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Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
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Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
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AlAlakhfash A, Agati L, Mazzesi G, Elhobi D, Alqwaiee A, Alhory K, Almesned A, Alhasnan Z, Alwadai A. The outcome of genetic and non-genetic pediatric cardiomyopathies. Egypt Heart J 2024; 76:43. [PMID: 38568384 PMCID: PMC10991189 DOI: 10.1186/s43044-024-00473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND Pediatric cardiomyopathies (CMP) can be familial or idiopathic with increasing detection of genetic mutations. The study is a retrospective single-center review of cardiomyopathy patients from January 2011 to May 2020. Results of the genetic study, as well as the outcome, were reported. Patients were divided according to the type of CMP, age of presentation, and EF at presentation. Univariate and multivariate analysis and ROC and survival curves were done. RESULTS We reported 229 patients under 14 years of age with a diagnosis of cardiomyopathy, most commonly DCM (160 patients (70%)) followed by HCM (26.2%). 52% presented at 6 months of age or less and 119 (52%) required ICU admission at presentation. The genetic and or metabolic disorder was confirmed in 21.4% of patients, most commonly VLCAD defect (16, 7%) and ELAC2 gene defect (10, 4.4%). During the disease course, 88 patients (38.4%) died (48 with DCM, 39 with HCM, and 1 with RCM). An EF of 20% or less at presentation and presentation at 6 months of age or less carries a risk for mortality in patients with DCM and HCM, respectively (RR 3.88 and 2.06 and OR of 11.09 and 4.35, respectively). Death was more common among HCM patients especially patients with positive genetic abnormality compared with patients with DCM. CONCLUSIONS The mortality for CMP in children reaches up to 40%, (30% in DCM and 65% in HCM patients). Mortality was higher in those with HCM, DCM with EF of 20% or less, and HCM presented at 6 months of age or less. Whole-exome and/or whole-genome sequencing is advised for all patients of CMP and at-risk family members.
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Affiliation(s)
- Ali AlAlakhfash
- Pediatric Cardiology Department, Prince Sultan Cardiac Center-Qassim, Qassim Health Cluster, MOH, P O BOX 896, 51421, Buraydah, Saudi Arabia.
| | - Luciano Agati
- Direttore U.O. "Diagnostica e Terapia Cardiovascolare", Dipartimento di Scienze Cardiovascolari E Respiratorie, Cattedra Di Cardiologia, Università Sapienza Roma, Policlinico Umberto I, PadiglioneRome, Italy
| | - Giuseppe Mazzesi
- Department of General Surgery and Cardiothoracic Surgery, "Paride Stefanini", Sapienza University of Rome, Rome, Italy
| | - Dalia Elhobi
- Pediatric Cardiology Department, Prince Sultan Cardiac Center-Qassim, Qassim Health Cluster, MOH, P O BOX 896, 51421, Buraydah, Saudi Arabia
| | - Abdullah Alqwaiee
- Pediatric Cardiology Department, Prince Sultan Cardiac Center-Qassim, Qassim Health Cluster, MOH, P O BOX 896, 51421, Buraydah, Saudi Arabia
| | - Khalid Alhory
- Pediatric Cardiology Department, Prince Sultan Cardiac Center-Qassim, Qassim Health Cluster, MOH, P O BOX 896, 51421, Buraydah, Saudi Arabia
| | - Abdulrahman Almesned
- Pediatric Cardiology Department, Prince Sultan Cardiac Center-Qassim, Qassim Health Cluster, MOH, P O BOX 896, 51421, Buraydah, Saudi Arabia
| | | | - Abdullah Alwadai
- Pediatric Cardiology Department, Prince Sultan Cardiac Center-Qassim, Qassim Health Cluster, MOH, P O BOX 896, 51421, Buraydah, Saudi Arabia
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Birat A, Ratel S, Dodu A, Grossoeuvre C, Dupont AC, Rance M, Morel C, Nottin S. A long duration race induces a decrease of left ventricular strains, twisting mechanics and myocardial work in trained adolescents. Eur J Sport Sci 2022:1-11. [PMID: 35757854 DOI: 10.1080/17461391.2022.2093131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND We investigated the acute cardiac consequences of a long-duration (>5 h) adventure race in adolescent athletes from evaluations of left ventricular (LV) strains and myocardial work. METHODS Twenty trained male adolescents (i.e. 8 ± 4 hours/week of endurance sports) aged 14 to 17 years participated in a competitive long-duration adventure race. Blood samples were collected before, immediately and 24 h after the race to determine the time course of troponin I (cTnI) considered as a myocardial damage biomarker. Resting echocardiography were conducted before and after the race to assess myocardial regional strains, LV twisting mechanics and myocardial work using speckle tracking echocardiography. RESULTS The mean completion time of the race was 05:38 ± 00:20 h, with a mean heart rate (HR) of 83 ± 5% of maximal HR. cTnI concentration significantly increased in 16/20 participants after the race (pre: 0.001 ± 0.002 vs. post: 0.244 ± 0.203 ng·dL-1, p < 0.001) and returned to baseline within 24 h. Stroke volume, ejection fraction and global longitudinal strains remained unchanged after the race while LV twist and global myocardial work significantly decreased (8.6 ± 3.3 vs. 6.3 ± 3.3 deg and 2080 ± 250 vs. 1781 ± 334 mmHg%, p < 0.05). Diastolic function, indexes of myocardial relaxation and LV untwisting rate (-91.0 ± 19.0 vs. -56.4 ± 29.1 deg·s-1, p < 0.001) were affected after the race. CONCLUSION We demonstrated for the first time that, in trained adolescents, a high-intensity endurance exercise of several hours induced an increase of the cTnI concentration associated with an alteration of myocardial function.
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Affiliation(s)
- Anthony Birat
- EA3533 AME2P, Université Clermont Auvergne, Clermont-Ferrand 63000, France.,Fédération Française Triathlon, Saint Denis 93210, France
| | - Sébastien Ratel
- EA3533 AME2P, Université Clermont Auvergne, Clermont-Ferrand 63000, France
| | - Alexandre Dodu
- Fédération Française Triathlon, Saint Denis 93210, France
| | | | - Anne-Charlotte Dupont
- Fédération Française Triathlon, Saint Denis 93210, France.,U1254 INSERM, Imagerie Adaptative Diagnostique et Interventionnelle (ADI), Université de Lorraine, Nancy 54510, France
| | - Mélanie Rance
- Centre de Ressources et d'Expertise de la Performance Sportive (CREPS), Bellerive-sur-Allier 03700, France
| | - Claire Morel
- Centre de Ressources et d'Expertise de la Performance Sportive (CREPS), Bellerive-sur-Allier 03700, France
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Yin G, Cui C, An J, Zhao K, Yang K, Li S, Yang X, Wang J, Dong Z, Yu S, He J, Chen X, Lu M, Zhao S. Assessment of Left Ventricular Systolic Function by Cardiovascular Magnetic Resonance Compressed Sensing Real-Time Cine Imaging Combined With Area-Length Method in Normal Sinus Rhythm and Atrial Fibrillation. Front Cardiovasc Med 2022; 9:896816. [PMID: 35711346 PMCID: PMC9197321 DOI: 10.3389/fcvm.2022.896816] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/03/2022] [Indexed: 11/30/2022] Open
Abstract
Background The most-commonly used multi-slice Simpson's method employed with routine two-dimensional segmented cine images makes it difficult to evaluate left ventricular (LV) volume and function due to endocardial border blurring and beat-to-beat variation during atrial fibrillation (AF) status. Objectives To assess the feasibility of compressed sensing real-time (CSRT) cine imaging combined with an area-length method for quantification of LV systolic function in normal sinus rhythm (NSR) and AF. Methods The CSRT cine sequence and routine segmented balanced Steady-State-Free-Precession cine sequence were performed in 71 patients with NSR (n = 36) or AF (n = 35). Image quality and edge sharpness for both sequences were assessed. The LV functional measurements in patients with NSR included end-diastolic volume (EDV), end-systolic volume (ESV), stroke volume (SV), ejection fraction (EF), cardiac output (CO), cardiac index (CI), and LV mass (LVM); all were assessed using segmented cine with Simpson's rule in short axis (SegSA_Simpson, as a reference standard) and area-length (AL) method in the two chamber (Seg2CH_AL) or four chamber (Seg4CH_AL) and CSRT cine with AL method in the two chamber (CSRT2CH_AL) or four chamber (CSRT4CH_AL). Finally, the mean, maximum, and minimum values of each LV functional parameter [EDV/ESV/SV/EF/CO/CI/LVM/heart rate (HR)] from 4~5 consecutive heartbeats were measured using CSRT2CH_AL in patients with AF. Results In patients with NSR, measurements of EDV (p > 0.05), ESV (p > 0.05), SV (p > 0.05), EF (p > 0.05), and LVM (p > 0.05) assessed with CSRT2CH_AL did not differ significantly from those obtained with SegSA_Simpson. In patients with AF, CSRT image quality score (p < 0.001) and edge sharpness (p < 0.001) both were significantly higher than those obtained from segmented cine. The CSRT2CH_AL provided significantly different results among mean, maximum, and minimum values of each LV parameter from 4~5 consecutive heartbeats (all p < 0.001) with strong inter- and intra-observer agreement in AF. Conclusions The CSRT cine sequence combined with two chamber area-length analysis accurately assessed LV systolic function in NSR. This approach is expected to permit the assessment of multiple parameters in consecutive heartbeats with good inter- and intra-observer reproducibility for beat-to-beat analysis of LV function in AF.
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Affiliation(s)
- Gang Yin
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Chen Cui
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Jing An
- Siemens Shenzhen Magnetic Resonance Ltd., Siemens MRI Center, Shenzhen, China
| | - Kankan Zhao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, SZ University Town, Shenzhen, China
| | - Kai Yang
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shuang Li
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Xinling Yang
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Jiaxin Wang
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Zhixiang Dong
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shiqin Yu
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Jian He
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Xiuyu Chen
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Minjie Lu
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
| | - Shihua Zhao
- MR Center, Stata Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking Union Medical College, Fuwai Hospital, Beijing, China
- *Correspondence: Shihua Zhao
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5
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Paysal J, Merlin E, Terral D, Chalard A, Rochette E, Obert P, Nottin S. Left Ventricular Strains and Myocardial Work in Adolescents With Anorexia Nervosa. Front Cardiovasc Med 2022; 9:798774. [PMID: 35211523 PMCID: PMC8861270 DOI: 10.3389/fcvm.2022.798774] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/10/2022] [Indexed: 11/25/2022] Open
Abstract
Background Anorexia nervosa (AN) is accompanied by bradycardia, low blood pressure (BP) and cardiac morphological remodeling. Systolic and diastolic functions are relatively preserved when assessed by standard ultrasound methods. However, novel advances based on speckle tracking echocardiography (STE), that could detect subtle and early alterations of left ventricular (LV) function, remained poorly used in AN patients. Objective The aim of this study was to assess the cardiac function of AN patients by evaluating LV myocardial strains, myocardial work (MW) and LV mechanical dispersion. We hypothesized that LV strains and global myocardial work would be decreased and LV twisting mechanisms enhanced to preserve the systolic function. Methods Fifty-nine adolescents including 26 women AN patients (14.6 ± 1.9 yrs. old) with a mean duration of AN of 19 ± 9 months and 33 controls (14.1 ± 2.0 yrs. old) underwent STE to assess LV morphology and myocardial regional strains. Results The global longitudinal strain (GLS) was higher in AN patients compared to controls (−18.8 ± 2.0 vs. −16.9 ± 2.8%, p = 0.006). The area under the pressure-strain loop, representing the global MW was not altered but was shifted to the left and downwards in AN patients, due to their lower BP and higher GLS. Intraventricular mechanical dispersion was similar in both groups. Circumferential strains, twisting/untwisting mechanics were preserved. Conclusion Our results strongly support that the cardiac morphological remodeling observed in our AN patients was associated with normal ventricular regional myocardial functions. Only GLS was higher in AN patients, but its clinical significance remains to be demonstrated.
