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Altit G, Lapointe A, Kipfmueller F, Patel N. Cardiac function in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151438. [PMID: 39018716 DOI: 10.1016/j.sempedsurg.2024.151438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/19/2024]
Abstract
Cardiac function is known to play critical role in the pathophysiological progression and ultimate clinical outcome of patients with congenital diaphragmatic hernia (CDH). While often anatomically normal, the fetal and neonatal heart in CDH can suffer from both right and left ventricular dysfunction. Here we explore the abnormal fetal heart, early postnatal right and left ventricular dysfunction, the interplay between cardiac dysfunction and pulmonary hypertension, evaluation and echocardiographic assessment of the heart, and therapeutic strategies for managing and supporting the pathophysiologic heart and CDH. Further, we take a common clinical scenario and provide clinically relevant guidance for the diagnosis and management of this complex process.
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Affiliation(s)
- Gabriel Altit
- Division of Neonatology, Montreal Children's Hospital, McGill University Health Centre, Montréal, Canada
| | - Anie Lapointe
- Division of Neonatology, Centre Hospitalier Universitaire Sainte-Justine, Montréal, Canada
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care Medicine, Children's Hospital University of Bonn, Germany
| | - Neil Patel
- Department of Neonatology, Royal Hospital for Children, Glasgow, UK.
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2
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Cyr JA, Burdett C, Pürstl JT, Thompson RP, Troughton SC, Sinha S, Best SM, Cameron RE. Characterizing collagen scaffold compliance with native myocardial strains using an ex-vivo cardiac model: The physio-mechanical influence of scaffold architecture and attachment method. Acta Biomater 2024:S1742-7061(24)00345-3. [PMID: 38942187 DOI: 10.1016/j.actbio.2024.06.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/30/2024] [Accepted: 06/21/2024] [Indexed: 06/30/2024]
Abstract
Applied to the epicardium in-vivo, regenerative cardiac patches support the ventricular wall, reduce wall stresses, encourage ventricular wall thickening, and improve ventricular function. Scaffold engraftment, however, remains a challenge. After implantation, scaffolds are subject to the complex, time-varying, biomechanical environment of the myocardium. The mechanical capacity of engineered tissue to biomimetically deform and simultaneously support the damaged native tissue is crucial for its efficacy. To date, however, the biomechanical response of engineered tissue applied directly to live myocardium has not been characterized. In this paper, we utilize optical imaging of a Langendorff ex-vivo cardiac model to characterize the native deformation of the epicardium as well as that of attached engineered scaffolds. We utilize digital image correlation, linear strain, and 2D principal strain analysis to assess the mechanical compliance of acellular ice templated collagen scaffolds. Scaffolds had either aligned or isotropic porous architecture and were adhered directly to the live epicardial surface with either sutures or cyanoacrylate glue. We demonstrate that the biomechanical characteristics of native myocardial deformation on the epicardial surface can be reproduced by an ex-vivo cardiac model. Furthermore, we identified that scaffolds with unidirectionally aligned pores adhered with suture fixation most accurately recapitulated the deformation of the native epicardium. Our study contributes a translational characterization methodology to assess the physio-mechanical performance of engineered cardiac tissue and adds to the growing body of evidence showing that anisotropic scaffold architecture improves the functional biomimetic capacity of engineered cardiac tissue. STATEMENT OF SIGNIFICANCE: Engineered cardiac tissue offers potential for myocardial repair, but engraftment remains a challenge. In-vivo, engineered scaffolds are subject to complex biomechanical stresses and the mechanical capacity of scaffolds to biomimetically deform is critical. To date, the biomechanical response of engineered scaffolds applied to live myocardium has not been characterized. In this paper, we utilize optical imaging of an ex-vivo cardiac model to characterize the deformation of the native epicardium and scaffolds attached directly to the heart. Comparing scaffold architecture and fixation method, we demonstrate that sutured scaffolds with anisotropic pores aligned with the native alignment of the superficial myocardium best recapitulate native deformation. Our study contributes a physio-mechanical characterization methodology for cardiac tissue engineering scaffolds.
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Affiliation(s)
- Jamie A Cyr
- Department of Materials Science & Metallurgy Cambridge University 27 Charles Babbage Road, Cambridge CB3 0FS, UK.
| | - Clare Burdett
- Department of Materials Science & Metallurgy Cambridge University 27 Charles Babbage Road, Cambridge CB3 0FS, UK
| | - Julia T Pürstl
- Department of Materials Science & Metallurgy Cambridge University 27 Charles Babbage Road, Cambridge CB3 0FS, UK
| | - Robert P Thompson
- Department of Materials Science & Metallurgy Cambridge University 27 Charles Babbage Road, Cambridge CB3 0FS, UK
| | - Samuel C Troughton
- Department of Materials Science & Metallurgy Cambridge University 27 Charles Babbage Road, Cambridge CB3 0FS, UK
| | - Sanjay Sinha
- Wellcome-MRC Cambridge Stem Cell Institute, Cambridge University, Jeffrey Cheah Biomedical Centre, Puddicombe Way, Cambridge CB2 0AW, UK
| | - Serena M Best
- Department of Materials Science & Metallurgy Cambridge University 27 Charles Babbage Road, Cambridge CB3 0FS, UK.
| | - Ruth E Cameron
- Department of Materials Science & Metallurgy Cambridge University 27 Charles Babbage Road, Cambridge CB3 0FS, UK.
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Mora V, Geraldo J, Roldán I, Galiana E, Gil C, Escribano P, Arbucci R, Hidalgo A, Gramage P, Trainini J, Carreras F, Lowenstein J. A New Coding System for the Identification of Left Ventricular Rotation Patterns and Their Relevance to Myocardial Function. Ann Biomed Eng 2024:10.1007/s10439-024-03539-4. [PMID: 38853207 DOI: 10.1007/s10439-024-03539-4] [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: 01/08/2024] [Accepted: 04/25/2024] [Indexed: 06/11/2024]
Abstract
Rotational mechanics is a fundamental determinant of left ventricular ejection fraction (LVEF). The coding system currently employed in clinical practice does not distinguish between rotational patterns. We propose an alternative coding system that makes possible to identify the rotational pattern of the LV and relate it to myocardial function. Echocardiographic images were used to generate speckle tracking-derived transmural global longitudinal strain (tGLS) and rotational parameters. The existence of twist (basal and apical rotations in opposite directions) is expressed as a rotational gradient with a positive value that is the sum of the basal and apical rotation angles. Conversely, when there is rigid rotation (basal and apical rotations in the same direction) the resulting gradient is assigned a negative value that is the subtraction between the two rotation angles. The rotational patterns were evaluated in 87 healthy subjects and 248 patients with LV hypertrophy (LVH) and contrasted with their myocardial function. Our approach allowed us to distinguish between the different rotational patterns. Twist pattern was present in healthy controls and 104 patients with LVH and normal myocardial function (tGLS ≥ 17%, both). Among 144 patients with LVH and myocardial dysfunction (tGLS < 17%), twist was detected in 83.3% and rigid rotation in 16.7%. LVEF was < 50% in 34.7%, and all patients with rigid rotation had a LVEF < 50%. The gradient rotational values showed a close relationship with LVEF (r = 0.73; p < 0.001). The proposed coding system allows us to identify the rotational patterns of the LV and to relate their values with LVEF.
