LV mass index and the E/e' ratio. CONCLUSIONS These results indicate that microvascular diabetic complications are associated with increased LAVI in well-controlled type 2 diabetic patients with preserved systolic function and free from ischemic heart disease, independently of multiple potential confounders.
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Affiliation(s)
- Stefano Bonapace
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Andrea Rossi
- Section of Cardiology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Paola Lipari
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Lorenzo Bertolini
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Luciano Zenari
- Division of General Medicine and Diabetes Unit "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Laura Lanzoni
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Guido Canali
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Giulio Molon
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Alessandro Mantovani
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Giacomo Zoppini
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enzo Bonora
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
| | - Enrico Barbieri
- Division of Cardiology, "Sacro Cuore" Hospital, Negrar (VR), Italy
| | - Giovanni Targher
- Section of Endocrinology, Diabetes and Metabolism, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy
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Dahlbäck C, Gudmundsson S. Investigations on atrial function in fetuses with signs of impaired placental function. Prenat Diagn 2015; 35:605-11. [DOI: 10.1002/pd.4580] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 02/12/2015] [Accepted: 02/12/2015] [Indexed: 11/12/2022]
Affiliation(s)
- Charlotte Dahlbäck
- Lund University, Department of Obstetrics and Gynecology; Skåne University Hospital; Malmö Sweden
| | - Saemundur Gudmundsson
- Lund University, Department of Obstetrics and Gynecology; Skåne University Hospital; Malmö Sweden
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Badran HM, Faheem N, Elnoamany MF, Kenawy A, Yacoub M. Characterization of Left Atrial Mechanics in Hypertrophic Cardiomyopathy and Essential Hypertension Using Vector Velocity Imaging. Echocardiography 2015; 32:1527-38. [DOI: 10.1111/echo.12885] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Affiliation(s)
- Hala Mahfouz Badran
- Cardiology Department; Menoufiya University; Shebin Egypt
- The BAHCM National Program; Aswan Egypt
- Aswan Heart Center; Aswan Egypt
| | - Naglaa Faheem
- Cardiology Department; Menoufiya University; Shebin Egypt
- The BAHCM National Program; Aswan Egypt
| | | | - Asma Kenawy
- Cardiology Department; Menoufiya University; Shebin Egypt
| | - Magdi Yacoub
- The BAHCM National Program; Aswan Egypt
- Aswan Heart Center; Aswan Egypt
- Imperial College; London United Kingdom
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22
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[Comments on the 2013 ESC/EASD guidelines on diabetes, prediabetes and cardiovascular diseases]. Herz 2014; 39:971-84. [PMID: 25416683 DOI: 10.1007/s00059-014-4168-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Patients with type 2 diabetes mellitus have an increased cardiovascular risk compared with non-diabetics. The new guidelines provide physicians with orientation with respect to disorders in glucose metabolism and the risk of occurrence of cardiovascular diseases. An HBA1c level in the range of 6-8% is currently recommended, depending on cardiovascular comorbidities: in young diabetics 6% is recommended to avoid hypoglycemia and in older individuals with cardiovascular complications 8%. The target blood pressure given in the new guidelines is <140/85 mmHg. The guidelines still recommend bypass surgery instead of percutaneous coronary intervention (PCI) for diabetics; however, this recommendation is based on studies that do not reflect current practice and is disputable. Diagnostic measures and therapy of cardiac failure and arrhythmic disorders in the guidelines do not essentially differ between patients with and without diabetes, basically due to a lack of studies.
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Tadic M, Cuspidi C. The influence of type 2 diabetes on left atrial remodeling. Clin Cardiol 2014; 38:48-55. [PMID: 25403642 DOI: 10.1002/clc.22334] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/02/2014] [Accepted: 08/12/2014] [Indexed: 01/18/2023] Open
Abstract
The influence of type 2 diabetes mellitus on cardiac remodeling has been evaluated for decades; however, the majority of investigations were focused only on the left ventricle. The impact of diabetes on the left atrial (LA) function is less researched. LA enlargement has been shown as an independent predictor of cardiovascular morbidity and mortality in the general and diabetic population; however, LA dysfunction has been proven to be an independent predictor only in the general population. There are not much follow-up data about the influence of diabetes on LA function. New echocardiographic techniques, such as 2-dimensional speckle tracking imaging, provide more accurate, sensitive, and reliable information about LA function than traditional, volumetric methods. The aim of this review was to summarize the most recent reports about the influence of diabetes on LA function, as well as to discuss the possible mechanisms and potential clinical implications of the relationship between diabetes and LA remodeling.