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Chaklader M, Rothermel BA. Calcineurin in the heart: New horizons for an old friend. Cell Signal 2021; 87:110134. [PMID: 34454008 PMCID: PMC8908812 DOI: 10.1016/j.cellsig.2021.110134] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/10/2021] [Accepted: 08/23/2021] [Indexed: 01/20/2023]
Abstract
Calcineurin, also known as PP2B or PPP3, is a member of the PPP family of protein phosphatases that also includes PP1 and PP2A. Together these three phosphatases carryout the majority of dephosphorylation events in the heart. Calcineurin is distinct in that it is activated by the binding of calcium/calmodulin (Ca2+/CaM) and therefore acts as a node for integrating Ca2+ signals with changes in phosphorylation, two fundamental intracellular signaling cascades. In the heart, calcineurin is primarily thought of in the context of pathological cardiac remodeling, acting through the Nuclear Factor of Activated T-cell (NFAT) family of transcription factors. However, calcineurin activity is also essential for normal heart development and homeostasis in the adult heart. Furthermore, it is clear that NFAT-driven changes in transcription are not the only relevant processes initiated by calcineurin in the setting of pathological remodeling. There is a growing appreciation for the diversity of calcineurin substrates that can impact cardiac function as well as the diversity of mechanisms for targeting calcineurin to specific sub-cellular domains in cardiomyocytes and other cardiac cell types. Here, we will review the basics of calcineurin structure, regulation, and function in the context of cardiac biology. Particular attention will be given to: the development of improved tools to identify and validate new calcineurin substrates; recent studies identifying new calcineurin isoforms with unique properties and targeting mechanisms; and the role of calcineurin in cardiac development and regeneration.
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Affiliation(s)
- Malay Chaklader
- Departments of Internal Medicine (Division of Cardiology) and Molecular Biology, University of Texas Southwestern Medical Centre, Dallas, TX, USA
| | - Beverly A Rothermel
- Departments of Internal Medicine (Division of Cardiology) and Molecular Biology, University of Texas Southwestern Medical Centre, Dallas, TX, USA.
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Tan AX, Shah SJ, Sanders JL, Psaty BM, Wu C, Gardin JM, Peralta CA, Newman AB, Odden MC. Association Between Myocardial Strain and Frailty in CHS. Circ Cardiovasc Imaging 2021; 14:e012116. [PMID: 33993730 DOI: 10.1161/circimaging.120.012116] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Myocardial strain, measured by speckle-tracking echocardiography, is a novel measure of subclinical cardiovascular disease and may reflect myocardial aging. We evaluated the association between myocardial strain and frailty-a clinical syndrome of lack of physiological reserve. METHODS Frailty was defined in participants of the CHS (Cardiovascular Health Study) as having ≥3 of the following clinical criteria: weakness, slowness, weight loss, exhaustion, and inactivity. Using speckle-tracking echocardiography data, we examined the cross-sectional (n=3206) and longitudinal (n=1431) associations with frailty among participants who had at least 1 measure of myocardial strain, left ventricular longitudinal strain (LVLS), left ventricular early diastolic strain rate and left atrial reservoir strain, and no history of cardiovascular disease or heart failure at the time of echocardiography. RESULTS In cross-sectional analyses, lower (worse) LVLS was associated with prevalent frailty; this association was robust to adjustment for left ventricular ejection fraction (adjusted odds ratio, 1.32 [95% CI, 1.07-1.61] per 1-SD lower strain; P=0.007) and left ventricular stroke volume (adjusted OR, 1.32 [95% CI, 1.08-1.61] per 1-SD lower strain; P=0.007). In longitudinal analyses, adjusted associations of LVLS and left ventricular early diastolic strain with incident frailty were 1.35 ([95% CI, 0.96-1.89] P=0.086) and 1.58 ([95% CI, 1.11-2.27] P=0.013, respectively). Participants who were frail and had the worst LVLS had a 2.2-fold increased risk of death (hazard ratio, 2.20 [95% CI, 1.81-2.66]; P<0.0001). CONCLUSIONS In community-dwelling older adults without prevalent cardiovascular disease, worse LVLS by speckle-tracking echocardiography, reflective of subclinical myocardial dysfunction, was associated with frailty. Frailty and LVLS have an additive effect on mortality risk.
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Affiliation(s)
- Annabel X Tan
- Department of Epidemiology and Population Health, Stanford University, CA (A.X.T., M.C.O.)
| | - Sanjiv J Shah
- Division of Cardiology, Department of Medicine, Northwestern University, Chicago, IL (S.J.S.)
| | - Jason L Sanders
- Division of Pulmonary and Critical Care Medicine, Brigham and Women's Hospital, Boston, MA (J.L.S.)
| | - Bruce M Psaty
- Cardiovascular Health Research Unit, Department of Medicine, Department of Epidemiology, and Department of Health Services, University of Washington, Seattle (B.M.P.).,Kaiser Permanente Washington Health Research Institute, Seattle (B.M.P.)
| | - Chenkai Wu
- Global Health Research Center, Duke Kunshan University, China (C.W.)
| | - Julius M Gardin
- Division of Cardiology, Rutgers New Jersey Medical School (J.G.)
| | - Carmen A Peralta
- Department of Medicine, University of California San Francisco (C.A.P.).,Cricket Health, Inc, San Francisco, CA (C.A.P.)
| | - Anne B Newman
- Department of Epidemiology, University of Pittsburgh, PA (A.B.N.)
| | - Michelle C Odden
- Department of Epidemiology and Population Health, Stanford University, CA (A.X.T., M.C.O.)
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Sabovčik F, Cauwenberghs N, Vens C, Kuznetsova T. Echocardiographic phenogrouping by machine learning for risk stratification in the general population. EUROPEAN HEART JOURNAL. DIGITAL HEALTH 2021; 2:390-400. [PMID: 36713600 PMCID: PMC9707985 DOI: 10.1093/ehjdh/ztab042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 03/25/2021] [Accepted: 04/15/2021] [Indexed: 02/01/2023]
Abstract
Aims There is a need for better phenotypic characterization of the asymptomatic stages of cardiac maladaptation. We tested the hypothesis that an unsupervised clustering analysis utilizing echocardiographic indexes reflecting left heart structure and function could identify phenotypically distinct groups of asymptomatic individuals in the general population. Methods and results We prospectively studied 1407 community-dwelling individuals (mean age, 51.2 years; 51.1% women), in whom we performed clinical and echocardiographic examination at baseline and collected cardiac events on average 8.8 years later. Cardiac phenotypes that were correlated at r > 0.8 were filtered, leaving 21 echocardiographic features, and systolic blood pressure for phenogrouping. We employed hierarchical and Gaussian mixture model-based clustering. Cox regression was used to demonstrate the clinical validity of constructed phenogroups. Unsupervised clustering analyses classified study participants into three distinct phenogroups that differed markedly in echocardiographic indexes. Indeed, cluster 3 had the worst left ventricular (LV) diastolic function (i.e. lowest e' velocity and left atrial (LA) reservoir strain, highest E/e', and LA volume index) and LV remodelling. The phenogroups were also different in cardiovascular risk factor profiles. We observed increase in the risk for incidence of adverse events across phenogroups. In the third phenogroup, the multivariable adjusted risk was significantly higher than the average population risk for major cardiovascular events (51%, P = 0.0028). Conclusion Unsupervised learning algorithms integrating routinely measured cardiac imaging and haemodynamic data can provide a clinically meaningful classification of cardiac health in asymptomatic individuals. This approach might facilitate early detection of cardiac maladaptation and improve risk stratification.
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Affiliation(s)
- František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Box 7001, B 3000 Leuven, Belgium
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Box 7001, B 3000 Leuven, Belgium
| | - Celine Vens
- Department of Public Health and Primary Care, Kulak Kortrijk Campus, University of Leuven, Leuven, Belgium,Subdivision ITEC Machine Learning and Artificial Intelligence,, IMEC and University of Leuven Research Group, Leuven, Belgium
| | - Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, KU Leuven Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 35, Block D, Box 7001, B 3000 Leuven, Belgium,Corresponding author. Tel: +32 16 34 71 04,
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9
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Zhao LT, Liu L, Meng PP, Wang YH, Li M, Yang J, Gu TX, Ma CY. Effect of pericardial incision on left ventricular morphology and systolic function in patients during coronary artery bypass grafting. Cardiovasc Ultrasound 2020; 18:27. [PMID: 32693817 PMCID: PMC7374912 DOI: 10.1186/s12947-020-00206-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 06/21/2020] [Indexed: 12/21/2022] Open
Abstract
Background Accurate assessment of left ventricular (LV) systolic function is important after coronary artery bypass grafting (CABG). LV ejection fraction (LVEF) is conventionally used to evaluate LV systolic function; deformation parameters can be used to detect subtle LV systolic dysfunction. It is unclear whether an incised pericardium without sutures during CABG could affect LV morphology and function. We investigated the effect of pericardial incision on LV morphology and systolic function during CABG. Methods Intraoperative transesophageal echocardiography was performed in 27 patients during elective off-pump beating heart CABG 5 min before and after pericardial incision. LV longitudinal and mid-cavity transversal diameters, sphericity index, volumes, and LVEF were measured. LV global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS), and twist obtained by two-dimensional speckle tracking echocardiography were measured simultaneously. Results LV mid-cavity transversal diameter increased, while the LV sphericity index decreased (P < 0.001) immediately after pericardial incision. The GLS, GCS, and twist significantly decreased, while the GRS notably increased (P < 0.001). The LV volumes and LVEF remained unchanged. Conclusions Pericardial incision immediately transformed LV morphology from an ellipsoid to sphere, with decreased longitudinal and circumferential strain and twist, and increased radial strain, while LVEF remained unchanged. This should be considered when evaluating LV systolic function in patients after CABG.
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Affiliation(s)
- Lan-Ting Zhao
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Lu Liu
- Department of Cardiac Surgery, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Ping-Ping Meng
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Yong-Huai Wang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Meng Li
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China
| | - Tian-Xiang Gu
- Department of Cardiac Surgery, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China.
| | - Chun-Yan Ma
- Department of Cardiovascular Ultrasound, The First Hospital of China Medical University, No. 155 Nanjingbei Street, Heping District, Shenyang, 11001, Liaoning, China.
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10
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Pettey G, Motshabi P. Novel modalities for the diagnosis of cardiac surgery associated acute kidney injury : a narrative review of the literature. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2020. [DOI: 10.36303/sajaa.2020.26.2.2305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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11
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Arenas IA, Podesta CA, Issa O, Lin J, Brenes JC. Myocardial longitudinal strain, fitness, and heart failure risk factors in young adults. Echocardiography 2020; 37:404-411. [PMID: 32077529 DOI: 10.1111/echo.14613] [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] [Received: 12/25/2019] [Accepted: 01/24/2020] [Indexed: 11/29/2022] Open
Abstract
AIMS To investigate the relationship between fitness, heart failure (HF) risk factors (age, blood pressure, and obesity), and global/regional myocardial longitudinal strain in young adults undergoing stress testing. METHODS Individuals 25-55 years old without any significant medical history, not taking medications, and with a normal maximal stress echocardiogram were eligible. Global and regional longitudinal strain (LS) was evaluated by 2D speckle tracking echocardiography. RESULTS One hundred and seventy patients were included, of which 60% were males. The mean age was 43 years old, 49% had optimal blood pressure, and 30% were obese. On average, patients achieved 10.5 (3) METS, and the global LS was -19.9 (3.1) %. Reduced fitness was associated with decreased global longitudinal strain (GLS). Those in the top GLS quartile walked on average 1 minute and 21 seconds longer compared with the lowest quartile (P < .001). The effect of fitness on LS was preferential to the mid and apex, such that there was an apex-to-base gradient. Obesity was also independently associated with reduced GLS. However, the reduction in LS in obese individuals was more prominent at the base and mid-walls with relative sparing of the apex. Similar to fitness, aging was also associated with an increase in the apex-to-base gradient of LS. Furthermore, diastolic filling parameters correlated distinctively with regional LS. CONCLUSIONS In young adults without cardiovascular disease, low fitness and obesity are independently associated with reduced left ventricular longitudinal strain. There is a differential effect of HF risk factors on regional longitudinal function.
