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Ferraro AM, Harrild DM, Powell AJ, Levy PT, Marx GR. Evolving Role of Three-Dimensional Echocardiography for Right Ventricular Volume Analysis in Pediatric Heart Disease: Literature Review and Clinical Applications. J Am Soc Echocardiogr 2024; 37:634-640. [PMID: 38467312 DOI: 10.1016/j.echo.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/26/2024] [Accepted: 03/02/2024] [Indexed: 03/13/2024]
Abstract
Accurate knowledge of right ventricular (RV) volumes and ejection fraction is fundamental to providing optimal care for pediatric patients with congenital and acquired heart disease, as well as pulmonary hypertension. Traditionally, these volumes have been measured using cardiac magnetic resonance because of its accuracy, reproducibility, and freedom from geometric assumptions. More recently, an increasing number of studies have described the measurement of RV volumes using three-dimensional (3D) echocardiography. In addition, volumes by 3D echocardiography have also been used for outcome research studies in congenital heart surgery. Importantly, 3D echocardiographic acquisitions can be obtained over a small number of cardiac cycles, do not require general anesthesia, and are less costly than CMR. The ease and safety of the 3D echocardiographic acquisitions allow serial studies in the same patient. Moreover, the studies can be performed in various locations, including the intensive care unit, catheterization laboratory, and general clinic. Because of these advantages, 3D echocardiography is ideal for serial evaluation of the same patient. Despite these potential advantages, 3D echocardiography has not become a standard practice in children with congenital and acquired heart conditions. In this report, the authors review the literature on the feasibility, reproducibility, and accuracy of 3D echocardiography in pediatric patients. In addition, the authors investigate the advantages and limitations of 3D echocardiography in RV quantification and offer a pathway for its potential to become a standard practice in the assessment, planning, and follow-up of congenital and acquired heart disease.
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Affiliation(s)
- Alessandra M Ferraro
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; PhD Program in Angio-Cardio-Thoracic Pathophysiology and Imaging, Sapienza University of Rome, Rome, Italy.
| | - David M Harrild
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Andrew J Powell
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Philip T Levy
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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Tawfik AM, Sobh DM, Gadelhak B, Zedan MM, Sobh HM, Eid R, Hamdy N, Batouty NM. Right Ventricular Strain Analysis By Tissue Tracking Cardiac Magnetic Resonance Imaging In Pediatric Patients With End-Stage Renal Disease. J Thorac Imaging 2024; 39:49-56. [PMID: 37265246 DOI: 10.1097/rti.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE To investigate right ventricular (RV) volume and mass by cardiac magnetic resonance (CMR) and the added value of tissue tracking strain analysis as markers of RV dysfunction in pediatric patients with end-stage renal disease (ESRD) and preserved RV ejection fraction. MATERIALS AND METHODS Twenty-five children with ESRD and preserved RVEF (>50%) and 10 healthy control children were enrolled. Tissue tracking CMR was used to assess Global Longitudinal, circumferential (GCS), and radial short and long axes (GRS SAX and GRS LAX) RV strains in the patients group compared with controls. Correlations between strain parameters and other CMR parameters and clinical biomarkers were assessed. Binary logistic regression was used to test the independence of cofounders and detect their significance. RESULTS RV end-diastolic volume and mass (RVMi) were significantly higher in patients (97.2±19.3 mL/m 2 and 26.6±7gr/m 2 ) than control (71±7.8 mL/m 2 and 11.9±2 gr/m 2 , P values 0.000). All RV global strain parameters were significantly impaired in patients compared with control (all P values <0.05). RV Global Longitudinal was significantly correlated to LVEF (r=-0.416, P =0.039), LVEDVi (r=0.481, P =0.015), LVMi (r=0.562, P =0.004), and systolic blood pressure index (r=0.586, P =0.002). RV GRS (LAX) was significantly correlated to LV GCS (r=-0.462, P =0.020) and LV GRS (SAX) (r=0.454, P =0.023). GRS (SAX) and GCS demonstrated the highest diagnostic accuracy (area under curve: 0.82 and 0.81) to detect strain impairment. Univariate binary logistic regression with patients versus control as dependent variables identified LVMi, RV end-diastolic volume, RVMi, weight, body surface area, RV GCS, RV GRS (LAX), RV GRS (SAX), LV GCS, and LV GRS (SAX) as significantly correlated to patients with ESRD. When adjusted to other cofounders in the multivariable model, only RVMi remained as an independent significant cofounder (Odds ratio:0.395, P =0.046). CONCLUSION RV global strain, volume, and mass by CMR are markers of RV dysfunction in ESRD pediatric patients with preserved RVEF.