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Affiliation(s)
- Marijana Tadic
- Department of Cardiology, University Clinical Hospital Centre "Dr. Dragisa Misovic-Dedinje,", Belgrade, Serbia
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Bytyçi I, Bajraktari G, Ibrahimi P, Berisha G, Rexhepaj N, Henein MY. Left atrial emptying fraction predicts limited exercise performance in heart failure patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. HEART & VESSELS 2014; 4:203-207. [PMID: 29450190 PMCID: PMC5801443 DOI: 10.1016/j.ijchv.2014.04.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2014] [Accepted: 04/13/2014] [Indexed: 02/08/2023]
Abstract
AIM We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF). METHODS This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s', e' and a'), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination. RESULTS Patients with limited exercise performance (≤ 300 m) were older (p = 0.01), had higher NYHA functional class (p = 0.004), higher LV mass index (p = 0.003), larger LA (p = 0.002), lower LV EF (p = 0.009), larger LV end-systolic dimension (p = 0.007), higher E/A ratio (p = 0.03), reduced septal MAPSE (p < 0.001), larger LA end-systolic volume (p = 0.03), larger LA end-diastolic volume (p = 0.005) and lower LA emptying fraction (p < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898-0.993), p = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, p < 0.001) in predicting poor exercise performance. CONCLUSION In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.
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Affiliation(s)
- Ibadete Bytyçi
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
| | - Gani Bajraktari
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
- Corresponding author at: Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, “Rrethi i Spitalit,” p.n., Prishtina, Kosovo. Tel.: + 377 45 800 808Corresponding author at: Clinic of Cardiology and AngiologyUniversity Clinical Centre of Kosova“Rrethi i Spitalit,” p.n.Tel.: + 377 45 800 808PrishtinaKosovo
| | - Pranvera Ibrahimi
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
- Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Gëzim Berisha
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
| | - Nehat Rexhepaj
- Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo
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Yurdakul S, Yıldirimtürk O, Aytekin S. Left atrial mechanical functions in chronic primary mitral regurgitation patients: a velocity vector imaging-based study. Arch Med Sci 2014; 10:455-63. [PMID: 25097574 PMCID: PMC4107252 DOI: 10.5114/aoms.2014.43740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 01/21/2012] [Accepted: 04/01/2012] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION Assessment of the left atrium (LA) mechanical function provides further information on the level of cardiac compensation. We aimed to evaluate LA function using a strain imaging method: velocity vector imaging (VVI) in chronic primary mitral regurgitation (MR). MATERIAL AND METHODS We recruited 48 patients with chronic, isolated, moderate to severe MR (54.70 ±15.35 years and 56% male) and 30 age- and sex-matched healthy controls (56.52 ±15.95 years and 56% male). The LA volumes during reservoir (RV), conduit (CV) and contractile phases (AV) were measured. Global strain (S), systolic strain rate (SRs), early diastolic (ESRd) and late diastolic strain rate (LSRd) were calculated. RESULTS LA RV (50 ±18.7 to 37.9 ±5.9; p = 0.0001), CV (43.1 ±29 to 21 ±2.56; p = 0.0001), and AV (17.9 ±13.5 to 10.9 ±1.9; p = 0.006) were increased in MR patients. The LA reservoir phase strain was 16.2 ±8.1% in the MR group and 51.1 ±5.7% in the control group (p = 0.0001). The LA SRs (1.01 ±0.52 s(-1) for MR and 2.1 ±0.22 s(-1) for controls; p = 0.0001), LA ESRd (0.83 ±0.34 s(-1) for MR and 2.26 ±0.17 s(-1) for controls; p = 0.0001) and LA LSRd (0.76 ±0.24 s(-1) for MR and 2.2 ±0.26 s(-1) for controls; p = 0.0001) were impaired in MR patients. CONCLUSIONS The LA deformation indices may be used as adjunctive parameters to determine LA dysfunction in chronic primary MR.