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Affiliation(s)
- Ivan A Arenas
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Carlos A Podesta
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Omar Issa
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Jeffrey Lin
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
| | - Juan C Brenes
- Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Florida
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12
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Naseri A, Sen I, Turgut K, Guzelbektes H, Constable PD. Echocardiographic assessment of left ventricular systolic function in neonatal calves with naturally occurring sepsis or septic shock due to diarrhea. Res Vet Sci 2019; 126:103-112. [PMID: 31445396 DOI: 10.1016/j.rvsc.2019.08.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 06/17/2019] [Accepted: 08/04/2019] [Indexed: 12/20/2022]
Abstract
Sepsis is associated with clinically relevant cardiovascular changes. The objectives of this study were to evaluate the clinical value of echocardiography for monitoring left ventricular (LV) systolic function in septic calves. A prospective longitudinal study was performed using a convenience sample. Twenty septic calves and 10 healthy calves were enrolled in the study. Arterial blood pressure (BP) was measured and M-mode echocardiography performed to characterize LV systolic function; the latter included measurement of ejection fraction, EF; stroke volume, SVI and cardiac output indexed to body weight, CI; E-point of septal separation, EPSS; pre-ejection period, PEP; ejection time, LVET; ratio of PEP to LVET; velocity of circumferential shortening, Vcf, LV end-diastolic volume index (LVEDVI) and LV end-systolic volume index (LVESVI) on admission and 6, 24, 48 and 72 h later in septic calves and once in healthy calves. Admission data were compared using the Mann-Whitney U test and P < .05 was considered significant. Decreased preload and afterload were present in septic calves, as indicated by marked decreases in BP, LVEDVI, LVESVI, SVI, CI, EPSS when compared to healthy calves. Systolic function appeared adequate in septic calves, based on EF and FS compared to control calves. There was no difference in heart rate, LVET, PEP:LVET, or Vcf between septic and health calves. We conclude that circulatory dysfunction, rather than systolic dysfunction predominates in septic calves. Positive associations on admission between CI and LVEDVI, LVESVI, and SVI support this conclusion. Echocardiographic determination of LVEDVI and CI appears useful in directing treatment in septic calves.
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Affiliation(s)
- Amir Naseri
- Selcuk University, Faculty of Veterinary Medicine, Department of Internal Medicine, Konya, Turkey.
| | - Ismail Sen
- Selcuk University, Faculty of Veterinary Medicine, Department of Internal Medicine, Konya, Turkey; Department of Internal Medicine, Faculty of Veterinary Medicine, Kyrgyz Turkish Manas University, Bishkek, Kyrgyzstan
| | - Kursad Turgut
- Selcuk University, Faculty of Veterinary Medicine, Department of Internal Medicine, Konya, Turkey; Near East University, Faculty of Veterinary Medicine, Department of Internal Medicine, Nicosia, North Cyprus, Turkey
| | - Hasan Guzelbektes
- Selcuk University, Faculty of Veterinary Medicine, Department of Internal Medicine, Konya, Turkey; Department of Internal Medicine, Faculty of Veterinary Medicine, Kyrgyz Turkish Manas University, Bishkek, Kyrgyzstan
| | - Peter D Constable
- University of Illinois at Urbana-Champaign, Department of Veterinary Clinical Medicine, College of Veterinary Medicine, Urbana, IL, United States
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13
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Cardim N, Dalen H, Voigt JU, Ionescu A, Price S, Neskovic AN, Edvardsen T, Galderisi M, Sicari R, Donal E, Stefanidis A, Delgado V, Zamorano J, Popescu BA. The use of handheld ultrasound devices: a position statement of the European Association of Cardiovascular Imaging (2018 update). Eur Heart J Cardiovasc Imaging 2019; 20:245-252. [PMID: 30351358 DOI: 10.1093/ehjci/jey145] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 09/13/2018] [Indexed: 12/19/2022] Open
Abstract
Recent technological advances in echocardiography, with progressive miniaturization of ultrasound machines, have led to the development of handheld ultrasound devices (HUD). These devices, no larger than some mobile phones, can be used to perform partial, focused exams as an extension to the physical examination. The European Association of Cardiovascular Imaging (EACVI) acknowledges that the dissemination of appropriate HUD use is inevitable and desirable, because of its potential impact on patient management. However, as a scientific society of cardiac imaging, our role is to provide guidance in order to optimize patient benefit and minimize drawbacks from inappropriate use of this technology. This document provides updated recommendations for the use of HUD, including nomenclature, appropriateness, indications, operators, clinical environments, data management and storage, educational needs, and training of potential users. It also addresses gaps in evidence, controversial issues, and future technological developments.
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Affiliation(s)
- Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, n° 100, Lisbon, Portugal.,Faculdade Ciências Médicas da Universidade nova de Lisboa, Campo Mártires da Pátria 130, Lisbon, Portugal
| | - Havard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Cardiology, St. Olav's University Hospital, Trondheim, Norway.,Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, Leuven, Belgium
| | - Adrian Ionescu
- Morriston Cardiac Regional Centre, ABMU LHB, Swansea, UK
| | - Susanna Price
- Adult Intensive Care Unit, Royal Brompton and Harefield NHS Foundation Trust, Sydney Street, London, UK
| | - Alexsandar N Neskovic
- Department of Cardiology, Clinical Hospital Center Zemun, Vukova 9, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Thor Edvardsen
- Department of Cardiology and Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet and University of Oslo, Sognsvannsveien 20, Oslo, Norway
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, VIa S. Pansini 5, Napples, Italy
| | - Rosa Sicari
- CNR, Institute of Clinical Physiology, Via G. Moruzzi, 1, Pisa, Italy
| | - Erwan Donal
- Service de Cardiologie et CIC-IT INSERM 1414, CHU Pontchaillou, Rennes, France.,LTSI, Université de Rennes 1, INSERM, UMR, Rennes, France
| | | | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden, The Netherlands
| | - Jose Zamorano
- Department of Cardiology, Hospital Ramón y Cajal, Ctra. de Colmenar Viejo, km. 9, 100, Madrid, Spain.,CIBERV, Madrid, Spain
| | - Bogdan A Popescu
- University of Medicine and Pharmacy "Carol Davila", Euroecolab, Institute of cardiovascular diseases "Prof. Dr. C C Iliescu, Bucharest, Romania
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14
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The Impact of Spironolactone in Heart Failure With Preserved Ejection Fraction. JACC Cardiovasc Imaging 2019; 12:795-797. [DOI: 10.1016/j.jcmg.2018.01.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 01/25/2018] [Indexed: 11/21/2022]
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15
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Ballo H, Tarkia M, Haavisto M, Stark C, Strandberg M, Vähäsilta T, Saunavaara V, Tolvanen T, Teräs M, Hynninen VV, Savunen T, Roivainen A, Knuuti J, Saraste A. Determinants of Myocardial Strain in Experimental Chronic Myocardial Infarction. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:568-578. [PMID: 30467033 DOI: 10.1016/j.ultrasmedbio.2018.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/17/2018] [Accepted: 10/04/2018] [Indexed: 06/09/2023]
Abstract
We evaluated the relationships between regional myocardial strain measured by speckle tracking echocardiography and viability, fibrosis, hypertrophy and oxygen consumption in the infarcted or remote myocardium in a pig model of chronic myocardial infarction (MI). Thirteen farm pigs with surgical occlusion of the left anterior descending coronary artery and five sham-operated pigs were studied 3 mo post-MI. Computed tomography revealed significant left ventricle remodeling. Reduced radial or circumferential strain identified areas of transmural infarction (area under the curve: 0.82 and 0.79, respectively). In the remote non-infarcted area, radial strain correlated inversely with the amount of fibrosis (r = -0.66, p = 0.04) and myocyte hypertrophy (r = -0.68, p = 0.03). Radial strain rate inversely correlated with myocardial resting oxygen consumption assessed with 11C-labeled acetate positron emission tomography (r = -0.71, p = 0.006). In conclusion, myocardial strain and strain rate reflect fibrosis, hypertrophy and oxygen consumption of the remote areas after MI.
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Affiliation(s)
- Haitham Ballo
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
| | - Miikka Tarkia
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Matti Haavisto
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Christoffer Stark
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Marjatta Strandberg
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland
| | - Tommi Vähäsilta
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Virva Saunavaara
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Department of Medical Physics, Division of Medical Imaging, Turku University Hospital, Turku PET Centre, Turku University Hospital, Turku, Finland
| | - Tuula Tolvanen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Mika Teräs
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Ville-Veikko Hynninen
- Department of Anesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital, Turku, Finland
| | - Timo Savunen
- Research Centre of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Anne Roivainen
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Turku Center for Disease Modeling, University of Turku, Turku, Finland
| | - Juhani Knuuti
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland
| | - Antti Saraste
- Turku PET Centre, University of Turku and Turku University Hospital, Turku, Finland; Heart Center, Turku University Hospital and University of Turku, Turku, Finland; Institute of Clinical Medicine, University of Turku, Turku, Finland
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16
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Santiago A, Aguado-Sierra J, Zavala-Aké M, Doste-Beltran R, Gómez S, Arís R, Cajas JC, Casoni E, Vázquez M. Fully coupled fluid-electro-mechanical model of the human heart for supercomputers. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2018; 34:e3140. [PMID: 30117302 DOI: 10.1002/cnm.3140] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 04/28/2018] [Accepted: 07/22/2018] [Indexed: 05/12/2023]
Abstract
In this work, we present a fully coupled fluid-electro-mechanical model of a 50th percentile human heart. The model is implemented on Alya, the BSC multi-physics parallel code, capable of running efficiently in supercomputers. Blood in the cardiac cavities is modeled by the incompressible Navier-Stokes equations and an arbitrary Lagrangian-Eulerian (ALE) scheme. Electrophysiology is modeled with a monodomain scheme and the O'Hara-Rudy cell model. Solid mechanics is modeled with a total Lagrangian formulation for discrete strains using the Holzapfel-Ogden cardiac tissue material model. The three problems are simultaneously and bidirectionally coupled through an electromechanical feedback and a fluid-structure interaction scheme. In this paper, we present the scheme in detail and propose it as a computational cardiac workbench.
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Affiliation(s)
- Alfonso Santiago
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Jazmín Aguado-Sierra
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Miguel Zavala-Aké
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | | | - Samuel Gómez
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Ruth Arís
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Juan C Cajas
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Eva Casoni
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Mariano Vázquez
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
- Instituto de Investigación en Inteligencia Artificial (IIIA), Consejo Superior de Investigaciones Científicas (CSIC), Barcelona, Spain
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17
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Gehlen H, Bildheim LM. Speckle-tracking analysis of myocardial deformation in correlation to age in healthy horses. J Vet Sci 2018; 19:676-682. [PMID: 29695144 PMCID: PMC6167342 DOI: 10.4142/jvs.2018.19.5.676] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 03/13/2018] [Accepted: 04/23/2018] [Indexed: 11/20/2022] Open
Abstract
An effect of aging on cardiac morphology and function has been shown in humans. In horses, cardiac wall motion analysis using two-dimensional speckle tracking (2D-ST) has not yet been reported. Our study included 57 horses of different warmblood breeds between 3 and 30 years old. Age had a significant influence on left ventricular free wall (LVFW) systolic strain rate (p ≤ 0.05) and early diastolic relaxation (p ≤ 0.01). In the interventricular septum (IVS), systolic (p ≤ 0.01) and late diastolic (p ≤ 0.05) contraction velocities also increased with age. In our study, 2D-ST revealed important information on myocardial function, which was most evident in the LVFW, where measurements were highly reproducible. Aging seems to be associated with structural changes within the myocardium and with decreasing contraction capacity in old animals. These physiological, age-related processes should be considered when performing cardiac wall motion analysis of the 2D-ST results for the LVFW and IVS in horses.