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Affiliation(s)
- Vicente Mora
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Juan Geraldo
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Ildefonso Roldán
- Cardiology Department, Universitat de València, Hospital Universitario Dr Peset, Avda Gaspar Aguilar 90, 46017, Valencia, Spain.
| | - Ester Galiana
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Celia Gil
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Pablo Escribano
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Rosina Arbucci
- Cardiodiagnosis Department, Medical Research, 1425, Buenos Aires, Argentina
| | - Alberto Hidalgo
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Paula Gramage
- Department of Cardiology, Hospital Universitario Dr Peset, 46017, Valencia, Spain
| | - Jorge Trainini
- Cardiodiagnosis Department, Medical Research, 1425, Buenos Aires, Argentina
| | - Francesc Carreras
- Department of Cardiology, Hospital Sant Pau, 08025, Barcelona, Spain
| | - Jorge Lowenstein
- Cardiodiagnosis Department, Medical Research, 1425, Buenos Aires, Argentina
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Ahn Y, Koo HJ, Lee SA, Jung D, Kang JW, Yang DH. Reference ranges of computed tomography-derived strains in four cardiac chambers. PLoS One 2024; 19:e0303986. [PMID: 38843302 PMCID: PMC11156317 DOI: 10.1371/journal.pone.0303986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 05/04/2024] [Indexed: 06/09/2024] Open
Abstract
Research on cardiovascular diseases using CT-derived strain is gaining momentum, yet there is a paucity of information regarding reference standard values beyond echocardiography, particularly in cardiac chambers other than the left ventricle (LV). We aimed to compile CT-derived strain values from the four cardiac chambers in healthy adults and assess the impact of age and sex on myocardial strains. This study included 101 (mean age: 55.2 ± 9.0 years, 55.4% men) consecutive healthy individuals who underwent multiphase cardiac CT. CT-derived cardiac strains, including LV global and segmental longitudinal, circumferential, and transverse strains, left atrial (LA), right atrial (RA), and right ventricle (RV) strains were measured by the commercially available software. Strain values were classified and compared by their age and sex. The normal range of CT-derived LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) were -20.2 ± 2.7%, -27.9 ± 4.1%, and 49.4 ± 12.1%, respectively. For LA, reservoir strain, pump strain, and conduit strain were 28.6 ± 8.5%, 13.2 ± 6.4%, and 15.5 ± 8.6%, respectively. The GLS of RA and RV were 27.9 ± 10.9% and -22.0 ± 5.7%, respectively. The absolute values of GLS of RA and RV of women were higher than that in men (32.4 ± 11.4 vs. 24.3 ± 9.1 and -25.2 ± 4.7 vs. -19.4 ± 5.0, respectively; p<0.001, both). Measurement of CT-derived strain in four cardiac chambers is feasible. The reference ranges of CT strains in four cardiac chambers can be used for future studies of various cardiac diseases using the cardiac strains.
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Affiliation(s)
- Yura Ahn
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Hyun Jung Koo
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Seung Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - DaSol Jung
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Republic of Korea
| | - Dong Hyun Yang
- Department of Radiology and Research Institute of Radiology, Republic of Korea
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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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6
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Siva NK, Singh Y, Hathaway QA, Sengupta PP, Yanamala N. A novel multi-task machine learning classifier for rare disease patterning using cardiac strain imaging data. Sci Rep 2024; 14:10672. [PMID: 38724564 PMCID: PMC11082231 DOI: 10.1038/s41598-024-61201-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 05/02/2024] [Indexed: 05/12/2024] Open
Abstract
To provide accurate predictions, current machine learning-based solutions require large, manually labeled training datasets. We implement persistent homology (PH), a topological tool for studying the pattern of data, to analyze echocardiography-based strain data and differentiate between rare diseases like constrictive pericarditis (CP) and restrictive cardiomyopathy (RCM). Patient population (retrospectively registered) included those presenting with heart failure due to CP (n = 51), RCM (n = 47), and patients without heart failure symptoms (n = 53). Longitudinal, radial, and circumferential strains/strain rates for left ventricular segments were processed into topological feature vectors using Machine learning PH workflow. In differentiating CP and RCM, the PH workflow model had a ROC AUC of 0.94 (Sensitivity = 92%, Specificity = 81%), compared with the GLS model AUC of 0.69 (Sensitivity = 65%, Specificity = 66%). In differentiating between all three conditions, the PH workflow model had an AUC of 0.83 (Sensitivity = 68%, Specificity = 84%), compared with the GLS model AUC of 0.68 (Sensitivity = 52% and Specificity = 76%). By employing persistent homology to differentiate the "pattern" of cardiac deformations, our machine-learning approach provides reasonable accuracy when evaluating small datasets and aids in understanding and visualizing patterns of cardiac imaging data in clinically challenging disease states.
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Affiliation(s)
- Nanda K Siva
- School of Medicine, West Virginia University, Morgantown, WV, USA
- Division of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Yashbir Singh
- Division of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Quincy A Hathaway
- School of Medicine, West Virginia University, Morgantown, WV, USA
- Division of Cardiology, Heart and Vascular Institute, West Virginia University, Morgantown, WV, USA
| | - Partho P Sengupta
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, 125 Patterson St, New Brunswick, NJ, 08901, USA.
| | - Naveena Yanamala
- Division of Cardiovascular Disease and Hypertension, Rutgers Robert Wood Johnson Medical School, 125 Patterson St, New Brunswick, NJ, 08901, USA.
- Institute for Software Research, School of Computer Science, Carnegie Mellon University, Pittsburgh, PA, USA.
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Zhang S, Zhou Q, Li X, Wang Y, Ma L, Huang D, Li G. Value of 2D speckle tracking technique combined with real-time 3-dimensional echocardiography in the evaluation of the right atrial function in patients with 3-branch coronary artery disease without myocardial infarction. Medicine (Baltimore) 2024; 103:e38058. [PMID: 38701248 PMCID: PMC11062688 DOI: 10.1097/md.0000000000038058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 04/08/2024] [Indexed: 05/05/2024] Open
Abstract
To evaluate the right atrial function in patients with 3-branch coronary artery disease (TBCAD) without myocardial infarction by 2D speckle tracking echocardiography (2D-STE) combined with real-time 3-dimensional echocardiography (RT-3DE). Fifty-six patients admitted to our hospital without myocardial infarction with TBCAD were selected. We divided them into 2 groups according to the coronary angiography results: 28 patients in group B (the rate of stenosis is 50% ~< 75%); 28 patients in group C (the rate of stenosis is ≥75%); in addition, 30 healthy volunteers were screened as group A. All subjects underwent RT-3DE to obtain the right atrial volume (RAVmax, RAVmin, and RAVp), and then we calculated the right atrial passive and active ejection fraction (RAPEF, RAAEF), and maximum volume index (RAVImax). In addition, to measure the strain rates (RASRs, RASRe, RASRa) of the right atrium during systole, early diastole, and late diastole, 2D-STE was applied. Correlations between the 2D-STE parameters and the results of N-terminal pro-brain natriuretic peptide (NT-proBNP) and Gensini scores were analyzed by Pearson linear analysis. Compared with group A, RAPEF and RASRe were reduced, while RAAEF and RASRa were elevated in group B (P < .05). RAPEF, RASRs, RASRe, and RASRa were decreased compared with groups A and B, while RAVmax, RAVmin, RAVp, RAVImax, and RAAEF were increased in group C (P < .05). There was a significant correlation between 2D-STE parameters and the results of NT-proBNP and Gensini scores (P < .05). The storage, conduit, and pump functions of the right atrium are reduced in patients with 3-branch coronary artery disease without myocardial infarction; 2D-STE combined with RT-3DE is valuable in the evaluation of the right atrium in patients with coronary artery disease.