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Affiliation(s)
- Selen Yurdakul
- Division of Cardiology, Florence Nightingale Hospital, Istanbul, Turkey
| | | | - Saide Aytekin
- Division of Cardiology, Florence Nightingale Hospital, Istanbul, Turkey
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL. ESC guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD - summary. Diab Vasc Dis Res 2014; 11:133-73. [PMID: 24800783 DOI: 10.1177/1479164114525548] [Citation(s) in RCA: 146] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Guía de práctica clínica de la ESC sobre diabetes, prediabetes y enfermedad cardiovascular, en colaboración con la European Association for the Study of Diabetes. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Aminian F, Esmaeilzadeh M, Moladoust H, Maleki M, Shahrzad S, Emkanjoo Z, Sadeghpour A. Does accessory pathway significantly alter left ventricular twist/torsion? A study in Wolff-Parkinson-White syndrome by velocity vector imaging. Echocardiography 2013; 31:872-8. [PMID: 24372902 DOI: 10.1111/echo.12470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the impact of manifest accessory pathway on left ventricle (LV) twist physiology in Wolff-Parkinson-White (WPW) patients. Although this issue was addressed in 1 study based on speckle tracking method, there was no comparative study with a different technique. We planned to use velocity vector imaging (VVI) to find out how much an accessory pathway can affect LV twist mechanics. METHODS Thirty patients were enrolled regarding inclusion and exclusion criteria. Two serial comprehensive transthoracic echocardiography evaluations were performed before and after radiofrequency catheter ablation (RFCA) within 24 hours. Stored cine loops were analyzed using VVI technique and LV twist and related parameters were extracted. RESULTS Comparing pre- and post-RFCA data, no significant changes were observed in LV systolic and diastolic dimensions, LV ejection fraction (LVEF), and Doppler and tissue Doppler-related parameters. VVI study revealed remarkable rise in peak LV apical rotation (10.3º ± 3.0º to 13.8º ± 3.6º, P < 0.001) and basal rotation (-6.0 ± 1.8º to -7.7 ± 1.8º, P < 0.001) after RFCA. Subsequently LV twist showed a surge from 14.7º ± 3.9º to 20.2º ± 4.4º (P < 0.001). LV untwisting rate changed significantly from -96 ± 67 to -149.0 ± 47.5°/sec (P < 0.001) and apical-basal rotation delay showed a remarkable decline after RFCA (106 ± 81 vs. 42.8 ± 26.0 msec, P < 0.001). CONCLUSION Accessory pathways have a major impact on LV twist mechanics.
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Evaluation of Left Atrial Two-Dimensional Strain in Patients with Systolic Heart Failure using Velocity Vector Imaging. ACTA ACUST UNITED AC 2013. [DOI: 10.5812/acvi.14486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Badran HM, Soltan G, Hassan H, Nazmy A, Faheem N, Saadan H, Yacoub MH. Changes in left atrial deformation in hypertrophic cardiomyopathy: Evaluation by vector velocity imaging. Glob Cardiol Sci Pract 2013; 2012:67-80. [PMID: 24688992 PMCID: PMC3963718 DOI: 10.5339/gcsp.2012.25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Accepted: 12/11/2012] [Indexed: 11/17/2022] Open
Abstract
Abstract:Objectives: Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. We assessed the global and regional left atrial (LA) function and its relation to left ventricular (LV) mechanics and clinical status in patients with HCM using Vector Velocity Imaging (VVI). Methods: VVI of the LA and LV was acquired from apical four- and two-chamber views of 108 HCM patients (age 40 ± 19years, 56.5% men) and 33 healthy subjects, all had normal LV systolic function. The LA subendocardium was traced to obtain atrial volumes, ejection fraction, velocities, and strain (ϵ)/strain rate (SR) measurements. Results: Left atrial reservoir (ϵsys,SRsys) and conduit (early diastolic SRe) function were significantly reduced in HCM compared to controls (P < .0001). Left atrial deformation directly correlated to LVϵsys, SRsys and negatively correlated to age, NYHA class, left ventricular outflow tract (LVOT) gradient, left ventricular mass index (LVMI), LA volume index and severity of mitral regurge (P < 0.001). Receiver operating characterist was constructed to explore the cutoff value of LA deformation in differentiation of LA dysfunction; ϵsys < 40% was 75% sensitive, 50% specific, SRsys < 1.7s− 1 was 70% sensitive, 61% specific, SRe> − 1.8s− 1 was 81% sensitive and 30% specific, SRa> − 1.5s− 1 was 73% sensitive and 40% specific. By multivariate analysis global LVϵsys and LV septal thickness are independent predictors for LAϵsys, while end systolic diameter is the only independent predictor for SRsys, P < .001. Conclusion: Left atrial reservoir and conduit function as measured by VVI were significantly impaired while contractile function was preserved among HCM patients. Left atrial deformation was greatly influenced by LV mechanics and correlated to severity of phenotype.