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Affiliation(s)
- Heidrun Gehlen
- Equine Clinic, Freie Universitaet Berlin, 14195 Berlin, Germany
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18
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Avram R, Marquis-Gravel G, Simard F, Pacheco C, Couture É, Tremblay-Gravel M, Desplantie O, Malhamé I, Bibas L, Mansour S, Parent MC, Farand P, Harvey L, Lessard MG, Ly H, Liu G, Hay AE, Marc Jolicoeur E. Understanding the patient perspective on research access to national health records databases for conduct of randomized registry trials. Int J Cardiol 2018; 262:110-116. [PMID: 29706388 DOI: 10.1016/j.ijcard.2017.12.074] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 11/02/2017] [Accepted: 12/20/2017] [Indexed: 01/01/2023]
Abstract
BACKGROUND Use of health administrative databases is proposed for screening and monitoring of participants in randomized registry trials. However, access to these databases raises privacy concerns. We assessed patient's preferences regarding use of personal information to link their research records with national health databases, as part of a hypothetical randomized registry trial. METHODS AND RESULTS Cardiology patients were invited to complete an anonymous self-reported survey that ascertained preferences related to the concept of accessing government health databases for research, the type of personal identifiers to be shared and the type of follow-up preferred as participants in a hypothetical trial. A total of 590 responders completed the survey (90% response rate), the majority of which were Caucasians (90.4%), male (70.0%) with a median age of 65years (interquartile range, 8). The majority responders (80.3%) would grant researchers access to health administrative databases for screening and follow-up. To this end, responders endorsed the recording of their personal identifiers by researchers for future record linkage, including their name (90%), and health insurance number (83.9%), but fewer responders agreed with the recording of their social security number (61.4%, p<0.05 with date of birth as reference). Prior participation in a trial predicted agreement for granting researchers access to the administrative databases (OR: 1.69, 95% confidence interval: 1.03-2.90; p=0.04). CONCLUSION The majority of Cardiology patients surveyed were supportive of use of their personal identifiers to access administrative health databases and conduct long-term monitoring in the context of a randomized registry trial.
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Affiliation(s)
- Robert Avram
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Guillaume Marquis-Gravel
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - François Simard
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Christine Pacheco
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Étienne Couture
- Centre Hospitalier Universitaire de Sherbrooke, Cardiology, Sherbrooke, Quebec, Canada; Université de Sherbrooke, Cardiology, Sherbrooke, Québec, Canada
| | - Maxime Tremblay-Gravel
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Olivier Desplantie
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | | | - Lior Bibas
- McGill University, Cardiology, Montreal, Québec, Canada
| | - Samer Mansour
- Centre Hospitalier Universitaire de Montréal - Hôtel Dieu Hospital, Montreal, Québec, Canada
| | - Marie-Claude Parent
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Paul Farand
- Centre Hospitalier Universitaire de Sherbrooke, Cardiology, Sherbrooke, Quebec, Canada; Université de Sherbrooke, Cardiology, Sherbrooke, Québec, Canada
| | - Luc Harvey
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada
| | | | - Hung Ly
- Montreal Heart Institute, Cardiology, Montréal, Québec, Canada; Université de Montréal, Cardiology, Montréal, Québec, Canada
| | - Geoffrey Liu
- University Hospital Network, Toronto, Ontario, Canada
| | - Annette E Hay
- Queen's University, Canadian Cancer Trials Group, Kingston, Ontario, Canada; Queen's University, Department of Medicine, Kingston, Ontario, Canada
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19
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Casas B, Viola F, Cedersund G, Bolger AF, Karlsson M, Carlhäll CJ, Ebbers T. Non-invasive Assessment of Systolic and Diastolic Cardiac Function During Rest and Stress Conditions Using an Integrated Image-Modeling Approach. Front Physiol 2018; 9:1515. [PMID: 30425650 PMCID: PMC6218619 DOI: 10.3389/fphys.2018.01515] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 10/09/2018] [Indexed: 01/08/2023] Open
Abstract
Background: The possibility of non-invasively assessing load-independent parameters characterizing cardiac function is of high clinical value. Typically, these parameters are assessed during resting conditions. However, for diagnostic purposes, the parameter behavior across a physiologically relevant range of heart rate and loads is more relevant than the isolated measurements performed at rest. This study sought to evaluate changes in non-invasive estimations of load-independent parameters of left-ventricular contraction and relaxation patterns at rest and during dobutamine stress. Methods: We applied a previously developed approach that combines non-invasive measurements with a physiologically-based, reduced-order model of the cardiovascular system to provide subject-specific estimates of parameters characterizing left ventricular function. In this model, the contractile state of the heart at each time point along the cardiac cycle is modeled using a time-varying elastance curve. Non-invasive data, including four-dimensional magnetic resonance imaging (4D Flow MRI) measurements, were acquired in nine subjects without a known heart disease at rest and during dobutamine stress. For each of the study subjects, we constructed two personalized models corresponding to the resting and the stress state. Results: Applying the modeling framework, we identified significant increases in the left ventricular contraction rate constant [from 1.5 ± 0.3 to 2 ± 0.5 (p = 0.038)] and relaxation constant [from 37.2 ± 6.9 to 46.1 ± 12 (p = 0.028)]. In addition, we found a significant decrease in the elastance diastolic time constant from 0.4 ± 0.04 s to 0.3 ± 0.03 s (p = 0.008). Conclusions: The integrated image-modeling approach allows the assessment of cardiovascular function given as model-based parameters. The agreement between the estimated parameter values and previously reported effects of dobutamine demonstrates the potential of the approach to assess advanced metrics of pathophysiology that are otherwise difficult to obtain non-invasively in clinical practice.
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Affiliation(s)
- Belén Casas
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Federica Viola
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Gunnar Cedersund
- Department of Biomedical Engineering, Linköping University, Linköping, Sweden
| | - Ann F Bolger
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Matts Karlsson
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Division of Applied Thermodynamics and Fluid Mechanics, Department of Management and Engineering, Linköping University, Linköping, Sweden
| | - Carl-Johan Carlhäll
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden.,Department of Clinical Physiology, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.,Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
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20
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Popović ZB, Desai MY, Griffin BP. Decision Making With Imaging in Asymptomatic Aortic Regurgitation. JACC Cardiovasc Imaging 2018; 11:1499-1513. [DOI: 10.1016/j.jcmg.2018.05.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2018] [Revised: 05/07/2018] [Accepted: 05/18/2018] [Indexed: 10/28/2022]
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21
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Lee JH, Park JH. Strain Analysis of the Right Ventricle Using Two-dimensional Echocardiography. J Cardiovasc Imaging 2018; 26:111-124. [PMID: 30310878 PMCID: PMC6160817 DOI: 10.4250/jcvi.2018.26.e11] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/11/2018] [Accepted: 08/28/2018] [Indexed: 01/12/2023] Open
Abstract
Right ventricular (RV) systolic dysfunction has been identified as an independent prognostic marker of many cardiovascular diseases. However, there are problems in measuring RV systolic function objectively and identification of RV dysfunction using conventional echocardiography. Strain echocardiography is a new imaging modality to measure myocardial deformation. It can measure intrinsic myocardial function and has been used to measure regional and global left ventricular (LV) function. Although the RV has different morphologic characteristics than the LV, strain analysis of the RV is feasible. After strain echocardiography was introduced to measure RV systolic function, it became more popular and was incorporated into recent echocardiographic guidelines. Recent studies showed that RV global longitudinal strain (RVGLS) can be used as an objective index of RV systolic function with prognostic significance. In this review, we discuss RVGLS measurement, normal reference values, and the clinical importance of RVGLS.
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Affiliation(s)
- Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Jae-Hyeong Park
- Department of Cardiology in Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
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Shi F, Feng S, Zhu J, Wu Y, Chen J. Left Ventricular Strain and Dyssynchrony in Young and Middle-Aged Peritoneal Dialysis Patients and Healthy Controls: A Case-Matched Study. Cardiorenal Med 2018; 8:271-284. [PMID: 30045025 DOI: 10.1159/000490395] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 05/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND This study aimed to evaluate the role of two-dimensional speckle-tracking imaging (2D-STI) and myocardial layer-specific analysis in evaluating early left ventricular (LV) myocardial function and systolic dyssynchrony in young and middle-aged uremic patients undergoing peritoneal dialysis (PD). METHODS We enrolled 31 PD patients aged ≤65 years with preserved LV ejection fraction (LVEF, ≥54%) as the PD group and 49 age-matched healthy people as the control group. Echocardiography was used to assess the left atrial diameter index (LADI, LAD/BSA), LV mass index (LVMI), LVEF, peak early diastolic velocity/late diastolic velocity (E/A) (measured by pulsed Doppler), and peak early diastolic velocity (by pulsed Doppler)/peak velocity of the early diastolic wave (by pulsed-wave tissue Doppler) (E/e'). Next, we used 2D-STI and myocardial layer-specific analysis to obtain longitudinal strains (LS) of the endocardium (LSendo), the myocardium (LSmyo), the epicardium (LSepi), and the global myocardium (GLS). Then, we measured the postsystolic index (PSI) to evaluate LV myocardial function. Time to peak LS (TTP) and peak strain dispersion (PSD) from 17 consecutive segments were assessed to quantify LV dyssynchrony. RESULTS Compared with the controls, PD patients had significantly increased LADI (p = 0.041), LVMI (p = 0.000), and E/e' (p = 0.009), but reduced LVEF (p = 0.000) and E/A (p = 0.000). The average values of GLS (GLS avg) (p = 0.01) and GLS of the apical 2-chamber view (p = 0.003), including the LSendo (p = 0.024), LSmyo (p = 0.024), and LSepi (p = 0.032), were significantly decreased in patients with PD compared with controls. In PSI, segments of LS were markedly delayed in the anterior septum (p = 0.047), anterior (p = 0.000) and septum wall (p = 0.024) from basal segments, anterior wall (p = 0.001) from middle segments, and anterior (p = 0.024) and inferior (p = 0.024) wall from apical segments. Moreover, PSD was significantly increased in PD patients (p = 0.015), while TTP was evidently delayed in the anterior septum (p = 0.004), anterior (p = 0.000) and posterior (p = 0.042) wall from basal segments, and inferior wall (p = 0.048) from apical segments. CONCLUSIONS Despite preserved LVEF, young and middle-aged PD patients developed LV dysfunction and myocardial systolic dyssynchrony earlier compared with controls.
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Affiliation(s)
- Fei Shi
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Sheng Feng
- Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jing Zhu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanni Wu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Jianchang Chen
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
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Katsi V, Georgiopoulos G, Laina A, Koutli E, Parissis J, Tsioufis C, Nihoyannopoulos P, Tousoulis D. Left ventricular ejection fraction as therapeutic target: is it the ideal marker? Heart Fail Rev 2018; 22:641-655. [PMID: 28601914 DOI: 10.1007/s10741-017-9624-5] [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] [Indexed: 12/11/2022]
Abstract
Heart failure (HF) consists the fastest growing clinical cardiac disease. HF patients are categorized on the basis of underlying left ventricular ejection fraction (LVEF) into HF with preserved EF (HFpEF), reduced LVEF (HFrEF), and mid-range LVEF (HFmrEF). While LVEF is the most commonly used surrogate marker of left ventricular (LV) systolic function, the implementation of two-dimensional echocardiography in estimating this parameter imposes certain caveats on current HF classification. Most importantly, LVEF could fluctuate in repeated measurements or even recover after treatment, thus blunting the borders between proposed categories of HF and enabling upward classification of patients. Under this prism, we sought to summarize possible procedures to improve systolic function in patients with HFrEF either naturally or by the means of pharmacologic and non-pharmacologic treatment and devices. Therefore, we reviewed established pharmacotherapy, including beta-blockers, inhibitors of renin-angiotensin-aldosterone axis, statins, and digoxin as well as novel treatments like sacubitril-valsartan, ranolazine, and ivabradine. In addition, we assessed evidence in favor of cardiac resynchronization therapy and exercise training programs. Finally, innovative therapeutic strategies, including stem cells, xanthine oxidase inhibitors, antibiotic regimens, and omega-3 polyunsaturated fatty acids, were also taken into consideration. We concluded that LVEF is subject to changes in HF after intervention and besides the aforementioned HFrEF, HFpEF, and HFmrEF categories, a new entity of HF patients with recovered LVEF should be acknowledged. An improved global and refined LV function assessment by sophisticated imaging modalities and circulating biomarkers is expected to render HF classification more accurate and indicate patients with viable-yet dysfunctional-myocardium and favorable characteristics as the ideal candidates for LVEF recovery by individualized HF therapy.