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Affiliation(s)
- Siran Zhang
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Qiao Zhou
- Department of Obstetrics and Gynecology Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Xiya Li
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Yifan Wang
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Le Ma
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Dongmei Huang
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
| | - Guangsen Li
- Department of Ultrasound, the Second Hospital of Dalian Medical University, Dalian, Liaoning Province, China
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Baturalp TB, Bozkurt S. Design and Analysis of a Polymeric Left Ventricular Simulator via Computational Modelling. Biomimetics (Basel) 2024; 9:269. [PMID: 38786479 PMCID: PMC11117906 DOI: 10.3390/biomimetics9050269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2024] [Revised: 04/12/2024] [Accepted: 04/27/2024] [Indexed: 05/25/2024] Open
Abstract
Preclinical testing of medical devices is an essential step in the product life cycle, whereas testing of cardiovascular implants requires specialised testbeds or numerical simulations using computer software Ansys 2016. Existing test setups used to evaluate physiological scenarios and test cardiac implants such as mock circulatory systems or isolated beating heart platforms are driven by sophisticated hardware which comes at a high cost or raises ethical concerns. On the other hand, computational methods used to simulate blood flow in the cardiovascular system may be simplified or computationally expensive. Therefore, there is a need for low-cost, relatively simple and efficient test beds that can provide realistic conditions to simulate physiological scenarios and evaluate cardiovascular devices. In this study, the concept design of a novel left ventricular simulator made of latex rubber and actuated by pneumatic artificial muscles is presented. The designed left ventricular simulator is geometrically similar to a native left ventricle, whereas the basal diameter and long axis length are within an anatomical range. Finite element simulations evaluating left ventricular twisting and shortening predicted that the designed left ventricular simulator rotates approximately 17 degrees at the apex and the long axis shortens around 11 mm. Experimental results showed that the twist angle is 18 degrees and the left ventricular simulator shortens 5 mm. Twist angles and long axis shortening as in a native left ventricle show it is capable of functioning like a native left ventricle and simulating a variety of scenarios, and therefore has the potential to be used as a test platform.
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Affiliation(s)
- Turgut Batuhan Baturalp
- Department of Mechanical Engineering, Texas Tech University, P.O. Box 41021, Lubbock, TX 79409, USA
| | - Selim Bozkurt
- School of Engineering, Ulster University, York Street, Belfast BT15 1AP, UK
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Wang L, Yuan W, Huang X, Zhao X, Zhao X. Cardiac magnetic resonance-derived mitral annular plane systolic excursion: a robust indicator for risk stratification after myocardial infarction. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03058-2. [PMID: 38400864 DOI: 10.1007/s10554-024-03058-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 01/17/2024] [Indexed: 02/26/2024]
Abstract
To explore the predictive value of mitral annular plane systolic excursion (MAPSE) derived by cardiac magnetic resonance (CMR) for major adverse cardiovascular events (MACE) in postmyocardial infarction (MI) patients. Patients with MI who underwent 3.0 T CMR (Chinese Clinical Trial Registry, ChiCTR2200055158) were recruited retrospectively. CMR parameters included MAPSE and LVEF. Patients were followed up for MACE for more than 6 months and were separated into a No-MACE group and a MACE group. A total of 165 post-MI patients were included, and 103 patients were finally analyzed (61 patients belonged to the No-MACE group, and 42 patients belonged to the MACE group). The LVEF and MAPSE of the patients belonging to the No-MACE group were considerably higher than those of the patients belonging to the MACE group. Both LVEF and MAPSE were effective indicators of the occurrence of MACE after MI. The risk of MACE decreased as LVEF and MAPSE increased. For the risk prediction of MACE after MI, compared with model I (chi-square value 4.0 vs. 31.4, P < 0.001) and model II (chi-square value 22.7 vs. 31.4, P = 0.003), model III had a significant incremental predictive value. Moreover, the cutoff value of MAPSE was 9.70 mm. CMR-derived MAPSE is an effective predictor of MACE occurrence in patients with MI, and MAPSE provided a significant incremental predictive value. Moreover, MAPSE could complement LVEF for superior risk stratification of MI patients.
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Affiliation(s)
- Lujing Wang
- Department of Radiology, West China Hospital of Sichuan University, The 37th Guoxue Lane, Chengdu, 610044, China
| | - Weifeng Yuan
- Department: Radiology Institution: Clinical Medical College, The First Affiliated Hospital of Chengdu Medical College, Chengdu, China
| | - Xinyi Huang
- Supply Chain Management, The State University of New Jersey, Rutgers, Newark, NJ, 07102, USA
| | - Xiaoying Zhao
- Department of Radiology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
- Department: Radiology Institution, The Second Affiliated Hospital of Kunming Medical University, The 374th Dianmian Road, Wuhua District, Kunming, 650101, Yunnan, China
| | - Xinxiang Zhao
- Department: Radiology Institution, The Second Affiliated Hospital of Kunming Medical University, The 374th Dianmian Road, Wuhua District, Kunming, 650101, Yunnan, China.
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10
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Vancheri F, Longo G, Henein MY. Left ventricular ejection fraction: clinical, pathophysiological, and technical limitations. Front Cardiovasc Med 2024; 11:1340708. [PMID: 38385136 PMCID: PMC10879419 DOI: 10.3389/fcvm.2024.1340708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/12/2024] [Indexed: 02/23/2024] Open
Abstract
Risk stratification of cardiovascular death and treatment strategies in patients with heart failure (HF), the optimal timing for valve replacement, and the selection of patients for implantable cardioverter defibrillators are based on an echocardiographic calculation of left ventricular ejection fraction (LVEF) in most guidelines. As a marker of systolic function, LVEF has important limitations being affected by loading conditions and cavity geometry, as well as image quality, thus impacting inter- and intra-observer measurement variability. LVEF is a product of shortening of the three components of myocardial fibres: longitudinal, circumferential, and oblique. It is therefore a marker of global ejection performance based on cavity volume changes, rather than directly reflecting myocardial contractile function, hence may be normal even when myofibril's systolic function is impaired. Sub-endocardial longitudinal fibers are the most sensitive layers to ischemia, so when dysfunctional, the circumferential fibers may compensate for it and maintain the overall LVEF. Likewise, in patients with HF, LVEF is used to stratify subgroups, an approach that has prognostic implications but without a direct relationship. HF is a dynamic disease that may worsen or improve over time according to the underlying pathology. Such dynamicity impacts LVEF and its use to guide treatment. The same applies to changes in LVEF following interventional procedures. In this review, we analyze the clinical, pathophysiological, and technical limitations of LVEF across a wide range of cardiovascular pathologies.