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Affiliation(s)
| | - Ghada Soltan
- Cardiology Department, Menoufiya University, Egypt
| | | | - Ahmed Nazmy
- Cardiology Department, Menoufiya University, Egypt
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Li Y, Ding W, Wang H, Song N, Lin L, Wang Z, Zhong M, Zhang Y, Zhang W. Relationship of CHA2DS2-VASc and CHADS2 score to left atrial remodeling detected by velocity vector imaging in patients with atrial fibrillation. PLoS One 2013; 8:e77653. [PMID: 24147047 PMCID: PMC3798687 DOI: 10.1371/journal.pone.0077653] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Accepted: 09/12/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND The CHADS2/CHA2DS2-VASc scores are used to predict thrombo-embolic/stroke in patients with nonvalvular atrial fibrillation (AF). Nevertheless, limited data are available regarding the association between these risk stratification for stroke and left atrial (LA) remodeling status of AF patients. The purpose of this study was to explore the association between these scores and LA remodeling status assessed quantificationally by echocardiography in AF patients. METHODS One hundred AF patients were divided into 3 groups based on the CHA2DS2-VASc/CHADS2 score: the score of 0 (low stroke risk), the score of 1 (moderate stroke risk) and the score of ≥2 (high stroke risk). All patients were performed through conventional and velocity vector imaging echocardiography. Echocardiographic parameters: maximum LA volume index (LAVImax), LA total emptying fraction (LAEFt) and LA mean strain were obtained to assess quantificationally LA remodeling status. RESULTS On categorizing with CHA2DS2-VASc, the score of 1 group showed augment in LAVImax and attenuation in LA mean strain derived from VVI, compared with the score of 0 group (LAVImax: 40.27±21.91 vs. 26.79±7.87, p=0.002; LA mean strain: 15.18±6.36 vs. 22±8.54, p=0.001). On categorizing with the CHADS2 score, similar trends were seen between the score of ≥2 and 1 groups (LAVImax: 43.72±13.77 vs. 31.41±9.50, p<0.001; LA mean strain: 11.01±5.31 vs. 18.63±7.00, p<0.001). With multivariate logistic regression, LAVImax (odds ratio: 0.92 , 95% C=I: 0.85 to 0.98, p= 0.01) and LA mean strain reflecting LA remodeling (odds ratio: 1.10, 95% CI: 1.02 to 1.19, p=0.01) were strongly predictive of the CHA2DS2-VASc score of 0. CONCLUSIONS The superiority of the CHADS2 score may lay in identifying LA remodeling of AF patients with high stroke risk. Whereas, the CHA2DS2-VASc score was better than the CHADS2 score at identifying LA remodeling of AF patients presenting low stroke risk.
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Affiliation(s)
- Yihui Li
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Wenyuan Ding
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Hua Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Nianpeng Song
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Leyu Lin
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Zhihao Wang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Ming Zhong
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Yun Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
| | - Wei Zhang
- Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Jinan, P.R. China
- Qilu Hospital of Shandong University, Jinan, P.R. China
- * E-mail:
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Rydén L, Grant PJ, Anker SD, Berne C, Cosentino F, Danchin N, Deaton C, Escaned J, Hammes HP, Huikuri H, Marre M, Marx N, Mellbin L, Ostergren J, Patrono C, Seferovic P, Uva MS, Taskinen MR, Tendera M, Tuomilehto J, Valensi P, Zamorano JL, Zamorano JL, Achenbach S, Baumgartner H, Bax JJ, Bueno H, Dean V, Deaton C, Erol C, Fagard R, Ferrari R, Hasdai D, Hoes AW, Kirchhof P, Knuuti J, Kolh P, Lancellotti P, Linhart A, Nihoyannopoulos P, Piepoli MF, Ponikowski P, Sirnes PA, Tamargo JL, Tendera M, Torbicki A, Wijns W, Windecker S, De Backer G, Sirnes PA, Ezquerra EA, Avogaro A, Badimon L, Baranova E, Baumgartner H, Betteridge J, Ceriello A, Fagard R, Funck-Brentano C, Gulba DC, Hasdai D, Hoes AW, Kjekshus JK, Knuuti J, Kolh P, Lev E, Mueller C, Neyses L, Nilsson PM, Perk J, Ponikowski P, Reiner Z, Sattar N, Schächinger V, Scheen A, Schirmer H, Strömberg A, Sudzhaeva S, Tamargo JL, Viigimaa M, Vlachopoulos C, Xuereb RG. ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD: the Task Force on diabetes, pre-diabetes, and cardiovascular diseases of the European Society of Cardiology (ESC) and developed in collaboration with the European Association for the Study of Diabetes (EASD). Eur Heart J 2013; 34:3035-87. [PMID: 23996285 DOI: 10.1093/eurheartj/eht108] [Citation(s) in RCA: 1394] [Impact Index Per Article: 126.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
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- The disclosure forms of the authors and reviewers are available on the ESC website www.escardio.org/guidelines