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Affiliation(s)
- V Katsi
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - G Georgiopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece.
| | - A Laina
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - E Koutli
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - J Parissis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - C Tsioufis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - P Nihoyannopoulos
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
| | - D Tousoulis
- 1st Cardiology Department, National and Kapodistrian University of Athens, University Medical School, Hippokration Hospital, Vasilissis Sofias 114, 11528, Athens, Greece
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Azoz A, Youssef A, Alshehri A, Gad A, Rashed M, Yahia M, Alsharqi M, Al Saikhan L. Correlation between ST segment shift and cardiac diastolic function in patients with acute myocardial infarction. J Electrocardiol 2018; 51:592-597. [PMID: 29996996 DOI: 10.1016/j.jelectrocard.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/01/2018] [Accepted: 03/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Diastolic dysfunction is the early sign of myocardial ischemia that usually occurs earlier than ECG changes. AIM OF THE STUDY To determine the existence of a correlation between ST segment shift and diastolic dysfunction among patients with AMI. METHODS Fourty six patients with significant ST segment elevation or depression and having symptoms of acute myocardial infarction for <12 h were enrolled in this study. Patients were examined for serial ECG, cardiac enzymes, and echocardiography. RESULTS There was no significant correlation between ST segment elevation or depression and majority of the diastolic indices. Few diastolic parameters; such as, E/A ratio of the mitral valve and deceleration time of the tricuspid valve showed a direct correlation with the ECG changes. Whereas, the Tei Index of the LV function showed a borderline correlation to the ST segment elevation at discharge. CONCLUSION Overall, there was no correlation between either ST segment elevation or depression and the LV or RV diastolic function in patients with acute coronary syndrome (ACS). Improvement of the ST segment total score was associated with improvement of the diastolic function grades at discharge. Moreover, this association has shown an evidence of dose response relationship, the more improvement in total score at discharge the more improvement in diastolic function grade level.
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Affiliation(s)
- Ayman Azoz
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
| | - Adel Youssef
- Department of Health Information Management, College of Public Health, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Abdullah Alshehri
- Department of Internal Medicine, College of Medicine, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Ahmed Gad
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mostafa Rashed
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Mohamed Yahia
- Department of Cardiology, Faculty of Medicine, University of Menoufia, Egypt
| | - Maryam Alsharqi
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
| | - Lamia Al Saikhan
- Cardiac Technology Department, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Saudi Arabia
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What Is the Heart? Anatomy, Function, Pathophysiology, and Misconceptions. J Cardiovasc Dev Dis 2018; 5:jcdd5020033. [PMID: 29867011 PMCID: PMC6023278 DOI: 10.3390/jcdd5020033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 01/08/2023] Open
Abstract
Cardiac dynamics are traditionally linked to a left ventricle, right ventricle, and septum morphology, a topography that differs from the heart's five-century-old anatomic description of containing a helix and circumferential wrap architectural configuration. Torrent Guasp's helical ventricular myocardial band (HVMB) defines this anatomy and its structure, and explains why the heart's six dynamic actions of narrowing, shortening, lengthening, widening, twisting, and uncoiling happen. The described structural findings will raise questions about deductions guiding "accepted cardiac mechanics", and their functional aspects will challenge and overturn them. These suppositions include the LV, RV, and septum description, timing of mitral valve opening, isovolumic relaxation period, reasons for torsion/twisting, untwisting, reasons for longitudinal and circumferential strain, echocardiographic sub segmentation, resynchronization, RV function dynamics, diastolic dysfunction's cause, and unrecognized septum impairment. Torrent Guasp's revolutionary contributions may alter future understanding of the diagnosis and treatment of cardiac disease.
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26
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Benameur N, Caiani EG, Arous Y, Ben Abdallah N, Kraiem T. Parametric Imaging for the Assessment of Cardiac Motion: A Review. Cardiovasc Eng Technol 2018; 9:377-393. [PMID: 29761408 DOI: 10.1007/s13239-018-0362-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 05/09/2018] [Indexed: 11/24/2022]
Abstract
The assessment of wall motion abnormalities such as hypokinesia or dyskinesia and the identification of their extent as well as their degree of severity allow an accurate evaluation of several ischemic heart diseases and an early diagnosis of heart failure. These dysfunctions are usually revealed by a drop of contraction indicating a regional hypokinesia or a total absence of the wall motion in case of akinesia. The discrimination between these contraction abnormalities plays also a significant role in the therapeutic decision through the differentiation between the infarcted zones, which have lost their contractile function, and the stunned areas that still retain viable myocardial tissues. The lack of a reliable method for the evaluation of wall motion abnormalities in cardiac imaging presents a major limitation for a regional assessment of the left ventricular function. In the past years, several techniques were proposed as additional tools for the local detection of wall motion deformation. Among these approaches, the parametric imaging is likely to represent a promising technique for the analysis of a local contractile function. The aim of this paper is to review the most recent techniques of parametric imaging computation developed in cardiac imaging and their potential contributions in clinical practice.
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Affiliation(s)
- Narjes Benameur
- Laboratory of Biophysics and Medical Technology, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia.
| | - Enrico Gianluca Caiani
- Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milan, Italy
| | - Younes Arous
- Military Hospital of Instruction of Tunis, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nejmeddine Ben Abdallah
- Military Hospital of Instruction of Tunis, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Tarek Kraiem
- Laboratory of Biophysics and Medical Technology, Higher Institute of Medical Technologies of Tunis, University of Tunis El Manar, 1006, Tunis, Tunisia.,Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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27
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Olesen JB, Villagomez-Hoyos CA, Moller ND, Ewertsen C, Hansen KL, Nielsen MB, Bech B, Lonn L, Traberg MS, Jensen JA. Noninvasive Estimation of Pressure Changes Using 2-D Vector Velocity Ultrasound: An Experimental Study With In Vivo Examples. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2018; 65:709-719. [PMID: 29733275 DOI: 10.1109/tuffc.2018.2808328] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
A noninvasive method for estimating intravascular pressure changes using 2-D vector velocity is presented. The method was first validated on computational fluid dynamic (CFD) data and with catheter measurements on phantoms. Hereafter, the method was tested in vivo at the carotid bifurcation and at the aortic valve of two healthy volunteers. Ultrasound measurements were performed using the experimental scanner SARUS, in combination with an 8 MHz linear array transducer for experimental scans and a carotid scan, whereas a 3.5-MHz phased array probe was employed for a scan of an aortic valve. Measured 2-D fields of angle-independent vector velocities were obtained using synthetic aperture imaging. Pressure drops from simulated steady flow through six vessel geometries spanning different degrees of diameter narrowing, running from 20%-70%, showed relative biases from 0.35% to 12.06%, depending on the degree of constriction. Phantom measurements were performed on a vessel with the same geometry as the 70% constricted CFD model. The derived pressure drops were compared to pressure drops measured by a clinically used 4F catheter and to a finite-element model. The proposed method showed peak systolic pressure drops of -3 kPa ± 57 Pa, while the catheter and the simulation model showed -5.4 kPa ± 52 Pa and -2.9 kPa, respectively. An in vivo acquisition of 10 s was made at the carotid bifurcation. This produced eight cardiac cycles from where pressure gradients of -227 ± 15 Pa were found. Finally, the aortic valve measurement showed a peak pressure drop of -2.1 kPa over one cardiac cycle. In conclusion, pressure gradients from convective flow changes are detectable using 2-D vector velocity ultrasound.
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28
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Schneider C, Forsythe L, Somauroo J, George K, Oxborough D. The impact of preload reduction with head-up tilt testing on longitudinal and transverse left ventricular mechanics: a study utilizing deformation volume analysis. Echo Res Pract 2018; 5:11-18. [PMID: 29339401 PMCID: PMC5776152 DOI: 10.1530/erp-17-0064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 12/07/2017] [Indexed: 11/18/2022] Open
Abstract
Background Left ventricular (LV) function is dependent on load, intrinsic contractility and
relaxation with a variable impact on specific mechanics. Strain (ε) imaging
allows the assessment of cardiac function; however, the direct relationship between
volume and strain is currently unknown. The aim of this study was to establish the
impact of preload reduction through head-up tilt (HUT) testing on
simultaneous left ventricular (LV) longitudinal and transverse
function and their respective contribution to volume change. Methods A focused transthoracic echocardiogram was performed on 10 healthy male participants
(23 ± 3 years) in the supine position and following 1 min
and 5 min of HUT testing. Raw temporal longitudinal ε (Ls) and transverse
ε (Ts) values were exported and divided into 5% increments across the cardiac
cycle and corresponding LV volumes were traced at each 5% increment. This provided
simultaneous LV longitudinal and transverse ε and volume loops (deformation
volume analysis – DVA). Results There was a leftward shift of the ε-volume loop from supine to 1 min and
5 min of HUT (P < 0.001). Moreover,
longitudinal shortening was reduced (P < 0.001)
with a concomitant increase in transverse thickening from supine to 1 min, which
was further augmented at 5 min (P = 0.018). Conclusions Preload reduction occurs within 1 min of HUT but does not further reduce at
5 min. This decline is associated with a decrease in longitudinal ε and
concomitant increase in transverse ε. Consequently, augmented transverse
relaxation appears to be an important factor in the maintenance of LV filling in the
setting of reduced preload. DVA provides information on the relative contribution of
mechanics to a change in LV volume and may have a role in the assessment of clinical
populations.
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Affiliation(s)
- Caroline Schneider
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lynsey Forsythe
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - John Somauroo
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
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Ross Agner BF, Katz MG, Williams ZR, Dixen U, Jensen GB, Schwarz KQ. Left Ventricular Systolic Function Assessed by Global Longitudinal Strain is Impaired in Atrial Fibrillation Compared to Sinus Rhythm. J Atr Fibrillation 2017; 10:1437. [PMID: 29487674 DOI: 10.4022/jafib.1437] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/19/2017] [Accepted: 10/14/2017] [Indexed: 01/19/2023]
Abstract
Background Atrial fibrillation (AF) is the most common aberrant cardiac arrhythmia. Many AF patients present with symptoms of dyspnea and fatigue, but have normal left ventricular ejection fraction (LVEF). Purpose To determine the reproducibility of measurements of global longitudinal strain (GLS) and strain rate in patients with AF and examine if the arrhythmia is associated with abnormal LV strain and strain rate independent of age, sex, heart rate, LVEF and LV mass. We hypothesized that AF independently reduces ventricular systolic performance. Methods The study was conducted as a retrospective analysis of images from 150 randomly selected patients with AF compared to an equal number of subjects with sinus rhythm (SR) matched for age, sex, heart rate, LVEF and LV mass. Half of the patients had normal LVEF (LVEF > 50%) and half had reduced LVEF (LVEF < 50%). GLS and strain rate were measured in each group, as were quantitative LV volumes and standard systolic and diastolic parameters. Results: GLS was significantly impaired in patients with AF compared to subjects with SR, both in the overall population (-12.25 ± 4.1% vs. -16.13 ± 4.7%, p<0.0001), in patients with normal LVEF (-14.41 ± 3.9% vs. -19.42 ± 3.1%, p<0.0001) and in patients with reduced LVEF (-10.10 ± 3.1% vs. -12.85 ± 3.5%, p<0.0001).Linear regression and Bland Altman analyses demonstrated good intraobserver and interobserver agreement for measurements of GLS and strain rate parameters even in patients with AF.
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Affiliation(s)
- Bue F Ross Agner
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Michael G Katz
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Zachary R Williams
- University of Rochester Medical Center, Department of Cardiology, Rochester, New York, USA
| | - Ulrik Dixen
- University of Rochester Medical Center, Department of Cardiology, Rochester, New York, USA
| | - Gorm B Jensen
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Karl Q Schwarz
- Hvidovre University Hospital, Department of Cardiology, Copenhagen, Denmark
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Barbosa D, Pedrosa J, Heyde B, Dietenbeck T, Friboulet D, Bernard O, D’hooge J. heartBEATS: A hybrid energy approach for real-time B-spline explicit active tracking of surfaces. Comput Med Imaging Graph 2017; 62:26-33. [DOI: 10.1016/j.compmedimag.2017.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/24/2017] [Accepted: 07/25/2017] [Indexed: 11/29/2022]
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Macatangay C, Viles-Gonzalez JF, Goldberger JJ. Role of Cardiac Imaging in Evaluating Risk for Sudden Cardiac Death. Card Electrophysiol Clin 2017; 9:639-650. [PMID: 29173407 DOI: 10.1016/j.ccep.2017.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sudden cardiac death (SCD) is a major cause of death from cardiovascular disease. Our ability to predict patients at the highest risk of developing lethal ventricular arrhythmias remains limited. Despite recent studies evaluating risk stratification tools, there is no optimal strategy. Cardiac imaging provides the opportunity to assess left ventricular ejection fraction, strain, fibrosis, and sympathetic innervation, all of which are pathophysiologically related to SCD risk. These modalities may play a role in the identification of vulnerable anatomic substrates that provide the pathophysiologic basis for SCD. Further studies are required to identify optimal imaging platform for risk assessment.