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Affiliation(s)
- Federico Vancheri
- Department of Internal Medicine, S.Elia Hospital, Caltanissetta, Italy
| | - Giovanni Longo
- Cardiovascular and Interventional Department, S.Elia Hospital, Caltanissetta, Italy
| | - Michael Y. Henein
- Institute of Public Health and Clinical Medicine, Umea University, Umea, Sweden
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Li W, Zhang XC, Qian YL, Chen XX, Quan RL, Yang T, Xiong CM, Gu Q, He JG. Biventricular intraventricular mechanical and electrical dyssynchrony in pulmonary arterial hypertension. Heliyon 2024; 10:e23352. [PMID: 38163214 PMCID: PMC10755332 DOI: 10.1016/j.heliyon.2023.e23352] [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: 07/19/2023] [Revised: 11/16/2023] [Accepted: 12/01/2023] [Indexed: 01/03/2024] Open
Abstract
Background Pulmonary arterial hypertension (PAH) leads to myocardial remodeling, manifesting as mechanical dyssynchrony (M-dys) and electrical dyssynchrony (E-dys), in both right (RV) and left ventricles (LV). However, the impacts of layer-specific intraventricular M-dys on biventricular functions and its association with E-dys in PAH remain unclear. Methods Seventy-nine newly diagnosed patients with PAH undergoing cardiac magnetic resonance scanning were consecutively recruited between January 2011 and December 2017. The biventricular volumetric and layer-specific intraventricular M-dys were analyzed. The QRS duration z-scores were calculated after adjusting for age and sex. Results 77.22 % of patients were female (mean age 30.30 ± 9.79 years; median follow-up 5.53 years). Further, 29 (36.71 %) patients succumbed to all-cause mortality by the end of the study. At the baseline, LV layer-specific intraventricular M-dys had apparent transmural gradients compared with RV in the radial and circumferential directions. However, deceased patients lost the transmural gradients. The LV longitudinal strain rate time to late diastolic peak in the myocardial region (LVmyoLSRTTLDPintra) predicted long-term survival. The Kaplan-Meier curve revealed that patients with PAH with LVmyoLSRTTLDPintra <20.01 milliseconds had a worse prognosis. Larger right ventricle (RV) intraventricular M-dys resulted in worse RV ejection fraction. However, larger LV intraventricular M-dys in the late diastolic phase indicated remarkable exercise capacity and higher LV stroke volume index. E-dys and intraventricular M-dys had no direct correlations. Conclusions The layer-specific intraventricular M-dys had varying impacts on biventricular functions in PAH. PAH patients with LVmyoLSRTTLDPintra <20.01 milliseconds had a worse prognosis. LV intraventricular M-dys in the late diastolic phase needs more attention to precisely evaluate LV function.
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Affiliation(s)
- Wen Li
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | | | - Yu-ling Qian
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiao-xi Chen
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Rui-lin Quan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tao Yang
- Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Chang-ming Xiong
- Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qing Gu
- Emergency Center, State Key Laboratory of Cardiovascular Disease, Key Laboratory of Pulmonary Vascular Medicine, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, and Peking Union Medical College, Beijing, China
| | - Jian-guo He
- Center of Pulmonary Vascular Disease, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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12
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Brahem M, Amor HIH, Sarraj R, Touil I, Kraiem S, Rouabhia R, Hmaier E, Mbarek GH, Ben Salem A, Mlouki I, Mhamdi S, Hachfi H, Younes M. Echocardiography Coupled with Strain Method in the Screening for Cardiac Involvement in Rheumatoid Arthritis. Curr Rheumatol Rev 2024; 20:72-81. [PMID: 37518997 DOI: 10.2174/1573397119666230727111601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 03/25/2023] [Accepted: 06/09/2023] [Indexed: 08/01/2023]
Abstract
OBJECTIVE In this study, the usefulness of transthoracic echocardiography (TTE) in systematic screening was assessed for various cardiac abnormalities in patients with rheumatoid arthritis (RA). METHODS We performed a comparative cross-sectional study from July 2020 to February 2021. Each patient underwent a TTE coupled with the strain technique. RESULTS Seventy-two RA patients and 72 controls were included. Abnormalities detected by TTE were more frequent in RA patients (80.6% vs. 36.1%; p < 0.01), and they were asymptomatic in 65.5% of cases. Valvular involvement was found in 45.8% of RA patients, with a significant difference (p < 0.01). Left ventricular diastolic dysfunction was also more frequent in the RA group (36.1% vs. 13.9%; p < 0.01). Left ventricular systolic dysfunction was absent in our study, but subclinical left ventricular myocardial damage assessed by Global Longitudinal Strain (GLS) method was found in 37.5% of RA patients and 16.6% of controls (p < 0.01). The mean GLS in RA patients was -17.8 ± 2.9 (-22 to -10.7) vs. -19.4 ± 1.9 (-24.7 to -15.7) in controls. Left ventricular hypertrophy was detected in 22.2% of RA patients and in 6.9% of controls (p < 0.01). Pericardial effusion and pulmonary arterial hypertension were present only in the RA group (2.8% of cases). We found a significant relationship between echocardiographic damage and disease activity (p < 0.01), number of painful joints (p < 0.01), functional impact (HAQ) (p = 0.01), CRP level (p < 0.01) and the use and dose of Corticosteroids (p = 0.02; p = 0.01). CONCLUSION Echocardiographic damage in RA is frequent and often asymptomatic, hence there has been an increased interest in systematic screening in order to improve the quality of life and vital prognosis of patients. Early management of RA can reduce the risk of occurrence of cardiac involvement.
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Affiliation(s)
- Mouna Brahem
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | | | - Rihab Sarraj
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Touil
- Department of Pneumology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Salma Kraiem
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ramzi Rouabhia
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ella Hmaier
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ghassen Haj Mbarek
- Department of Cardiology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Ameni Ben Salem
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Imen Mlouki
- Department of Preventive Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Sana Mhamdi
- Department of Preventive Medicine, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Haifa Hachfi
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
| | - Mohamed Younes
- Department of Rheumatology, Taher Sfar University Hospital, Mahdia, Tunisia
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13
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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Morrison BN, Campbell AJ, Coté AT, Mohammad A, Sambrook L, Robinson G, George K, Oxborough D. Three-Dimensional-Derived Echocardiographic Left Ventricular Structure and Function and Indices from the 12-Lead Electrocardiogram across the Menstrual Cycle in Healthy Physically Active Females: An Exploratory Study. J Cardiovasc Dev Dis 2023; 10:331. [PMID: 37623344 PMCID: PMC10455515 DOI: 10.3390/jcdd10080331] [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: 06/30/2023] [Revised: 07/17/2023] [Accepted: 07/27/2023] [Indexed: 08/26/2023] Open
Abstract
Background: The impact of the menstrual phases on left ventricular (LV) structure and function using 3D echocardiography and resting electrocardiogram (ECG) in healthy, eumenorrheic, and physically active females has not been investigated. Methods: sixteen females (20 y ± 2) underwent 3D echocardiography and an ECG at three time points in the menstrual cycle phases (follicular, ovulation, luteal). LV end-diastolic volume (LVEDVi), LV ejection fraction (LVEF), LV mass allometrically indexed to height2.7 (LVMi), torsion, and global longitudinal, circumferential, and radial strain (GLS, GCS, and GRS) were evaluated. ECG data of the P and QRS waves were presented as well as axis deviation, chamber enlargement, and any rhythm abnormalities. Results: LVMi was significantly higher in the luteal phase (36.4 g/m2.7 ± 3.3) compared to the follicular (35.0 g/m2.7 ± 3.7) and ovulation (34.7 g/m2.7 ± 4.3) phases (p = 0.026). There were no differences in other indices of LV structure and function or ECG variables across all phases of the menstrual cycle or evidence of arrhythmia. Conclusions: In physically active females, there is a small but significantly higher LVMi associated with the luteal phase of the menstrual cycle with no concomitant change in LV function or ECG parameters. These findings are important to consider when conducting clinical or research serial assessments.