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Affiliation(s)
- Ahmed M Tawfik
- Department of Diagnostic and Interventional Radiology
- Department of Radiology, Andalusia Hospital AlShalalat, Andalusia Group for Medical Services, Alexandria, Egypt
| | - Donia M Sobh
- Department of Diagnostic and Interventional Radiology
| | | | - Mohamed M Zedan
- Department of Pediatrics, Pediatric Nephrology Unit, Mansoura University Children's Hospital
| | - Hoda M Sobh
- Department of Cardiology, Mansoura University, Faculty of Medicine, Mansoura
| | - Riham Eid
- Department of Pediatrics, Pediatric Nephrology Unit, Mansoura University Children's Hospital
| | - Nashwa Hamdy
- Department of Radiology, Andalusia Hospital AlShalalat, Andalusia Group for Medical Services, Alexandria, Egypt
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Qi L, Zhi B, Zhang J, Zhang L, Luo S, Zhang L. Defining Biventricular Abnormalities by Cardiac Magnetic Resonance in Pre-Dialysis Patients with Chronic Kidney Disease. KIDNEY DISEASES (BASEL, SWITZERLAND) 2023; 9:277-284. [PMID: 37900003 PMCID: PMC10601957 DOI: 10.1159/000529526] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 01/30/2023] [Indexed: 10/31/2023]
Abstract
Introduction The aim of the study was to investigate biventricular structural and functional abnormalities in pre-dialysis patients across stages of chronic kidney disease (CKD) by cardiac magnetic resonance (CMR). Methods Fifty-one CKD patients with CMR exams were retrospectively analyzed. Patients were divided into three groups according to estimated glomerular filtration rate (eGFR): CKD 1 group (patients with normal eGFR≥90 mL/min/1.73 m2, n = 20), CKD 2-3 group (patients with eGFR< 90 to ≥30 mL/min/1.73 m2, n = 14), and CKD 4-5 group (patients with eGFR<30 mL/min/1.73 m2, n = 17). Twenty-one age- and sex-matched healthy controls (HC) were recruited. CMR-derived left ventricular (LV) and right ventricular (RV) structural and functional measures were compared. Association between CMR parameters and clinical measures was assessed. Results There was an increasing trend in RV mass index (RVMi) and LV mass index (LVMi) with the occurrence and development of CKD from HC group to CKD 4-5 group although no significant difference was observed between CKD 1 group and HC group. LV global radial strain and LV global circumferential strain dropped and native T1 value elevated significantly in CKD 4-5 group compared with the other three groups (all p < 0.05), while RV strain measures, RV ejection fraction, and LV ejection fraction showed no significant difference among 4 groups (all p > 0.05). Elevated LV end-diastolic volume index (β = 0.356, p = 0.016) and RV end-systolic volume index (β = 0.488, p = 0.001) were independently associated with RVMi. Increased systolic blood pressure (β = 0.309, p = 0.004), LV end-systolic volume index (β = 0.633, p < 0.001), and uric acid (β = 0.261, p = 0.013) were independently associated with LVMi. Meanwhile, serum phosphorus (β = 0.519, p = 0.001) was independently associated with native T1 value. Conclusion In pre-dialysis CKD patients, left and right ventricular remolding has occurred. RVMi and LVMi were the first changed CMR indexes in the development of CKD when eGFR began to drop. Because fluid volume overload was the independent risk factor for RVMi and LVMi increase, reasonable controlling fluid volume overload may slow down the progression of biventricular remolding and may reduce related cardiovascular disease risk.