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Affiliation(s)
- Constancia Macatangay
- Cardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Juan F Viles-Gonzalez
- Cardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136, USA
| | - Jeffrey J Goldberger
- Cardiovascular Division, Department of Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th Street, Miami, FL 33136, USA.
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Avendaño-Pérez L, Soto ME, Ávila-Vanzzini N, Bracamontes-Castelo G, Ruán-Díaz JC, Alexanderson-Rosas E, Espinola-Zavaleta N. Mechanical deformation in adult patients with unrepaired aortic coarctation. Int J Cardiovasc Imaging 2017; 34:735-741. [PMID: 29189934 DOI: 10.1007/s10554-017-1286-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Accepted: 11/28/2017] [Indexed: 01/16/2023]
Abstract
Aortic coarctation is a congenital heart disease that causes an increased left ventricular afterload, resulting in increased systolic parietal tension, compensatory hypertrophy, and left ventricular systolic and diastolic dysfunction. The speckle tracking is a new echocardiographic technique that allows the detection of subclinic left ventricular systolic dysfunction. The aim of this study was to detect early left ventricular dysfunction using mechanical deformation by echocardiography in adults with un-repaired aortic coarctation. A total of 41 subjects were studied, 20 patients with aortic coarctation and 21 control subjects, 21 women (51.2%), with an average age of 30 ± 10 years. All patients with aortic coarctation had systemic arterial hypertension (p < 0.001). Seventy percent (14/20) of the patients had bicuspid aortic valve. Statistically significance (p < 0.005) were found in left ventricular mass index, E/e ratio, pulmonary artery systolic pressure and peak velocity and maximum gradient of the aortic valve. The global longitudinal deformation of the left ventricle in patients with aortic coarctation was significative decreased, p < 0.001. The ejection fraction and the global longitudinal deformation of the left ventricle were significantly lower in patients with aortic coarctation compared to the control group, p < 0.003, p < 0.001, respectively. The subgroup of patients with coarctation and left ventricular ejection fraction < 55% had a marked decrease in global longitudinal strain (- 15.9 ± 4%). The radial deformation was increased in patients with aortic coarctation and showed a trend to be significant (r = 0.421; p < 0.06). A significant negative correlation was observed between the global longitudinal deformation and left ventricular mass index (r = 0.54; p = 0.01) in the aortic coarctation group. The patients with aortic coarctation and left ventricular hypertrophy had marked reduction of left ventricular global longitudinal deformation (- 16%, p < 0.05). In our study patients with normal left ventricular ejection fraction had abnormal global longitudinal deformation and also the increased left ventricular mass was related with a decreased left ventricular global longitudinal deformation as a sign of subclinical systolic dysfunction.
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Affiliation(s)
- Leonel Avendaño-Pérez
- Laboratory of Echocardiography and Non-invasive Hemodynamics, National Institute of Cardiology "Ignacio Chávez", Juan Badiano No 1, Colonia Sección XVI, Tlalpan, C. P. 14030, Mexico City, Mexico
| | - María Elena Soto
- Department Immunology, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Nydia Ávila-Vanzzini
- Department of Out-patients Clinic, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Guillermo Bracamontes-Castelo
- Laboratory of Echocardiography and Non-invasive Hemodynamics, National Institute of Cardiology "Ignacio Chávez", Juan Badiano No 1, Colonia Sección XVI, Tlalpan, C. P. 14030, Mexico City, Mexico
| | - José Carlos Ruán-Díaz
- Laboratory of Echocardiography and Non-invasive Hemodynamics, National Institute of Cardiology "Ignacio Chávez", Juan Badiano No 1, Colonia Sección XVI, Tlalpan, C. P. 14030, Mexico City, Mexico
| | - Erick Alexanderson-Rosas
- Department of Nuclear Medicine, National Institute of Cardiology "Ignacio Chavez", Mexico City, Mexico
| | - Nilda Espinola-Zavaleta
- Laboratory of Echocardiography and Non-invasive Hemodynamics, National Institute of Cardiology "Ignacio Chávez", Juan Badiano No 1, Colonia Sección XVI, Tlalpan, C. P. 14030, Mexico City, Mexico.
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Kinno M, Nagpal P, Horgan S, Waller AH. Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 2 (Diastolic and Regional Assessment). Curr Cardiol Rep 2017; 19:6. [PMID: 28116679 DOI: 10.1007/s11886-017-0816-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Assessing left ventricular diastolic and regional function is a crucial part of the cardiovascular evaluation. Diastolic function is as important as systolic function for left ventricular performance because it is the determinant of the ability of the left atrium and ventricle to fill at relatively low pressures. Additionally, diastolic function plays an important role in the management and prognosis of patients with symptoms and signs of heart failure. Technical advances in the imaging modalities have allowed a comprehensive noninvasive assessment of global and regional cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare clinically available techniques and novel approaches using echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of diastolic and regional left ventricular function.
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Affiliation(s)
- Menhel Kinno
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA
| | - Prashant Nagpal
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephen Horgan
- Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA. .,Department of Radiology, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA.
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Kinno M, Nagpal P, Horgan S, Waller AH. Comparison of Echocardiography, Cardiac Magnetic Resonance, and Computed Tomographic Imaging for the Evaluation of Left Ventricular Myocardial Function: Part 1 (Global Assessment). Curr Cardiol Rep 2017; 19:9. [PMID: 28176279 DOI: 10.1007/s11886-017-0815-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Assessing left ventricular function is an essential part of the cardiovascular evaluation as it plays an important role in managing the patient and predicting prognosis. Recent advances in the imaging modalities currently allow a non-invasive comprehensive assessment of cardiac mechanics and precise estimation of cardiovascular hemodynamics. In this review, we will discuss and compare the currently available techniques and novel approaches utilized by echocardiography, cardiac magnetic resonance, and computed tomography for the assessment of global left ventricular performance.
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Affiliation(s)
- Menhel Kinno
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA
| | - Prashant Nagpal
- Department of Radiology, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Stephen Horgan
- Department of Cardiovascular Medicine, Morristown Medical Center, Gagnon Cardiovascular Institute, Morristown, NJ, USA
| | - Alfonso H Waller
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, 185 South Orange Avenue, Newark, NJ, 07103, USA.
- Department of Radiology, Rutgers New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ, USA.
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Lee JH, Park JH, Park SW, Kim WS, Sohn IS, Chin JY, Cho JS, Youn HJ, Jung HO, Lee SH, Kim SH, Chung WJ, Shim CY, Jeong JW, Choi EY, Rim SJ, Kim JY, Kim KH, Shin JH, Kim DH, Jeon U, Choi JH, Kim YJ, Joo SJ, Kim KH, Cho KI, Cho GY. Current Awareness and Use of the Strain Echocardiography in Routine Clinical Practices: Result of a Nationwide Survey in Korea. J Cardiovasc Ultrasound 2017; 25:91-97. [PMID: 29093771 PMCID: PMC5658294 DOI: 10.4250/jcu.2017.25.3.91] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/10/2017] [Accepted: 09/01/2017] [Indexed: 12/22/2022] Open
Abstract
Background Because conventional echocardiographic parameters have several limitations, strain echocardiography has often been introduced in clinical practice. However, there are also obstacles in using it in clinical practice. Therefore, we wanted to find the current status of awareness on using strain echocardiography in Korea. Methods We conducted a nationwide survey to evaluate current use and awareness of strain echocardiography from the members of the Korean Society of Echocardiography. Results We gathered total 321 questionnaires from 25 cardiology centers in Korea. All participants were able to perform or interpret echocardiographic examinations. All participating institutions performed strain echocardiography. Most of our study participants (97%) were aware of speckle tracking echocardiography and 185 (58%) performed it for clinical and research purposes. Two-dimensional strain echocardiography was the most commonly used modality and left ventricle (LV) was the most commonly used cardiac chamber (99%) for clinical purposes. Most of the participants (89%) did not think LV strain can replace LV ejection fraction (LVEF) in their clinical practice. The common reasons for not performing routine use of strain echocardiography was diversity of strain measurements and lack of normal reference value. Many participants had a favorable view of the future of strain echocardiography. Conclusion Most of our study participants were aware of strain echocardiography, and all institutions performed strain echocardiography for clinical and research purposes. However, they did not think the LV strain values could replace LVEF. The diversity of strain measurements and lack of normal reference values were common reasons for not using strain echocardiography in clinical practice.
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Affiliation(s)
- Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Woo-Shik Kim
- Cardiovascular Center, Department of Internal Medicine, Kyung Hee University Medical Center, Kyung Hee University School of Medicine, Seoul, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jung Yeon Chin
- Division of Cardiology, Eulji University School of Medicine, Daejeon, Korea
| | - Jung Sun Cho
- Division of Cardiology, Department of Internal Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Daejeon, Korea
| | - Ho-Joong Youn
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hae Ok Jung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sun Hwa Lee
- Department of Cardiology, Chonbuk National University Hospital, Chonbuk National University, Jeonju, Korea
| | - Seong-Hwan Kim
- Division of Cardiology, Department of Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Wook-Jin Chung
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Won Jeong
- Department of Internal Medicine, Wonkwang University Hospital, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Eui-Young Choi
- Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Se-Joong Rim
- Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jang-Young Kim
- Department of Internal Medicine, Wonju College of Medicine, Yonsei University, Wonju, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Joon-Han Shin
- Department of Cardiology, Ajou University Medical Centre, Suwon, Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ung Jeon
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Soonchunhyang University College of Medicine, Cheonan, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Yong-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Jae Joo
- Division of Cardiology, Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Ki-Hong Kim
- Division of Cardiology, Heart Center, College of Medicine, Konyang University, Daejeon, Korea
| | - Kyoung Im Cho
- Division of Cardiology, Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
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Chen J, Ceholski DK, Liang L, Fish K, Hajjar RJ. Variability in coronary artery anatomy affects consistency of cardiac damage after myocardial infarction in mice. Am J Physiol Heart Circ Physiol 2017; 313:H275-H282. [PMID: 28550174 DOI: 10.1152/ajpheart.00127.2017] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 05/08/2017] [Accepted: 05/20/2017] [Indexed: 12/16/2022]
Abstract
Low reliability and reproducibility in heart failure models are well established. The purpose of the present study is to explore factors that affect model consistency of myocardial infarction (MI) in mice. MI was induced by left coronary artery (LCA) ligation. The coronary artery was casted with resin and visualized with fluorescent imaging ex vivo. LCA characteristics and MI size were analyzed individually in each animal, and MI size was correlated with left ventricular (LV) function by echocardiography. Coronary anatomy varies widely in mice, posing challenges for surgical ligation and resulting in inconsistent MI size postligation. The length of coronary arterial trunk, level of bifurcation, number of branches, and territory supplied by these branches are unique in each animal. When the main LCA trunk is ligated, this results in a large MI, but when a single branch is ligated, MI size is variable due to differing levels of LCA ligation and area supplied by the branches. During the ligation procedure, nearly 40% of LCAs are not grossly visible to the surgeon. In these situations, the surgeon blindly sutures a wider and deeper area of tissue in an attempt to catch the LCA. Paradoxically, these situations have greater odds of resulting in smaller MIs. In conclusion, variation in MI size and LV function after LCA ligation in mice is difficult to avoid. Anatomic diversity of the LCA in mice leads to inconsistency in MI size and functional parameters, and this is independent of potential technical modifications made by the operator.NEW & NOTEWORTHY In the present study, we demonstrate that left coronary artery diversity in mice is one of the primary causes of variable myocardial infarction size and cardiac functional parameters in the left coronary artery ligation model. Recognition of anatomic diversity is essential to improve reliability and reproducibility in heart failure research.