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Affiliation(s)
- Barbara N. Morrison
- School of Human Kinetics, Trinity Western University, Langley, BC V2Y 1Y1, Canada; (B.N.M.); (A.J.C.); (A.T.C.)
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (A.M.); (L.S.); (G.R.); (K.G.)
| | - Allison J. Campbell
- School of Human Kinetics, Trinity Western University, Langley, BC V2Y 1Y1, Canada; (B.N.M.); (A.J.C.); (A.T.C.)
| | - Anita T. Coté
- School of Human Kinetics, Trinity Western University, Langley, BC V2Y 1Y1, Canada; (B.N.M.); (A.J.C.); (A.T.C.)
| | - Aleah Mohammad
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (A.M.); (L.S.); (G.R.); (K.G.)
| | - Laura Sambrook
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (A.M.); (L.S.); (G.R.); (K.G.)
| | - Georgia Robinson
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (A.M.); (L.S.); (G.R.); (K.G.)
| | - Keith George
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (A.M.); (L.S.); (G.R.); (K.G.)
| | - David Oxborough
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool L3 3AF, UK; (A.M.); (L.S.); (G.R.); (K.G.)
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Josse M, Patrier L, Isnard M, Turc-Baron C, Grandperrin A, Nottin S, Mandigout S, Cristol JP, Maufrais C, Obert P. Cardioprotective Effect of Acute Intradialytic Exercise: A Comprehensive Speckle-Tracking Echocardiography Analysis. J Am Soc Nephrol 2023; 34:1445-1455. [PMID: 37071035 PMCID: PMC10400099 DOI: 10.1681/asn.0000000000000149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
SIGNIFICANCE STATEMENT Hemodialysis (HD) can lead to acute left ventricular (LV) myocardial wall motion abnormalities (myocardial stunning) due to segmental hypoperfusion. Exercise during dialysis is associated with favorable effects on central hemodynamics and BP stability, factors considered in the etiology of HD-induced myocardial stunning. In a speckle-tracking echocardiography analysis, the authors explored effects of acute intradialytic exercise (IDE) on LV regional myocardial function in 60 patients undergoing HD. They found beneficial effects of IDE on LV longitudinal and circumferential function and on torsional mechanics, not accounted for by cardiac loading conditions or central hemodynamics. These findings support the implementation of IDE in people with ESKD, given that LV transient dysfunction imposed by repetitive HD may contribute to heart failure and increased risk of cardiac events in such patients. BACKGROUND Hemodialysis (HD) induces left ventricular (LV) transient myocardial dysfunction. A complex interplay between linear deformations and torsional mechanics underlies LV myocardial performance. Although intradialytic exercise (IDE) induces favorable effects on central hemodynamics, its effect on myocardial mechanics has never been comprehensively documented. METHODS To evaluate the effects of IDE on LV myocardial mechanics, assessed by speckle-tracking echocardiography, we conducted a prospective, open-label, two-center randomized crossover trial. We enrolled 60 individuals with ESKD receiving HD, who were assigned to participate in two sessions performed in a randomized order: standard HD and HD incorporating 30 minutes of aerobic exercise (HDEX). We measured global longitudinal strain (GLS) at baseline (T0), 90 minutes after HD onset (T1), and 30 minutes before ending HD (T2). At T0 and T2, we also measured circumferential strain and twist, calculated as the net difference between apical and basal rotations. Central hemodynamic data (BP, cardiac output) also were collected. RESULTS The decline in GLS observed during the HD procedure was attenuated in the HDEX sessions (estimated difference, -1.16%; 95% confidence interval [95% CI], -0.31 to -2.02; P = 0.008). Compared with HD, HDEX also demonstrated greater improvements from T0 to T2 in twist, an important component of LV myocardial function (estimated difference, 2.48°; 95% CI, 0.30 to 4.65; P = 0.02). Differences in changes from T0 to T2 for cardiac loading and intradialytic hemodynamics did not account for the beneficial effects of IDE on LV myocardial mechanics kinetics. CONCLUSIONS IDE applied acutely during HD improves regional myocardial mechanics and might warrant consideration in the therapeutic approach for patients on HD.
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Affiliation(s)
- Matthieu Josse
- UPR4278 Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Laure Patrier
- Fondation Charles Mion – AIDER Santé, Grabels, France
- CHU Nîmes, Nîmes, France
| | | | - Cécile Turc-Baron
- Fondation Charles Mion – AIDER Santé, Grabels, France
- CHRU, Montpellier, France
| | - Antoine Grandperrin
- UPR4278 Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Stéphane Nottin
- UPR4278 Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | | | - Jean-Paul Cristol
- Fondation Charles Mion – AIDER Santé, Grabels, France
- CHRU, Montpellier, France
- PhyMedExp, University of Montpellier, INSERM, CNRS, Montpellier, France
| | - Claire Maufrais
- UPR4278 Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
| | - Philippe Obert
- UPR4278 Laboratory of Experimental Cardiovascular Physiology, Avignon University, Avignon, France
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Cardoso CB, Brandão CVS, Juliani PS, Filadelpho AL, Pereira GJ, Lourenço MLG, Hataka A, Padovani CR. Morphogeometric Evaluation of the Left Ventricle and Left Atrioventricular Ring in Dogs: A Computerized Anatomical Study. Animals (Basel) 2023; 13:1996. [PMID: 37370507 DOI: 10.3390/ani13121996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
In veterinary, there is scarce availability of morphogeometric studies in normal and remodeled hearts; furthermore, ventricular geometry acts as an indicator of cardiac function. It is a highly necessary field of knowledge for the development of therapeutic protocols, especially surgical ones. The objectives of this study were: to obtain measurements of the left atrioventricular valve ring and left ventricle, to analyze the proportionality between the segments of the left cardiac chamber of normal hearts and to describe reference values for morphogeometric analysis of the left ventricle. For this, 50 hearts from small (Group 1-G1) and medium to large (Group 2-G2) dogs were laminated in the apical, basal and equatorial segments, and submitted to computer analysis to identify the perimeter of each segment and the left atrioventricular ring, wall thickness and distance from the atrioventricular sulcus to the apex. The largest internal perimeter was that of the equatorial. The basal segment had the highest mean for ventral parietal wall thickness, suggesting greater contractile reserve at that location. Considering the proportionality relationships, there was no statistical difference between the intersegmental perimeter indices for the two groups. This suggests that despite the animals' weight variations, the proportions between the left ventricular segments are maintained. Therefore, it is concluded that the data can be used as a standard of comparison for cardiac geometric assessments, as well as a basis for the development of therapeutic measures in the context of adverse cardiac remodeling.