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Sampaio F, Pimenta J, Bettencourt N, Fontes-Carvalho R, Silva AP, Valente J, Bettencourt P, Fraga J, Gama V. Left atrial function is impaired in cirrhosis: a speckle tracking echocardiographic study. Hepatol Int 2013. [PMID: 26202416 DOI: 10.1007/s12072-013-9469-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE Abnormalities in left ventricular systolic and diastolic function have been described in patients with cirrhosis. There are no studies on left atrial (LA) function in these patients. We aimed to evaluate LA function in cirrhosis patients using myocardial deformation imaging. METHODS We included 111 hospitalized and ambulatory patients with cirrhosis and 18 healthy controls. A comprehensive echocardiographic evaluation was performed; LA strain was assessed using velocity vector imaging. RESULTS Peak atrial longitudinal strain at the end of ventricular systole was lower in patients [41.9 % (34.4-51.0) vs. 48.0 % (42.0-57.1), p = 0.02]. No differences were found in atrial strain before atrial contraction in patients and controls [17.5 % (14.3-22.4) vs. 20.7 % (14.1-26.3), p = 0.14]. On multivariate linear regression analysis, E' velocity was the only variable independently associated with peak atrial longitudinal strain (R (2) = 47 %). No correlation was found between the LA volume index (LAVI) and peak atrial longitudinal strain (r = -0.136, p = 0.219). Peak atrial longitudinal strain performed better than LAVI in identifying patients with elevated filling pressures (AUC = 0.81 vs. 0.52). CONCLUSIONS Patients with cirrhosis have abnormal atrial reservoir function, which may be related to the same factors associated with impaired ventricular relaxation. LA enlargement in cirrhosis may not reflect elevated filling pressures and should not be used as an isolated marker of diastolic dysfunction. The atrial "pump" function does not seem to be affected in cirrhosis patients.
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Affiliation(s)
- Francisco Sampaio
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal.
- Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal.
| | - Joana Pimenta
- Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Nuno Bettencourt
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal
- Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Ricardo Fontes-Carvalho
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal
- Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - Ana Paula Silva
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal
| | - João Valente
- Internal Medicine Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal
| | - Paulo Bettencourt
- Cardiovascular R&D Unit, University of Porto Medical School, Porto, Al. Prof. Hernani Monteiro, 4200-319, Porto, Portugal
| | - José Fraga
- Gastroenterology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal
| | - Vasco Gama
- Cardiology Department, Centro Hospitalar de Gaia/Espinho, Rua Conceição Fernandes, 4430-502, Vila Nova de Gaia, Portugal
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Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI. Left Atrial Strain Is Reduced in Patients with Atrial Fibrillation, Stroke or TIA, and Low Risk CHADS2 Scores. J Am Soc Echocardiogr 2012; 25:1327-32. [DOI: 10.1016/j.echo.2012.09.004] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Indexed: 10/27/2022]
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Kadappu KK, Boyd A, Eshoo S, Haluska B, Yeo AET, Marwick TH, Thomas L. Changes in left atrial volume in diabetes mellitus: more than diastolic dysfunction? Eur Heart J Cardiovasc Imaging 2012; 13:1016-23. [PMID: 22544873 DOI: 10.1093/ehjci/jes084] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
AIM To evaluate left atrial (LA) volume and function as assessed by strain and strain rate derived from 2D speckle tracking and their association with diastolic dysfunction (DD) in patients with diabetes mellitus (DM). METHODS AND RESULTS Seventy three patients with DM were compared with age- and gender-matched normal controls; 30 patients with DM alone were compared to those with hypertension (HT) alone. The maximum LA volume, traditional measures of atrial function, 2D strain and strain rate were analysed. The LA indexed volume (LAVI) was larger in DM group than that in normal controls (38.2 ± 9.9 vs. 20.5 ± 4.8 ml/m(2), P< 0.0001), as well as in DM alone compared with hypertensive patients (33.9 ± 10 vs. 25.7 ± 8 ml/m(2), P< 0.0001). Global strain was significantly reduced in the DM group compared with that in normal controls (22.5 ± 8.67 vs. 30.6 ± 8.27%; P< 0.0001) but was similar with HT. There was a weak correlation between LAVI and global strain with increasing grades of DD (r= 0.439, P< 0.0001 and r= - 0.316, P< 0.0001, respectively) in the diabetic group. However, there was no significant difference in LAVI between these groups. A logistic regression analysis for predictors of LAVI demonstrated that only diabetes was a determinant of LAVI. Patients with diabetes showed a significant reduction in global strain compared with normal controls but no difference with increasing grades of diastolic function. CONCLUSIONS LA enlargement in DM is independent of associated HT and diastolic function. LA enlargement is associated with LA dysfunction as evaluated by 2D strain. It is likely that a combination of DD and a diabetic atrial myopathy contribute to LA enlargement in patients with DM.