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Affiliation(s)
- Jiqiu Chen
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Delaine K Ceholski
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Lifan Liang
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kenneth Fish
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, New York
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Dori G, Schliamser JE, Lichtenstein O, Anshelevich I, Flugelman MY. A novel system for continuous, real-time monitoring of heart motion signals. Eur J Med Res 2017; 22:13. [PMID: 28356163 PMCID: PMC5371206 DOI: 10.1186/s40001-017-0252-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2016] [Accepted: 03/16/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding cardiac mechanics is important for developing cardiac therapies. Current modalities for assessing cardiac mechanics sample patient's heart at specific heart rate, contractility, preload, and afterload. The objective of this study was to test the feasibility of a novel system composed of intra-cardiac leads equipped with an inertial module chip (3D accelerometers and 3D gyroscopes) in monitoring continuous heart motion. METHODS In this descriptive study, four healthy pigs were anesthetized and instrumented with motion-sensitive intra-cardiac leads; the temporal correlation between signals from motion sensors and tissue Doppler from the chest wall were studied; changes in real-time heart accelerations (ACC) and angular velocity (ANGV) were reported as percentages of change from baseline. RESULTS Heart motion signals were sensed continuously from the right ventricular apex (RVa) and coronary sinus (CS). Volume expansion did not produce significant changes in the ACC and ANGV signals. Increasing heart rate increased the peak systolic ACC signal recorded from RVa and CS by 94 and 76%, respectively, and increased both peak systolic (61% RVa and 27% CS) and diastolic ANGV (200% CS vs. 31% RVa). Epinephrine administration increased peak systolic ACC signals at both sites (246% RVa; 331% CS). Peak systolic and diastolic ANGV increased in response to epinephrine (systolic: 198% RVa and 175% CS; diastolic: 723% CS and 89% RVa) (p = 0.125 for all changes expressed in percent). Temporal correlation between the ANGV signal and tissue Doppler signal was detected throughout all interventions. CONCLUSIONS A novel system for continuously monitoring heart motion signals from within the heart was presented. Heart motion signals in response to physiologic manipulations were characterized.
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Affiliation(s)
- Guy Dori
- Department of Internal Medicine E, HaEmek Medical Center, Rabin Blvd, 18101, Afula, Israel. .,Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. .,DHS Medical Ltd., Nazareth Industrial Area, POB 1252, 17111, Nazareth Elit, Israel.
| | - Jorge E Schliamser
- Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.,DHS Medical Ltd., Nazareth Industrial Area, POB 1252, 17111, Nazareth Elit, Israel
| | - Oscar Lichtenstein
- Faculty of Biomedical Engineering, Technion-Israel Institute of Technology, Haifa, Israel.,DHS Medical Ltd., Nazareth Industrial Area, POB 1252, 17111, Nazareth Elit, Israel
| | - Ilia Anshelevich
- DHS Medical Ltd., Nazareth Industrial Area, POB 1252, 17111, Nazareth Elit, Israel
| | - Moshe Y Flugelman
- Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.,Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel
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Romano S, Mansour IN, Kansal M, Gheith H, Dowdy Z, Dickens CA, Buto-Colletti C, Chae JM, Saleh HH, Stamos TD. Left Ventricular global longitudinal strain predicts heart failure readmission in acute decompensated heart failure. Cardiovasc Ultrasound 2017; 15:6. [PMID: 28298230 PMCID: PMC5353964 DOI: 10.1186/s12947-017-0098-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 03/01/2017] [Indexed: 11/10/2022] Open
Abstract
Background The goal of this study was to determine if left ventricular (LV) global longitudinal strain (GLS) predicts heart failure (HF) readmission in patients with acute decompensated heart failure. Methods and results Two hundred ninety one patients were enrolled at the time of admission for acute decompensated heart failure between January 2011 and September 2013. Left ventricle global longitudinal strain (LV GLS) by velocity vector imaging averaged from 2, 3 and 4-chamber views could be assessed in 204 out of 291 (70%) patients. Mean age was 63.8 ± 15.2 years, 42% of the patients were males and 78% were African American or Hispanic. Patients were followed until the first HF hospital readmission up to 44 months. Patients were grouped into quartiles on the basis of LV GLS. Kaplan-Meier curves showed significantly higher readmission rates in patients with worse LV GLS (log-rank p < 0.001). After adjusting for age, sex, history of ischemic heart disease, dementia, New York Heart Association class, LV ejection fraction, use of angiotensin converting enzyme inhibitors or angiotensin receptor blockers, systolic and diastolic blood pressure on admission and sodium level on admission, worse LV GLS was the strongest predictor of recurrent HF readmission (p < 0.001). The ejection fraction was predictive of readmission in univariate, but not in multivariate analysis. Conclusion LV GLS is an independent predictor of HF readmission after acute decompensated heart failure with a higher risk of readmission in case of progressive worsening of LV GLS, independent of the ejection fraction.
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Affiliation(s)
- Simone Romano
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA.,Department of Medicine, University of Verona, Ospedale policlinico Borgo Roma, Piazzale scuro 10, 37134, Verona, Italy
| | - Ibrahim N Mansour
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - Mayank Kansal
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - Hana Gheith
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - Zachary Dowdy
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - Carolyn A Dickens
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - Cassandra Buto-Colletti
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - June M Chae
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - Hussam H Saleh
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA
| | - Thomas D Stamos
- Division of Cardiology, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, M/C 715, Chicago, IL, 60612, USA.
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Bordi L, Kovács I, Bajka B, Blendea C, Rat N, Benedek A, Suciu Z, Benedek I. New Imaging-Based Tools for the Assessment of Ventricular Function in Ischemic Heart Diseases. JOURNAL OF INTERDISCIPLINARY MEDICINE 2017. [DOI: 10.1515/jim-2017-0020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
AbstractIschemic heart disease morbidity and mortality are closely related to global and regional left ventricular function. The evaluation of left ventricular global function is a relevant part in the evolution of ischemic heart disease because it plays a significant role in prognosis prediction and patient management after revascularization. Regional function is also a critical part of the evolution, offering a possible and reliable mode for the assessment of myocardial disease. Currently several techniques for the evaluation of left ventricular parameters and function are in use. In this review we will discuss and compare currently available methods for the evaluation of global and regional left ventricular function such as 2D and 3D echocardiography, 3D speckle-tracking echocardiography, multi-slice computed tomography, and cardiac magnetic resonance imaging.
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Parra V, Rothermel BA. Calcineurin signaling in the heart: The importance of time and place. J Mol Cell Cardiol 2017; 103:121-136. [PMID: 28007541 PMCID: PMC5778886 DOI: 10.1016/j.yjmcc.2016.12.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 12/12/2016] [Accepted: 12/16/2016] [Indexed: 12/20/2022]
Abstract
The calcium-activated protein phosphatase, calcineurin, lies at the intersection of protein phosphorylation and calcium signaling cascades, where it provides an essential nodal point for coordination between these two fundamental modes of intracellular communication. In excitatory cells, such as neurons and cardiomyocytes, that experience rapid and frequent changes in cytoplasmic calcium, calcineurin protein levels are exceptionally high, suggesting that these cells require high levels of calcineurin activity. Yet, it is widely recognized that excessive activation of calcineurin in the heart contributes to pathological hypertrophic remodeling and the progression to failure. How does a calcium activated enzyme function in the calcium-rich environment of the continuously contracting heart without pathological consequences? This review will discuss the wide range of calcineurin substrates relevant to cardiovascular health and the mechanisms calcineurin uses to find and act on appropriate substrates in the appropriate location while potentially avoiding others. Fundamental differences in calcineurin signaling in neonatal verses adult cardiomyocytes will be addressed as well as the importance of maintaining heterogeneity in calcineurin activity across the myocardium. Finally, we will discuss how circadian oscillations in calcineurin activity may facilitate integration with other essential but conflicting processes, allowing a healthy heart to reap the benefits of calcineurin signaling while avoiding the detrimental consequences of sustained calcineurin activity that can culminate in heart failure.
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Affiliation(s)
- Valentina Parra
- Advanced Centre for Chronic Disease (ACCDiS), Facultad Ciencias Quimicas y Farmaceuticas, Universidad de Chile, Santiago,Chile; Departamento de Bioquímica y Biología Molecular, Facultad de Ciencias Quimicas y Farmaceuticas, Universidad de Chie, Santiago, Chile
| | - Beverly A Rothermel
- Department of Internal Medicine (Cardiology Division), University of Texas Southwestern Medical Centre, Dallas, TX, USA; Department of Molecular Biology, University of Texas Southwestern Medical Centre, Dallas, TX, USA.
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Koenig TR, Mitchell KJ, Schwarzwald CC. Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed-Wave Tissue Doppler Imaging. J Vet Intern Med 2017; 31:556-567. [PMID: 28109132 PMCID: PMC5354014 DOI: 10.1111/jvim.14641] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/14/2016] [Accepted: 11/21/2016] [Indexed: 12/31/2022] Open
Abstract
Background Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease. Objectives To describe the use of pulsed‐wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease. Animals Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD. Methods Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one‐way ANOVA and Dunnett's test. Results A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEPm/ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S1 (8.9 [5.2 to 12.6] cm/s), and decreased E1 (−2.6 [−4.7 to −0.5] cm/s), Em (−14.2 [−19.9 to −8.5] cm/s), and Em/Am ratio (−1.6 [−2.6 to −0.6]). Conclusions and Clinical Importance Pulsed‐wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.
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Affiliation(s)
- T R Koenig
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - K J Mitchell
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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Park JH, Lee JH, Lee SY, Choi JO, Shin MS, Kim MJ, Jung HO, Park JR, Sohn IS, Kim H, Park SM, Yoo NJ, Choi JH, Kim HK, Cho GY, Lee MR, Park JS, Shim CY, Kim DH, Shin DH, Shin GJ, Shin SH, Kim KH, Kim WS, Park SW. Normal 2-Dimensional Strain Values of the Left Ventricle: A Substudy of the Normal Echocardiographic Measurements in Korean Population Study. J Cardiovasc Ultrasound 2016; 24:285-293. [PMID: 28090256 PMCID: PMC5234340 DOI: 10.4250/jcu.2016.24.4.285] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/09/2016] [Accepted: 11/30/2016] [Indexed: 11/22/2022] Open
Abstract
Background It is important to understand the distribution of 2-dimensional strain values in normal population. We performed a multicenter trial to measure normal echocardiographic values in the Korean population. Methods This was a substudy of the Normal echOcardiogRaphic Measurements in KoreAn popuLation (NORMAL) study. Echocardiographic specialists measured frequently used echocardiographic indices in healthy people according to a standardized method at 23 different university hospitals. The strain values were analyzed from digitally stored images. Results Of a total of 1003 healthy participants in NORMAL study, 2-dimensional strain values were measured in 501 subjects (265 females, mean age 47 ± 15 years old) with echocardiographic images only by GE echocardiographic machines. Interventricular septal thickness, left ventricular (LV) posterior wall thickness, systolic and diastolic LV dimensions, and LV ejection fraction were 7.5 ± 1.0 mm, 7.4 ± 1.0 mm, 29.9 ± 2.8 mm, 48.9 ± 3.6 mm, and 62 ± 4%, respectively. LV longitudinal systolic strain (LS) values of apical 4-chamber (A4C) view, apical 3-chamber (A3C) view, apical 2-chamber (A2C) view, and LV global LS (LVGLS) were −20.1 ± 2.3, −19.9 ± 2.7, −21.2 ± 2.6, and −20.4 ± 2.2%, respectively. LV longitudinal systolic strain rate (LVLSR) values of the A4C view, A3C view, A2C view, and LV global LSR (LVGLSR) were −1.18 ± 0.18, −1.20 ± 0.21, −1.25 ± 0.21, and −1.21 ± 0.21−s, respectively. Females had lower LVGLS (−21.2 ± 2.2% vs. −19.5 ± 1.9%, p < 0.001) and LVGLSR (−1.25 ± 0.18−s vs. −1.17 ± 0.15−s, p < 0.001) values than males. Conclusion We measured LV longitudinal strain and strain rate values in the normal Korean population. Since considerable gender differences were observed, normal echocardiographic cutoff values should be differentially applied based on sex.