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Affiliation(s)
- Catarina Borges Cardoso
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Cláudia Valéria Seullner Brandão
- Department of Veterinary Surgery and Animal Reproduction, School of Veterinary Medicine and Animal-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Paulo Sérgio Juliani
- Cardiovascular Surgery Service, WeVets Veterinary Hospital, São Paulo 02511-000, SP, Brazil
| | - André Luis Filadelpho
- Institute of Biosciences, Department of Anatomy-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Geovane José Pereira
- School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Maria Lúcia Gomes Lourenço
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Alessandre Hataka
- Department of Veterinary Clinics, School of Veterinary Medicine and Animal Sciences-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
| | - Carlos Roberto Padovani
- Institute of Biosciences, Department of Biostatistics-UNESP-Botucatu, São Paulo 18618-681, SP, Brazil
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17
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Wang Z, Xie R, Shi Q, Li Y, Chang J, Yuan J, Gong H, Chen J. Vacuum-assisted tissue embedding for whole-heart imaging. BIOMEDICAL OPTICS EXPRESS 2023; 14:2539-2550. [PMID: 37342702 PMCID: PMC10278630 DOI: 10.1364/boe.488766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/23/2023]
Abstract
The use of combined optical imaging and tissue sectioning has potential for use in visualizing heart-wide fine structures at single-cell resolution. However, existing tissue preparation methods fail to generate ultrathin cavity-containing cardiac tissue slices with minimal deformation. This study developed an efficient vacuum-assisted tissue embedding method to prepare high-filled, agarose-embedded whole-heart tissue. Utilizing optimized vacuum parameters, we achieved 94% filled whole-heart tissue with the thinnest cut slice of 5 µm. We subsequently imaged a whole mouse heart sample using vibratome-integrated fluorescence micro-optical sectioning tomography (fMOST) with a voxel size of 0.32 µm × 0.32 µm × 1 µm. The imaging results indicated that the vacuum-assisted embedding method enabled whole-heart tissue to withstand long-term thin cutting while ensuring that slices were consistent and of high quality.
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Affiliation(s)
- Zhi Wang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
- HUST-Suzhou Institute for Brainsmatics, JITRI, Suzhou, China
| | - Ruiheng Xie
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
| | - Qishuo Shi
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
| | - Yafeng Li
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
| | - Jin Chang
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
| | - Jing Yuan
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
- HUST-Suzhou Institute for Brainsmatics, JITRI, Suzhou, China
| | - Hui Gong
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
- HUST-Suzhou Institute for Brainsmatics, JITRI, Suzhou, China
| | - Jianwei Chen
- Britton Chance Center for Biomedical Photonics, Wuhan National Laboratory for Optoelectronics, MoE Key Laboratory for Biomedical Photonics, Huazhong University of Science and Technology, Wuhan, China
- HUST-Suzhou Institute for Brainsmatics, JITRI, Suzhou, China
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Wilczek J, Jadczyk T, Wojakowski W, Gołba KS. Left ventricular electrical potential measured by the NOGA XP electromechanical mapping method as a predictor of response to cardiac resynchronization therapy. Front Cardiovasc Med 2023; 10:1107415. [PMID: 37215549 PMCID: PMC10193837 DOI: 10.3389/fcvm.2023.1107415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 04/18/2023] [Indexed: 05/24/2023] Open
Abstract
Objectives The aim of the study was to determine whether left ventricular electrical potential measured by electromechanical mapping with the NOGA XP system has predictive value for response to CRT. Background Approximately 30% of patients who undergo cardiac resynchronization therapy do not see the expected effects. Methods The group of 38 patients qualified for CRT implantation were included in the study, of which 33 patients were analyzed. A 15% reduction in ESV after 6 months of pacing was used as a criterion for a positive response to CRT. The mean value and sum of unipolar and bipolar potentials obtained by mapping with the NOGA XP system and their predictive value in relation to the effect of CRT were analyzed using a bulls-eye projection at three levels: 1) the global value of the left ventricular (LV) potentials, 2) the potentials of the individual LV walls and 3) the mean value of the potentials of the individual segments (basal and middle) of the individual LV walls. Results 24 patients met the criterion of a positive response to CRT vs. 9 non-responders. At the global analysis stage, the independent predictors of favorable response to CRT were the sum of the unipolar potential and bipolar mean potential. In the analysis of individual left ventricular walls, the mean bipolar potential of the anterior and posterior wall and in the unipolar system, mean septal potential was found to be an independent predictor of favorable response to CRT. In the detailed segmental analysis, the independent predictors were the bipolar potential of the mid-posterior wall segment and the basal anterior wall segment. Conclusions Measurement of bipolar and unipolar electrical potentials with the NOGA XP system is a valuable method for predicting a favorable response to CRT.
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Affiliation(s)
- Jacek Wilczek
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
- Electrocardiology Department, Upper Silesian Medical Center, Katowice, Poland
| | - Tomasz Jadczyk
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Interventional Cardiac Electrophysiology Group, International Clinical Research Center, St. Anne's University Hospital in Brno, Brno, Czech Republic
| | - Wojciech Wojakowski
- Division of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Third Department of Cardiology, Upper Silesian Medical Center, Katowice, Poland
| | - Krzysztof S. Gołba
- Department of Electrocardiology and Heart Failure, Medical University of Silesia, Katowice, Poland
- Electrocardiology Department, Upper Silesian Medical Center, Katowice, Poland
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Antúnez-Montes OY, Kocica MJ, Olavarria AS, Corno AF, Millan RA, Rosales CI, Sanchez Aparicio HE. Helical structure of the ventricular myocardium. A narrative review of cardiac mechanics. Echocardiography 2023; 40:161-173. [PMID: 36610038 DOI: 10.1111/echo.15515] [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: 09/13/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 01/09/2023] Open
Abstract
To date, the ventricular myocardial band is the anatomical-functional model that best explains cardiac mechanics during systolic-diastolic phenomena in the cardiac cycle. The implications of the model fundamentally affect the anatomical interpretation of the ventricular myocardium, giving meaning to the direction that muscle fibers take, turning them into an object of study with potential clinical, imaging, and surgical applications. Re-interpreting the anatomy of the ventricular muscle justifies changes in the physiological interpretation, from its functional focus as a fiber unraveling the mechanical phenomena carried out during systole and diastole. We identify the functioning of the heart from the electrical and hemodynamic point of view, but it is necessary to delve into the mechanics that originate the hemodynamic changes observed flowmetrically, and that manifested during the pathology. In this review, the mechanical phenomena that the myocardium performs in each phase of the cardiac cycle are broken down in detail, emphasizing the physical displacements that each of the muscle segments presents, as well as a vision of their alteration and in which pathologies they are mainly identified. Visually, an anatomical correlation to the echocardiogram is provided, pointing out the direction of the segmental myocardial displacement by the strain velocity vector technique.