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Affiliation(s)
- Li Qi
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Beibei Zhi
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Jun Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Lingyan Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
| | - Song Luo
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Longjiang Zhang
- Department of Radiology, Jinling Hospital, Nanjing Medical University, Nanjing, China
- Department of Radiology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Ladányi Z, Bárczi A, Fábián A, Ujvári A, Cseprekál O, Kis É, Reusz GS, Kovács A, Merkely B, Lakatos BK. Get to the heart of pediatric kidney transplant recipients: Evaluation of left- and right ventricular mechanics by three-dimensional echocardiography. Front Cardiovasc Med 2023; 10:1094765. [PMID: 37008334 PMCID: PMC10063872 DOI: 10.3389/fcvm.2023.1094765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/15/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundKidney transplantation (KTX) markedly improves prognosis in pediatric patients with end-stage kidney failure. Still, these patients have an increased risk of developing cardiovascular disease due to multiple risk factors. Three-dimensional (3D) echocardiography allows detailed assessment of the heart and may unveil distinct functional and morphological changes in this patient population that would be undetectable by conventional methods. Accordingly, our aim was to examine left- (LV) and right ventricular (RV) morphology and mechanics in pediatric KTX patients using 3D echocardiography.Materials and methodsPediatric KTX recipients (n = 74) with median age 20 (14–26) years at study enrollment (43% female), were compared to 74 age and gender-matched controls. Detailed patient history was obtained. After conventional echocardiographic protocol, 3D loops were acquired and measured using commercially available software and the ReVISION Method. We measured LV and RV end-diastolic volumes indexed to body surface area (EDVi), ejection fraction (EF), and 3D LV and RV global longitudinal (GLS) and circumferential strains (GCS).ResultsBoth LVEDVi (67 ± 17 vs. 61 ± 9 ml/m2; p < 0.01) and RVEDVi (68 ± 18 vs. 61 ± 11 ml/m2; p < 0.01) were significantly higher in KTX patients. LVEF was comparable between the two groups (60 ± 6 vs. 61 ± 4%; p = NS), however, LVGLS was significantly lower (−20.5 ± 3.0 vs. −22.0 ± 1.7%; p < 0.001), while LVGCS did not differ (−29.7 ± 4.3 vs. −28.6 ± 10.0%; p = NS). RVEF (59 ± 6 vs. 61 ± 4%; p < 0.05) and RVGLS (−22.8 ± 3.7 vs. −24.1 ± 3.3%; p < 0.05) were significantly lower, however, RVGCS was comparable between the two groups (−23.7 ± 4.5 vs. −24.8 ± 4.4%; p = NS). In patients requiring dialysis prior to KTX (n = 64, 86%) RVGCS showed correlation with the length of dialysis (r = 0.32, p < 0.05).ConclusionPediatric KTX patients demonstrate changes in both LV and RV morphology and mechanics. Moreover, the length of dialysis correlated with the contraction pattern of the right ventricle.