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Affiliation(s)
- Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Ju-Hee Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hae Ok Jung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyungseop Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Jin Yoo
- Department of Internal Medicine, Wonkwang University Hospital, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Rae Lee
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hee Shin
- Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gil Ja Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Woo-Shik Kim
- Department of Internal Medicine, Cardiovascular Center, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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The interplay between renin-angiotensin system activation, abnormal myocardial deformation and neurohumoral activation in hypertensive heart disease: a speckle tracking echocardiography study. Int J Cardiovasc Imaging 2016; 33:323-329. [DOI: 10.1007/s10554-016-1010-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 10/24/2016] [Indexed: 12/18/2022]
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Chen J, Hammoudi N, Benard L, Ceholski DK, Zhang S, Lebeche D, Hajjar RJ. The Probability of Inconstancy in Assessment of Cardiac Function Post-Myocardial Infarction in Mice. ACTA ACUST UNITED AC 2016; 5. [PMID: 27917392 PMCID: PMC5130155 DOI: 10.4172/2329-6607.1000195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
In the present study, we explore the inherent variability that leads to overlaps in cardiac functional parameters between control and post-myocardial infarction (MI) mice. Heart failure was induced by Left Coronary Artery (LCA) ligation in mice. Average Ejection Fraction (EF) measured by echocardiography was lower in MI mice compared to control, but exhibited higher Standard Deviation (SD) and Standard Error (SEM), notably in 2D mode. Fractional Shortening (FS) showed a higher degree of overlap between MI and control mice even though the mean values were significantly different. Hemodynamic measurements of EF resulted in greater SD, SEM, ± 95% confidence intervals, and effect size. In comparing echocardiography at different time points, EF and FS were consistent by mean, but had apparent fluctuation in individual tracks, which were more obvious in MI than control mice. Hemodynamic measurements showed more complexity in data collection in mice in vivo. MI size showed variability that correlated with severity of cardiac function. These studies show that there is inherent variability in functional cardiac parameters after induction of heart failure by MI in mice. Analysis of these parameters by traditional statistical methods is insufficient, and we propose a more robust statistical analysis for proper data interpretation.
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Affiliation(s)
- Jiqiu Chen
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Nadjib Hammoudi
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Ludovic Benard
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Delaine K Ceholski
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Shihong Zhang
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Djamel Lebeche
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Roger J Hajjar
- Cardiovascular Research Center, Icahn School of Medicine at Mount Sinai, New York, USA
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Na HM, Cho GY, Lee JM, Cha MJ, Yoon YE, Lee SP, Kim HK, Kim YJ, Sohn DW. Echocardiographic Predictors for Left Ventricular Remodeling after Acute ST Elevation Myocardial Infarction with Low Risk Group: Speckle Tracking Analysis. J Cardiovasc Ultrasound 2016; 24:128-34. [PMID: 27358705 PMCID: PMC4925390 DOI: 10.4250/jcu.2016.24.2.128] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Revised: 04/21/2016] [Accepted: 05/10/2016] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND We sought to assess echocardiographic predictors of left ventricular (LV) adverse remodeling after successfully reperfused acute ST elevation myocardial infarction (STEMI). LV remodeling is commonly found in STEMI patients and it may suggest adverse outcome in acute myocardial infarction. We sought to identify whether 2D strain and torsion be independent parameters for prediction of LV adverse remodeling. METHODS We investigated 208 patients with low-risk STEMI patients who had follow up echocardiography at 6 or more months. After clinical assessments, all patients received revascularization according to current guideline. LV remodeling was defined as > 20% increase in end-diastolic volume (EDV) at follow up. RESULTS During the follow-up (11.9 ± 5.3 months), 53 patients (25.5%) showed LV remodeling. In univariate analysis, EDV, end-systolic volume, deceleration time (DT), CK-MB, and global longitudinal strain (GLS) were associated with LV remodeling. In multivariate analysis, EDV [hazard ratio (HR): 0.922, 95% confidence interval (CI): 0.897-0.948, p< 0.001], GLS (HR 0.842, 95% CI: 0.728-0.974, p = 0.020), DT (HR: 0.989, 95% CI: 0.980-0.998, p = 0.023) and CK-MB (HR: 1.003, 95% CI: 1.000-1.005, p = 0.033) independently predicted LV remodeling. However, global circumferential strain, net twist, and twist or untwist rate were not associated with remodeling. CONCLUSION Of various parameters of speckle strain, only GLS predicted adverse remodeling in STEMI patients.
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Affiliation(s)
- Hyun-Min Na
- College of Medicine, Seoul National University, Seoul, Korea
| | - Goo-Yeong Cho
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Joo Myung Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Myung-Jin Cha
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yeonyee E Yoon
- Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seung-Pyo Lee
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Hyung-Kwan Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
| | - Dae-Won Sohn
- Cardiovascular Center, Seoul National University Hospital, Seoul, Korea
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46
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Liu XY, Liu FC, Deng CY, Zhang MZ, Yang M, Xiao DZ, Lin QX, Cai ST, Kuang SJ, Chen J, Chen SX, Zhu JN, Yang H, Rao F, Fu YH, Yu XY. Left ventricular deformation associated with cardiomyocyte Ca(2+) transients delay in early stage of low-dose of STZ and high-fat diet induced type 2 diabetic rats. BMC Cardiovasc Disord 2016; 16:41. [PMID: 26879576 PMCID: PMC4754853 DOI: 10.1186/s12872-016-0220-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022] Open
Abstract
Background In the early stage of diabetes, the cardiac ejection fraction is preserved, despite the existence of the subclinical cardiac dysfunction to some extent. However, the detailed phenotype of this dysfunction and the underlying mechanism remain unclear. To improve our understanding of this issue, we used low-dose STZ and high-fat diet to induce type 2 diabetic models in rats. The effects and the mechanism associated with the early stages of the disease were analyzed. Methods The type 2 diabetic mellitus (T2DM) in SD rats were induced through 30 mg/kg STZ and high-fat diet. Two-dimensional spackle-tracking echocardiography (STE) and the dobutamine test were performed to examine the cardiac function. Calcium transients of left ventricular myocytes were detected and the related intracellular signalling factors were analyzed by western blotting. Results After 6-weeks, T2DM rats in left ventricular (LV) diastole showed decreased global and segment strain(S) levels (P < 0.05), both in the radial and circumferential directions. Strain rate (Sr) abatement occurred in three segments in the radial and circumferential directions (P < 0.05), and the radial global Sr also decreased (P < 0.05). In the systolic LV, radial Sr was reduced, except the segment of the anterior septum, and the Sr of the lateral wall and post septum decreased in the circumferential direction (P < 0.05). Conventional M-mode echocardiography failed to detect significant alterations of cardiac performance between the two groups even after 12 weeks, and the decreased ejection fraction (EF%), fractional shortening (FS%) and end-systolic diameters (ESD) could be detected only under stress conditions induced by dobutamine (P < 0.05). In terms of calcium transients in cardiac myocytes, the Tpeak in model rats at 6 weeks was not affected, while the Tdecay1/2 was higher than that of the controls (P < 0.05), and both showed a dose-dependent delay after isoproterenol treatment (P < 0.05). Western blot analysis showed that in 6-week T2DM rats, myocardial p-PLB expression was elevated, whereas p-CaMKII, p-AMPK and Sirt1 were significantly down-regulated (P < 0.05). Conclusion A rat model of T2DM was established by low dose STZ and a high-fat diet. LV deformation was observed in the early stages of T2DM in association with the delay of Ca2+ transients in cardiomyocytes due to the decreased phosphorylation of CaMKII. Myocardial metabolism remodeling might contribute to the early LV function and calcium transportation abnormalities.
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Affiliation(s)
- Xiao-Ying Liu
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Fu-Cheng Liu
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China.,Department of Cardiology of the First Affiliated Hospital, Jinan University, Guangzhou, 510630, P.R. China
| | - Chun-Yu Deng
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Meng-Zhen Zhang
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Min Yang
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Ding-Zhang Xiao
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Qiu-Xiong Lin
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Shi-Ting Cai
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Su-Juan Kuang
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Jing Chen
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Shao-Xian Chen
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Jie-Ning Zhu
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Hui Yang
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Fang Rao
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Yong-Heng Fu
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China
| | - Xi-Yong Yu
- Guangdong Cardiovascular Institute and Medical Research Center, Guangdong General Hospital, Guangdong Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, 510080, P.R. China. .,Institute of Molecular and Clinical Pharmacology, Guangzhou Medical University, Guangzhou, 511436, P.R. China.
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Iacoviello M, Citarelli G, Antoncecchi V, Romito R, Monitillo F, Leone M, Puzzovivo A, Lattarulo MS, Rizzo C, Caldarola P, Ciccone MM. Right Ventricular Longitudinal Strain Measures Independently Predict Chronic Heart Failure Mortality. Echocardiography 2016; 33:992-1000. [DOI: 10.1111/echo.13199] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Massimo Iacoviello
- Cardiology Unit; Cardiothoracic Department; Policlinic University Hospital; Bari Italy
| | | | | | - Roberta Romito
- Emergency Cardiology Unit; Policlinic University Hospital; Bari Italy
| | | | - Marta Leone
- School of Cardiology; University of Bari; Bari Italy
| | - Agata Puzzovivo
- Cardiology Department; Bari Local Health Service; Bari Italy
| | | | | | | | - Marco Matteo Ciccone
- Cardiology Unit; Cardiothoracic Department; Policlinic University Hospital; Bari Italy
- School of Cardiology; University of Bari; Bari Italy
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Jain S, Londono FJ, Segers P, Gillebert TC, De Buyzere M, Chirinos JA. MRI Assessment of Diastolic and Systolic Intraventricular Pressure Gradients in Heart Failure. Curr Heart Fail Rep 2016; 13:37-46. [DOI: 10.1007/s11897-016-0281-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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49
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Echocardiographic assessment of left ventricular systolic function: from ejection fraction to torsion. Heart Fail Rev 2015; 21:77-94. [DOI: 10.1007/s10741-015-9521-8] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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50
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Shao C, Zhu J, Chen J, Xu W. Independent prognostic value of left atrial function by two-dimensional speckle tracking imaging in patients with non -ST-segment-elevation acute myocardial infarction. BMC Cardiovasc Disord 2015; 15:145. [PMID: 26537456 PMCID: PMC4634898 DOI: 10.1186/s12872-015-0135-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Accepted: 10/25/2015] [Indexed: 11/13/2022] Open
Abstract
Background The objective of this study is to evaluate left atrial(LA) function and its prognostic value by two-dimensional speckle tracking echocardiography (STE) in patients with non-ST-segment-elevation acute myocardial infarction (NSTEAMI). Methods Global longitudinal LA S/SR data obtained by 2D speckle imaging with automated software (Echo PAC, GE Medical). Results Clinical variables and angiographic, echocardiographic, and STE parameters were studied in 65 patients with NSTEAMI (51 males and 14 females; mean age of 60.7 ± 9.8 years) who underwent elective PCI. The final study population consisted of 51 individuals (43 males and 8 females; mean age of 62.9 ± 11.1 years) and a 12 ± 3 months follow-up was performed. A total of 22 combined cardiovascular events(20 patients) occurred. With the use of Univariable Cox regression, all parameters were evaluated in the prediction of cardiac events, ischemic events, and/or cardiac death. According to ROC analysis, baseline mean global left atrial SRs (ROC area 0.82, p = 0.001) and baseline mean global left atrial SRe (ROC area 0.68, p = 0.036) were the only predictive variables. Conclusions In patients with NSTEAMI, we found that the novel global strain parameter of left atrial function is a valuable predictor of combined cardiovascular events over conventional echocardiography and may therefore be an important clinical tool for risk stratification in the acute phase of NSTEAMI.
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Affiliation(s)
- Chunlai Shao
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street 1055, Suzhou, China.
| | - Jing Zhu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street 1055, Suzhou, China.
| | - Jianchang Chen
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street 1055, Suzhou, China.
| | - Weiting Xu
- Department of Cardiology, The Second Affiliated Hospital of Soochow University, Sanxiang Street 1055, Suzhou, China.
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