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Affiliation(s)
| | - Mladen J Kocica
- UC Clinical Center of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
| | | | - Antonio Francesco Corno
- Children's Heart Institute, Memorial Hermann Children's Hospital, McGovern Medical School, UTHealth in Houston, Texas, USA
| | - Rocio Aceves Millan
- Echocardiography Section, November 20 National Medical Center, ISSSTE, Mexico City, Mexico
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20
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Mora V, Roldán I, Romero E, Saad A, Gil C, Contreras MB, Trainini J, Escribano P, Gimeno P, Arbucci R, Valls A, Lowenstein J. Myocardial Wringing and Rigid Rotation in Cardiac Amyloidosis. CJC Open 2023; 5:128-135. [PMID: 36880078 PMCID: PMC9984891 DOI: 10.1016/j.cjco.2022.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/08/2022] [Indexed: 11/16/2022] Open
Abstract
Background The motion of the heart is a result of the helicoidal arrangement of the myofibers in the organ's wall. We aimed to study the relationship between the wringing motion state and the degree of ventricular function in patients with cardiac amyloidosis (CA). Methods Fifty patients with CA and decreased global longitudinal strain (LS) were evaluated using 2-dimensional speckle-tracking echocardiography. We have expressed LS as positive values to facilitate understanding. Normal twist, which occurs when basal and apical rotations occur in opposite directions, was coded as positive. When the apex and base rotate in the same direction (rigid rotation), twist was coded as negative. Left ventricular (LV) wringing (calculated as twist/LS, which takes into account actions that occur simultaneously during LV systole [ie, longitudinal shortening and twist]) was evaluated according to LV ejection fraction (LVEF). Results Most of the patients (66%) who participated in the study were diagnosed with transthyretin amyloidosis. A positive relationship was observed between wringing and LVEF (r = 0.75, P < 0.0001). In advanced stages of ventricular dysfunction, rigid rotation appeared in 66.6% of patients with LVEF ≤ 40%, in whom negative values of twist and wringing were observed. LV wringing proved to be a good discriminator of LVEF (area under the curve 0.90, P < 0.001, 95% confidence interval 0.79-0.97); for example, wringing < 1.30°/% detected LVEF < 50% with 85.7% sensibility and 89.7% specificity. Conclusions Wringing, which integrates twist and simultaneous LV longitudinal shortening, is a conditioning rotational parameter of the degree of ventricular function in patients with CA.
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Affiliation(s)
- Vicente Mora
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Ildefonso Roldán
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Elena Romero
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Ariel Saad
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Celia Gil
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - M Belen Contreras
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Jorge Trainini
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Pablo Escribano
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Pau Gimeno
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Rosina Arbucci
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
| | - Amparo Valls
- Department of Cardiology, Hospital Universitario Dr Peset. Valencia, Spain
| | - Jorge Lowenstein
- Cardiodiagnosis Department, Medical Research, Buenos Aires, Argentina
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21
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Marzlin N, Hays AG, Peters M, Kaminski A, Roemer S, O'Leary P, Kroboth S, Harland DR, Khandheria BK, Tajik AJ, Jain R. Myocardial Work in Echocardiography. Circ Cardiovasc Imaging 2023; 16:e014419. [PMID: 36734221 DOI: 10.1161/circimaging.122.014419] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Myocardial work is an emerging tool in echocardiography that incorporates left ventricular afterload into global longitudinal strain analysis. Myocardial work correlates with myocardial oxygen consumption, and work efficiency can also be assessed. Myocardial work has been evaluated in a variety of clinical conditions to assess the added value of myocardial work compared to left ventricular ejection fraction and global longitudinal strain. This review showcases the current use of myocardial work in adult echocardiography and its possible role in cardiac pathologies.
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Affiliation(s)
- Nathan Marzlin
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Allison G Hays
- Johns Hopkins School of Medicine, Baltimore, MD (A.G.H.)
| | - Matthew Peters
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Abigail Kaminski
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Sarah Roemer
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Patrick O'Leary
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Stacie Kroboth
- Academic Affairs, Cardiovascular Research, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, Wisconsin (S.K.)
| | - Daniel R Harland
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Bijoy K Khandheria
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - A Jamil Tajik
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
| | - Renuka Jain
- Aurora Cardiovascular and Thoracic Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Advocate Aurora Health, Milwaukee, WI (N.M., M.P., A.K., S.R., P.O., D.R.H., B.K.K., A.J.T., R.J.)
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22
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Erevik CB, Kleiven Ø, Frøysa V, Bjørkavoll-Bergseth M, Chivulescu M, Klæboe LG, Dejgaard L, Auestad B, Skadberg Ø, Melberg T, Urheim S, Haugaa K, Edvardsen T, Ørn S. Myocardial inefficiency is an early indicator of exercise-induced myocardial fatigue. Front Cardiovasc Med 2023; 9:1081664. [PMID: 36712275 PMCID: PMC9874326 DOI: 10.3389/fcvm.2022.1081664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 12/22/2022] [Indexed: 01/12/2023] Open
Abstract
Background The effect of prolonged, high-intensity endurance exercise on myocardial function is unclear. This study aimed to determine the left ventricular (LV) response to increased exercise duration and intensity using novel echocardiographic tools to assess myocardial work and fatigue. Materials and methods LV function was assessed by echocardiography before, immediately, and 24 h after a cardiopulmonary exercise test (CPET) and a 91-km mountain bike leisure race. Cardiac Troponin I (cTnI) was used to assess myocyte stress. Results 59 healthy recreational athletes, 52 (43-59) years of age, 73% males, were included. The race was longer and of higher intensity generating higher cTnI levels compared with the CPET (p < 0.0001): Race/CPET: exercise duration: 230 (210, 245)/43 (40, 45) minutes, mean heart rate: 154 ± 10/132 ± 12 bpm, max cTnI: 77 (37, 128)/12 (7, 23) ng/L. Stroke volume and cardiac output were higher after the race than CPET (p < 0.005). The two exercises did not differ in post-exercise changes in LV ejection fraction (LVEF) or global longitudinal strain (GLS). There was an increase in global wasted work (p = 0.001) following the race and a persistent reduction in global constructive work 24 h after exercise (p = 0.003). Conclusion Increased exercise intensity and duration were associated with increased myocardial wasted work post-exercise, without alterations in LVEF and GLS from baseline values. These findings suggest that markers of myocardial inefficiency may precede reduction in global LV function as markers of myocardial fatigue.