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Affiliation(s)
- Zsuzsanna Ladányi
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
- Correspondence: Zsuzsanna Ladányi
| | - Adrienn Bárczi
- 1st Department of Pediatrics, Semmelweis University, Budapest, Hungary
| | - Alexandra Fábián
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Adrienn Ujvári
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Orsolya Cseprekál
- Department of Surgery, Transplantation and Gastroenterology, Semmelweis University, Budapest, Hungary
| | - Éva Kis
- Department of Pediatric Cardiology, Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | | | - Attila Kovács
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Béla Merkely
- Heart and Vascular Center, Semmelweis University, Budapest, Hungary
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Demirci DE, Demirci D, İnci A. Long-term impacts of different dialysis modalities on right ventricular function in patients with end-stage renal disease. Echocardiography 2022; 39:1316-1323. [PMID: 36126344 DOI: 10.1111/echo.15455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 08/20/2022] [Accepted: 09/03/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Right ventricular dysfunction is a major cause of heart failure and mortality in end-stage renal disease patients. Scarce data is available regarding the comparison of echocardiographic right ventricular function in end-stage renal disease patients on hemodialysis (HD) and peritoneal dialysis (PD). The aim of the study was to evaluate the long-term impacts of different dialysis modalities on right ventricular function assessed by conventional echocardiography, in end-stage renal disease patients with preserved left ventricular function. METHODS The study included 120 patients grouped as follows: PD (n = 40), HD with arterio-venous fistula (n = 40), and healthy control subjects (n = 40). Conventional echocardiography was performed on all patients. A classification of right ventricular function was defined in HD patients by using tricuspid annular plane systolic excursion (TAPSE), right ventricular myocardial performance index (RV-MPI), fractional area change (FAC), and tricuspid lateral annulus systolic velocity (Sa) values. Correlation analysis was performed by using the right ventricular dysfunction score, clinical, and echocardiographic parameters. RESULTS The mean age of the study population was 51.9 ± 13.1 years and 47.5% were females. TAPSE and Sa velocity were found to be significantly lower and RV-MPI was significantly higher in patients undergoing HD, compared with control and PD patients. Logistic regression analysis showed that HD treatment was an independent risk factor for developing right ventricular dysfunction. CONCLUSION RV function was impaired in patients undergoing HD compared with patients on PD.
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Affiliation(s)
- Duygu Ersan Demirci
- Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Deniz Demirci
- Department of Cardiology, Istanbul Training and Research Hospital, Istanbul, Turkey
| | - Ayça İnci
- Department of Nephrology, Antalya Training and Research Hospital, Antalya, Turkey
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Daralammouri Y, Qaddumi J, Ayoub K, Abu-Hantash D, Al-Sadi MA, Ayaseh RM, Azamtta M, Sawalmeh O, Hamdan Z. Pathological right ventricular changes in synthesized electrocardiogram in end-stage renal disease patients and their association with mortality and cardiac hospitalization: a cohort study. BMC Nephrol 2022; 23:79. [PMID: 35209873 PMCID: PMC8867672 DOI: 10.1186/s12882-022-02707-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/11/2022] [Indexed: 11/20/2022] Open
Abstract
Background Right ventricular (RV) function is an important prognostic predictor for end-stage renal disease (ESRD) patients. Non-invasive evaluation of RV function by simple electrocardiogram (ECG) is not yet evident. The purpose of this article was to investigate the presence and association of pathological right ventricular changes in synthesized ECG with cardiac hospitalization and mortality. Methods A prospective cohort study of 137 ESRD patients (mean age: 56 years) were recruited from the hemodialysis unit in An-Najah National University Hospital, Nablus, Palestine. Synthesized ECG was done right before the hemodialysis (HD) session. The pathological right ventricular changes were recorded for each patient. The relationship between pathological RV changes and mortality, cardiac and non-cardiac hospitalization was assessed through a 6-months follow-up period. Results Right ventricular Q wave was found in 2.2% of patients, while right ventricular ST elevation was found in 0.7% of patients, and right ventricular negative T wave was found in 0.7% of patients. During the 6-month period of follow-up, 36 (26.3%) patients were hospitalized, nine patients (6.6%) due to cardiac causes. A total of 8 (5.83%) patients died, out of those 4 patients (2.91%) due to cardiac causes. Using Fisher’s exact test, there was a significant association between pathological abnormalities in synthesized ECG and hospitalization among hemodialysis patients, (p = 0.047). Pathological changes in synthesized ECG were less prevalent in non-cardiac hospitalizations than in cardiac hospitalizations. Conclusions The presence of pathological RV synthesized ECG changes can predict cardiac hospitalization in ESRD patients. Synthesized ECG is a good available tool that can be easily performed in ESRD patients. To determine whether Synthesized ECG can be used as a screening tool for pathological RV changes in a dialysis patients, more research with a larger number of patients and a longer follow-up period is required.