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Affiliation(s)
- Krishna Kishor Kadappu
- South Western Sydney Clinical School, University of New South Wales and Liverpool Hospital, NSW, Australia
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Liu F, Liu S, Ma Z, Zhan X, Tao G, Cheng L, Song X. Assessment of left ventricular systolic function in fetuses without myocardial hypertrophy of gestational diabetes mellitus mothers using velocity vector imaging. J OBSTET GYNAECOL 2012; 32:252-6. [DOI: 10.3109/01443615.2011.645092] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M, Ballo P. Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 2011; 24:898-908. [PMID: 21665431 DOI: 10.1016/j.echo.2011.04.014] [Citation(s) in RCA: 293] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Indexed: 01/08/2023]
Abstract
BACKGROUND Systemic hypertension and type 2 diabetes mellitus are associated with impaired left atrial (LA) function, but whether LA functional abnormalities also occur in patients with hypertension and diabetes who have normal LA sizes is unknown. The aim of this study was to explore LA strain using speckle-tracking echocardiography in patients with hypertension or diabetes and normal LA size. METHODS LA strain was studied by speckle-tracking echocardiography in 155 patients with hypertension or diabetes with LA volume indexes < 28 mL/m(2) (83 with hypertension, 34 with diabetes, and 38 with both diabetes and hypertension) and 36 age-matched controls. The following indexes were measured: peak atrial longitudinal strain, time to peak atrial longitudinal strain, atrial longitudinal strain during early diastole and late diastole, and peak LA strain rate during ventricular systole, early diastole, and late diastole. RESULTS Peak atrial longitudinal strain was lower in patients with hypertension (29.0 ± 6.5%) and those with diabetes (24.7 ± 6.4%) than in controls (39.6 ± 7.8%) and further reduced in patients with diabetes and hypertension (18.3 ± 5.0%) (P < .0001). Similar results were found for atrial longitudinal strain during early diastole, atrial longitudinal strain during late diastole, and peak LA strain rate during ventricular systole and early diastole (P < .0001 for all). An inverse trend was found for time to peak atrial longitudinal strain, whereas no differences in peak LA strain rate during late diastole were observed. Two-way analysis of variance showed no interactions between hypertension and diabetes. In multivariate analyses, hypertension and diabetes were both independently associated with decreases in all LA strain and strain rate indexes, with the exception of peak LA strain rate during late diastole. CONCLUSIONS LA deformation mechanics are impaired in patients with hypertension or diabetes with normal LA size. The coexistence of both conditions further impairs LA performance in an additive fashion. Speckle-tracking echocardiography may be considered a promising tool for the early detection of LA strain abnormalities in these patients.
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Affiliation(s)
- Sergio Mondillo
- Department of Cardiovascular Diseases, University of Siena, Siena, Italy
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Guan Z, Zhang D, Huang R, Zhang F, Wang Q, Guo S. Association of left atrial myocardial function with left ventricular diastolic dysfunction in subjects with preserved systolic function: a strain rate imaging study. Clin Cardiol 2011; 33:643-649. [PMID: 20960540 DOI: 10.1002/clc.20784] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the relationship between left atrial (LA) myocardial function and left ventricular (LV) diastolic dysfunction in subjects with preserved LV ejection fraction (LVEF). METHODS The study included a group of 118 hypertensive patients and normal subjects. LV diastolic dysfunction was classified into 4 groups: none, mild, moderate, and severe. Peak strain rates in systole (S-Sr), early diastole (E-Sr), and late diastole (A-Sr) were obtained from Doppler-derived strain rate imaging to evaluate LA myocardial deformation. RESULTS No significant difference in LA dimension was observed in subjects with different degrees of LV diastolic dysfunction, although LA myocardial strain rate parameters were all significantly different across the 4 groups (all with P < 0.001). Compared with patients of normal diastolic function, the mild diastolic dysfunction group had significantly lower E-Sr (0.62 ± 0.18 s⁻¹ vs 1.20 ± 0.38 s⁻¹, P < 0.001) and S-Sr (0.78 ± 0.16 s⁻¹ vs 0.94 ± 0.22 s⁻¹, P < 0.001) but increased A-Sr (1.14 ± 0.29 s⁻¹ vs 1.00 ± 0.23 s⁻¹, P = 0.05). CONCLUSIONS By using strain rate imaging, significant changes of LA deformation in response to different stages of LV diastolic dysfunction were detected in subjects with preserved LVEF. Quantification of LA myocardial function rather than LA size may have the potential to predict early LV diastolic dysfunction in subjects with preserved LVEF.