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Affiliation(s)
- Yunis Daralammouri
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine. .,Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.
| | - Jamal Qaddumi
- Public Health Department, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Khubaib Ayoub
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Doaa Abu-Hantash
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mai Arafat Al-Sadi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Rofayda M Ayaseh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Murad Azamtta
- Department of Cardiology, An-Najah National University Hospital, Nablus, Palestine
| | - Osama Sawalmeh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine
| | - Zakaria Hamdan
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine.,Department of Internal Medicine, An-Najah National University Hospital, Nablus, Palestine.,Nephrology Unit, An-Najah National University Hospital, Nablus, Palestine
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Sobh DM, Batouty NM, Tawfik AM, Gadelhak B, Elmokadem AH, Hammad A, Eid R, Hamdy N. Left Ventricular Strain Analysis by Tissue Tracking- Cardiac Magnetic Resonance for early detection of Cardiac Dysfunction in children with End-Stage Renal Disease. J Magn Reson Imaging 2021; 54:1476-1485. [PMID: 34037288 DOI: 10.1002/jmri.27700] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/02/2021] [Accepted: 05/03/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Cardiovascular disease is a major cause of morbidity and mortality in end-stage renal disease (ESRD). Reduction in left ventricular ejection fraction (LVEF) represents late left ventricle (LV) dysfunction. Cardiac MRI myocardial strain analysis is an alternative method for assessment of LV function. PURPOSE To investigate whether LV strain analysis is more sensitive than LVEF for early detection of systolic dysfunction in children with ESRD. STUDY TYPE Case control. POPULATION Thirty-two children with ESRD (median 14 years, 17 females) and 10 healthy control (median 12.5 years, 7 females). FIELD STRENGTH AND SEQUENCES A 1.5 T /retrospective ECG-gated steady-state free precession (SSFP). ASSESSMENT LVEF, and indexed LV mass (LVMi) and LV end-diastolic volume (LVEDVi) were measured. Using tissue tracking analysis, LV endocardial and epicardial contours were traced in short and long axes at end diastole to calculate global longitudinal (GLS), circumferential (GCS) and radial (GRS) strains. STATISTICAL ANALYSIS Cardiac MRI and strain parameters were compared between patients and control, and between subgroup with preserved LVEF and control by Student t-test/Mann Whitney test. Diagnostic accuracy was assessed by Receiver operating characteristic analysis. Strain as predictor of poor outcome (mortality, pulmonary edema, and/or heart failure) within 1-year follow up was investigated by binary logistic regression. RESULTS Compared to control, cardiac MRI LVEF, LVEDVi, LVMi, GLS, GCS and GRS were significantly impaired in patients. Patients with preserved LVEF had significantly higher LVEDVi, LVMi and significantly impaired GCS and GRS than control. Strain parameters were significantly correlated with LVEF, LVEDVi, and LVMi. GCS and GRS demonstrated greater diagnostic accuracy than GLS (area under curve: 0.89). LVEF, LVMi, GCS, and GRS were correlated with poor outcome. CONCLUSION Cardiac MRI tissue tracking could identify subclinical LV dysfunction in children with ESRD and still preserved LVEF. Furthermore, LV strain parameters (GCS and GRS) were correlated with future cardiovascular events. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Donia M Sobh
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Nihal M Batouty
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Ahmed M Tawfik
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Basma Gadelhak
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Ali H Elmokadem
- Department of Diagnostic and Interventional radiology, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Ayman Hammad
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Riham Eid
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University, Faculty of Medicine, Mansoura, Egypt
| | - Nashwa Hamdy
- Pediatric Nephrology Unit, Department of Pediatrics, Mansoura University Children's Hospital, Mansoura University, Faculty of Medicine, Mansoura, Egypt
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Xing X, Liu J, Deng Y, Xu S, Wei L, Yang M, He X, Cao B, Huang X, Yue Q, Yang J, Teng Z. Impact of renal function on the prognosis of acute pulmonary embolism patients: a systematic review and meta-analysis. Expert Rev Respir Med 2020; 16:91-98. [PMID: 33297795 DOI: 10.1080/17476348.2021.1862653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVES We conduct a study to explore the influence of impaired renal function on prognosis in Acute pulmonary embolism (APE) patients. METHODS A meta-analysis was performed using the EMBASE and PubMed databases for relevant publications reporting the impact of impaired renal function on the clinical outcomes in patients with APE. RESULTS Eventually, 17 articles were included in our analysis. The results suggested that renal insufficiency (RI) is a predictor of poor prognosis in APE patients(short-term mortality: pooled OR = 2.83, 95%CI: 2.20-3.63; long-term mortality: pooled OR = 2.30, 95%CI: 1.72-3.08; adverse outcomes: pooled OR = 3.02, 95%CI: 2.60-3.51). The short-term and long-term mortality rates of APE patients with RI were both higher than those in patients without RI. In addition, acute kidney injury(AKI) could serve as a predictive factor of poor prognosis (pooled OR = 2.75, 95%CI: 2.45-3.08), and it doubles the overall mortality rate in APE patients. However, chronic kidney disease (CKD) did not predict poor prognosis in APE patients (pooled OR = 1.94, 95%CI: 0.99-3.81), although it could slightly increase the overall mortality rate in APE patients. CONCLUSIONS RI and AKI could be included in the prognosis evaluation for APE, but the impact of CKD in APE patients has yet to be determined.
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Affiliation(s)
- Xiqian Xing
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Jie Liu
- Department of Respiratory Medicine, The Fourth Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Yishu Deng
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Shuanglan Xu
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Li Wei
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Mei Yang
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Xiaohua He
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Bing Cao
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Xiaoxian Huang
- Department of Respiratory Medicine, The Affiliated Hospital of Yunnan University, the Second People's Hospital of Yunnan Province, Kunming, China
| | - Qiaoning Yue
- Department of Orthopedic Surgery, The People's Hospital of Yuxi City, the Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
| | - Jiao Yang
- First Department of Respiratory Medicine, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhaowei Teng
- Department of Orthopedic Surgery, The People's Hospital of Yuxi City, the Sixth Affiliated Hospital of Kunming Medical University, Yuxi, China
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Aortic Stiffness and Heart Failure in Chronic Kidney Disease. CURRENT CARDIOVASCULAR IMAGING REPORTS 2020. [DOI: 10.1007/s12410-020-9534-0] [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
Abstract
Purpose of Review
To provide an update on the recent findings in the field of aortic stiffness and heart failure in patients with chronic kidney disease (CKD).
Recent Findings
Stratification of cardiovascular risk in CKD remains an open question. Recent reports suggest that aortic stiffness, an independent predictor of cardiovascular events in many patient populations, is also an important prognostic factor in CKD. Also, novel measures of myocardial tissue characterization, native T1 and T2 mapping techniques, have potential as diagnostic and prognostic factors in CKD.
Summary
Cardiovascular magnetic resonance has the ability to thoroughly evaluate novel imaging markers: aortic stiffness, native T1, and native T2. Novel imaging markers can be used for diagnostic and prognostic purposes as well as potential therapeutic targets in CKD population.