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Affiliation(s)
- Zhiqiang Guan
- Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Di Zhang
- Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Rongjie Huang
- Department of Cardiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Fang Zhang
- Department of Electrocardiography, the First Affiliated Hospital of Guangxi Medical University, Nanning, People's Republic of China
| | - Qingrong Wang
- Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
| | - Shenglan Guo
- Department of Ultrasound, the First Affiliated Hospital of Guangxi Medical University, Nanning, P. R. China
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Moustafa SE, Alharthi M, Kansal M, Deng Y, Chandrasekaran K, Mookadam F. Global left atrial dysfunction and regional heterogeneity in primary chronic mitral insufficiency. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:384-93. [DOI: 10.1093/ejechocard/jer033] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Mirza M, Caracciolo G, Khan U, Mori N, Saha SK, Srivathsan K, Altemose G, Scott L, Sengupta P, Jahangir A. Left atrial reservoir function predicts atrial fibrillation recurrence after catheter ablation: a two-dimensional speckle strain study. J Interv Card Electrophysiol 2011; 31:197-206. [PMID: 21424845 DOI: 10.1007/s10840-011-9560-6] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Accepted: 02/18/2011] [Indexed: 12/12/2022]
Abstract
BACKGROUND Predictors of atrial fibrillation (AF) recurrence after catheter ablation (CA) are not fully defined. We hypothesized that 2D left atrial (LA) regional strain maps would help identify abnormal atrial substrate that increases susceptibility to AF recurrence post-CA. METHODS AND RESULTS Sixty-three patients (63 ± 10 years, 60% male) underwent CA for symptomatic paroxysmal (75%) or persistent (25%) AF. Baseline LA mechanical function determined using speckle tracking echocardiography was compared between those with AF recurrence (AFR) and no recurrence post-CA. Bi-dimensional global and regional maps of LA wall velocity, strain, and strain rate (SR) were obtained during end ejection and early diastole. After 18 ± 12 months of follow-up, 34 patients were free of AFR post-CA. There were no differences in clinical characteristics, LA and LV volumes, and Doppler estimates of LV diastolic function and filling pressures at baseline between patients with recurrent AF and those that maintained sinus rhythm. However, the LA emptying fraction (55 ± 17% vs. 64 ± 14%, p = 0.04), global and regional systolic and diastolic strains, SR, and velocities were reduced in patients with recurrent AF. There was marked attenuation of peak LA lateral wall longitudinal strain (LS; 11 ± 7% vs. 20 ± 14%, p = 0.007) and SR (0.9 ± 0.4 vs.1.3 ± 0.6 s(-1), p = 0.01). Multivariate analysis revealed lateral wall LS (odds ratio = 1.15, 95% CI = 1.02-1.28, p = 0.01) as an independent predictor of AFR. CONCLUSIONS Regional LA lateral wall LS is a pre-procedural determinant of AFR in patients undergoing CA, independent of LA enlargement. Characterization of atrial myocardial tissue properties by speckle tracking echo may aid the appropriate selection of adjunctive strategies and prognostication of patients undergoing CA.
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Affiliation(s)
- Mahek Mirza
- Division of Cardiovascular Diseases, Mayo Clinic, 13400 East Shea Boulevard, Scottsdale, AZ 85259, USA
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Butz T, Lang CN, van Bracht M, Prull MW, Yeni H, Maagh P, Plehn G, Meissner A, Trappe HJ. Segment-orientated analysis of two-dimensional strain and strain rate as assessed by velocity vector imaging in patients with acute myocardial infarction. Int J Med Sci 2011; 8:106-13. [PMID: 21326953 PMCID: PMC3039226 DOI: 10.7150/ijms.8.106] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2010] [Accepted: 01/31/2011] [Indexed: 11/15/2022] Open
Abstract
AIMS Strain rate imaging techniques have been proposed for the detection of ischemic or viable myocardium in coronary artery disease, which is still a challenge in clinical cardiology. This retrospective comparative study analyzed regional left ventricular function and scaring with two-dimensional strain (2DS) in the first 4 to 10 days after acute anterior myocardial infarction (AMI). METHODS AND RESULTS The study population consisted of 32 AMI patients with an LAD occlusion and successful reperfusion. The assessment of peak systolic 2DS and peak systolic strain rate (SR) was performed segment-oriented with the angle-independent speckle tracking algorithm Velocity Vector Imaging (VVI). The infarcted, adjacent and non-infarcted segments were revealed by late enhancement MRI (LE-MRI), which was used as reference for the comparison with 2DS. The infarcted segments showed a significant decrease of tissue velocities, 2DS and SR in comparison to the non-affected segments. CONCLUSION 2DS and SR as assessed by VVI seem to be a suitable approach for echocardiographic quantification of global and regional myocardial function as well as a promising tool for multimodal risk stratification after anterior AMI.
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Affiliation(s)
- Thomas Butz
- Department of Cardiology and Angiology, Marienhospital Herne, Ruhr University Bochum, Herne, Germany.
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Deng Y, Alharthi MS, Thota VR, Yin L, Li C, Emani UR, Chandrasekaran K, Khandheria B, Mookadam F. Evaluation of left ventricular rotation in obese subjects by velocity vector imaging. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2010; 11:424-8. [PMID: 20190270 DOI: 10.1093/ejechocard/jep230] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIMS Obesity is a well-known risk factor in the development of cardiovascular disease. We hypothesize that early left ventricular (LV) dysfunction secondary to obesity could be signalled by abnormal LV rotation. METHODS AND RESULTS This prospective study examined 60 subjects divided into two groups: obese group with body mass index (BMI) >or=30 and control group with BMI <25. The peak rotation, twist, and torsion of the left ventricle were studied in obese and control subjects, using velocity vector imaging. Age and gender were comparable between the two groups. Obese subjects had higher BMI, waist circumference, fasting glucose, triglycerides, systolic and diastolic blood pressure, low-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol (P < 0.05). In obese subjects, LV mass and LV mass index were increased, and the ratio of mitral early and late diastolic filling velocity was decreased (P < 0.05). In obese subjects, the peak twist and torsion of the left ventricle displayed a lower trend, and the peak rotation of the left ventricle apex decreased significantly (3.81 +/- 2.09 degrees vs. 5.77 +/- 3.27 degrees , P < 0.001). CONCLUSION Obesity was associated with changes in LV rotation. Velocity vector imaging is a feasible and reproducible echocardiographic technique for the detection of early subclinical LV dysfunction.
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Affiliation(s)
- Yan Deng
- Department of Cardiovascular Ultrasound and Non-invasive Cardiology, Sichuan Academy of Medical Science, Sichuan Provincial People's Hospital, Sichuan, China
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Tayyareci Y, Yildirimtürk O, Aytekin V, Memic K, Behramoglu F, Demiroglu IC, Aytekin S. Preoperative Left Atrial Mechanical Dysfunction Predicts Postoperative Atrial Fibrillation After Coronary Artery Bypass Graft Operation - A Velocity Vector Imaging-Based Study -. Circ J 2010; 74:2109-17. [DOI: 10.1253/circj.cj-10-0197] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | | | - Vedat Aytekin
- Department of Cardiology, TC. Istanbul Bilim University
| | - Kadriye Memic
- Department of Cardiology, TC. Istanbul Bilim University
| | | | | | - Saide Aytekin
- Department of Cardiology, TC. Istanbul Bilim University
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Velocity Vector Imaging in the Measurement of Left Ventricular Twist Mechanics: Head-to-Head One Way Comparison Between Speckle Tracking Echocardiography and Velocity Vector Imaging. J Am Soc Echocardiogr 2009; 22:1344-52. [DOI: 10.1016/j.echo.2009.09.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Indexed: 11/24/2022]
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Francia P, Cosentino F, Schiavoni M, Huang Y, Perna E, Camici GG, Lüscher TF, Volpe M. p66Shc protein, oxidative stress, and cardiovascular complications of diabetes: the missing link. J Mol Med (Berl) 2009; 87:885-91. [DOI: 10.1007/s00109-009-0499-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2009] [Revised: 06/16/2009] [Accepted: 06/25/2009] [Indexed: 10/20/2022]
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