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Ureche C, Sascău R, Țăpoi L, Covic A, Moroșanu C, Voroneanu L, Burlacu A, Stătescu C, Covic A. Multi-modality cardiac imaging in advanced chronic kidney disease. Echocardiography 2019; 36:1372-1380. [DOI: 10.1111/echo.14413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/24/2019] [Accepted: 05/26/2019] [Indexed: 11/24/2022] Open
Affiliation(s)
- Carina Ureche
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Radu Sascău
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Laura Țăpoi
- Cardiovascular Disease Institute; Iasi Romania
| | - Andreea Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | | | - Luminița Voroneanu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
| | - Alexandru Burlacu
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Department of Interventional Cardiology; Cardiovascular Diseases Institute; Iasi Romania
| | - Cristian Stătescu
- Cardiovascular Disease Institute; Iasi Romania
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
| | - Adrian Covic
- ‘Grigore T. Popa’ University of Medicine; Iasi Romania
- Nephrology Clinic, Dialysis and Renal Transplant Center - ‘C.I. Parhon’ University Hospital; Iasi Romania
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11
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Right ventricular failure management. Curr Opin Cardiol 2018; 34:213-217. [PMID: 30575646 DOI: 10.1097/hco.0000000000000595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Review recent advances in the diagnosis and management of right ventricular (RV) failure. RECENT FINDINGS Temporary and durable device-based management of RV failure has emerging applications. SUMMARY Research advances and clinical management in RV failure have been limited by a lack of consensus on a universal definition. Echocardiographic and cardiac MRI-based predictors of RV failure are imperfect. Combinations of hemodynamic and imaging variables may have better predictive value. Loading conditions and ventriculo-arterial coupling play important roles in RV function. The current treatment approach to RV failure includes a combination of inotropy and vasodilatation but lacks conclusive evidence. Emerging biochemical and molecular targets hold promise but have yet to be proven in human studies.
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Niel O, Bastard P, Boussard C, Hogan J, Kwon T, Deschênes G. Artificial intelligence outperforms experienced nephrologists to assess dry weight in pediatric patients on chronic hemodialysis. Pediatr Nephrol 2018; 33:1799-1803. [PMID: 29987454 DOI: 10.1007/s00467-018-4015-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 06/24/2018] [Accepted: 06/27/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dry weight is the lowest weight patients on hemodialysis can tolerate; correct dry weight estimation is necessary to minimize morbi-mortality, but is difficult to achieve. Here, we used artificial intelligence to improve the accuracy of dry weight assessment in hemodialysis patients. METHODS/RESULTS We designed a neural network which used bio-impedancemetry, blood volume monitoring, and blood pressure values as inputs; output was artificial intelligence dry weight. Fourteen pediatric patients were switched from nephrologist to artificial intelligence dry weight. Artificial intelligence dry weight was higher (28.6%), lower (50%), or identical to nephrologist dry weight. Mean difference between artificial intelligence and nephrologist dry weights was 0.497 kg (- 1.33 to + 1.29 kg). In patients for whom artificial intelligence dry weight was lower than nephrologist dry weight, systolic blood pressure significantly decreased after dry weight decrease to artificial intelligence dry weight (77th to 60th percentile, p = 0.022); anti-hypertensive treatments were successfully decreased or discontinued in 28.7% of cases. In patients for whom artificial intelligence dry weight was higher than nephrologist dry weight, no hypertension was observed after dry weight increase to artificial intelligence dry weight; when present, symptoms of dry weight underestimation receded. CONCLUSIONS Neural network predictions outperformed those of experienced nephrologists in most cases, proving artificial intelligence is a powerful tool for predicting dry weight in hemodialysis patients.
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Affiliation(s)
- Olivier Niel
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Paul Bastard
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Charlotte Boussard
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Julien Hogan
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Thérésa Kwon
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
| | - Georges Deschênes
- Pediatric Nephrology Department, Robert Debré Hospital, 48 Boulevard Sérurier, 75019, Paris, France
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