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Affiliation(s)
- Christine Bjørkvik Erevik
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway,*Correspondence: Christine Bjørkvik Erevik,
| | - Øyunn Kleiven
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Vidar Frøysa
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | | | - Monica Chivulescu
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Gunnar Klæboe
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Lars Dejgaard
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Bjørn Auestad
- Department of Mathematics and Physics, University of Stavanger, Stavanger, Norway,Research Department, Stavanger University Hospital, Stavanger, Norway
| | - Øyvind Skadberg
- Department of Biochemistry, Stavanger University Hospital, Stavanger, Norway
| | - Tor Melberg
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
| | - Stig Urheim
- Department of Cardiology, Bergen University Hospital, Bergen, Norway
| | - Kristina Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Stein Ørn
- Department of Cardiology, Stavanger University Hospital, Stavanger, Norway
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23
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Durr AJ, Korol AS, Hathaway QA, Kunovac A, Taylor AD, Rizwan S, Pinti MV, Hollander JM. Machine learning for spatial stratification of progressive cardiovascular dysfunction in a murine model of type 2 diabetes mellitus. PLoS One 2023; 18:e0285512. [PMID: 37155623 PMCID: PMC10166525 DOI: 10.1371/journal.pone.0285512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 04/25/2023] [Indexed: 05/10/2023] Open
Abstract
Speckle tracking echocardiography (STE) has been utilized to evaluate independent spatial alterations in the diabetic heart, but the progressive manifestation of regional and segmental cardiac dysfunction in the type 2 diabetic (T2DM) heart remains understudied. Therefore, the objective of this study was to elucidate if machine learning could be utilized to reliably describe patterns of the progressive regional and segmental dysfunction that are associated with the development of cardiac contractile dysfunction in the T2DM heart. Non-invasive conventional echocardiography and STE datasets were utilized to segregate mice into two pre-determined groups, wild-type and Db/Db, at 5, 12, 20, and 25 weeks. A support vector machine model, which classifies data using a single line, or hyperplane, that best separates each class, and a ReliefF algorithm, which ranks features by how well each feature lends to the classification of data, were used to identify and rank cardiac regions, segments, and features by their ability to identify cardiac dysfunction. STE features more accurately segregated animals as diabetic or non-diabetic when compared with conventional echocardiography, and the ReliefF algorithm efficiently ranked STE features by their ability to identify cardiac dysfunction. The Septal region, and the AntSeptum segment, best identified cardiac dysfunction at 5, 20, and 25 weeks, with the AntSeptum also containing the greatest number of features which differed between diabetic and non-diabetic mice. Cardiac dysfunction manifests in a spatial and temporal fashion, and is defined by patterns of regional and segmental dysfunction in the T2DM heart which are identifiable using machine learning methodologies. Further, machine learning identified the Septal region and AntSeptum segment as locales of interest for therapeutic interventions aimed at ameliorating cardiac dysfunction in T2DM, suggesting that machine learning may provide a more thorough approach to managing contractile data with the intention of identifying experimental and therapeutic targets.
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Affiliation(s)
- Andrya J Durr
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Anna S Korol
- Department of Neuroscience, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Quincy A Hathaway
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Center for Inhalation Toxicology (iTOX), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Amina Kunovac
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Center for Inhalation Toxicology (iTOX), West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Andrew D Taylor
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Saira Rizwan
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
| | - Mark V Pinti
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- West Virginia University School of Pharmacy, Morgantown, West Virginia, United States of America
- Department of Physiology and Pharmacology, West Virginia University School of Pharmacy, Morgantown, West Virginia, United States of America
| | - John M Hollander
- Division of Exercise Physiology, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
- Mitochondria, Metabolism & Bioenergetics Working Group, West Virginia University School of Medicine, Morgantown, West Virginia, United States of America
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24
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Sharrack N, Das A, Kelly C, Teh I, Stoeck CT, Kozerke S, Swoboda PP, Greenwood JP, Plein S, Schneider JE, Dall'Armellina E. The relationship between myocardial microstructure and strain in chronic infarction using cardiovascular magnetic resonance diffusion tensor imaging and feature tracking. J Cardiovasc Magn Reson 2022; 24:66. [PMID: 36419059 PMCID: PMC9685947 DOI: 10.1186/s12968-022-00892-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 10/03/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiac diffusion tensor imaging (cDTI) using cardiovascular magnetic resonance (CMR) is a novel technique for the non-invasive assessment of myocardial microstructure. Previous studies have shown myocardial infarction to result in loss of sheetlet angularity, derived by reduced secondary eigenvector (E2A) and reduction in subendocardial cardiomyocytes, evidenced by loss of myocytes with right-handed orientation (RHM) on helix angle (HA) maps. Myocardial strain assessed using feature tracking-CMR (FT-CMR) is a sensitive marker of sub-clinical myocardial dysfunction. We sought to explore the relationship between these two techniques (strain and cDTI) in patients at 3 months following ST-elevation MI (STEMI). METHODS 32 patients (F = 28, 60 ± 10 years) underwent 3T CMR three months after STEMI (mean interval 105 ± 17 days) with second order motion compensated (M2), free-breathing spin echo cDTI, cine gradient echo and late gadolinium enhancement (LGE) imaging. HA maps divided into left-handed HA (LHM, - 90 < HA < - 30), circumferential HA (CM, - 30° < HA < 30°), and right-handed HA (RHM, 30° < HA < 90°) were reported as relative proportions. Global and segmental analysis was undertaken. RESULTS Mean left ventricular ejection fraction (LVEF) was 44 ± 10% with a mean infarct size of 18 ± 12 g and a mean infarct segment LGE enhancement of 66 ± 21%. Mean global radial strain was 19 ± 6, mean global circumferential strain was - 13 ± - 3 and mean global longitudinal strain was - 10 ± - 3. Global and segmental radial strain correlated significantly with E2A in infarcted segments (p = 0.002, p = 0.011). Both global and segmental longitudinal strain correlated with RHM of infarcted segments on HA maps (p < 0.001, p = 0.003). Mean Diffusivity (MD) correlated significantly with the global infarct size (p < 0.008). When patients were categorised according to LVEF (reduced, mid-range and preserved), all cDTI parameters differed significantly between the three groups. CONCLUSION Change in sheetlet orientation assessed using E2A from cDTI correlates with impaired radial strain. Segments with fewer subendocardial cardiomyocytes, evidenced by a lower proportion of myocytes with right-handed orientation on HA maps, show impaired longitudinal strain. Infarct segment enhancement correlates significantly with E2A and RHM. Our data has demonstrated a link between myocardial microstructure and contractility following myocardial infarction, suggesting a potential role for CMR cDTI to clinically relevant functional impact.
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Affiliation(s)
- N Sharrack
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - A Das
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C Kelly
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - I Teh
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - C T Stoeck
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
- Centre for Surgical Research, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - S Kozerke
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - P P Swoboda
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J P Greenwood
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - S Plein
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - J E Schneider
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - E Dall'Armellina
- Biomedical Imaging Sciences Department, Leeds Institute for Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
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25
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Zhen XW, Li WC, Wang H, Song NP, Zhong L. Does types of atrial fibrillation matter in the impairment of global and regional left ventricular mechanics and intra-ventricular dyssynchrony? Front Cardiovasc Med 2022; 9:1019472. [DOI: 10.3389/fcvm.2022.1019472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAtrial fibrillation (AF) is the most common sustained cardiac arrhythmia, which is associated with cardiac dysfunction. This study aimed to compare the impairment severity of left ventricular strain and intra-ventricular dyssynchrony using echocardiography-derived velocity vector imaging in patients with different types of AF without heart failure.Methods168 non-valvular AF patients with normal left ventricular ejection fraction (98 paroxysmal AF patients and 70 persistent AF patients) and 86 healthy control subjects were included in this study. Regional and global left ventricular longitudinal and circumferential strain were measured. Time to regional peak longitudinal strain was measured and the standard deviation of all 12 segments (SDT-S) was used as a measure of intra-ventricular dyssynchrony.ResultsSignificantly lower GLS (−18.71 ± 3.00% in controls vs. −17.10 ± 3.01% in paroxysmal AF vs. −12.23 ± 3.25% in persistent AF, P < 0.05) and GCS (−28.75 ± 6.34% in controls vs. −24.43 ± 6.86% in paroxysmal AF vs. −18.46 ± 6.42% in persistent AF, P < 0.01) were observed in either persistent AF subjects or paroxysmal AF subjects compared with healthy control subjects (P < 0.05). The impairment was much worse in persistent AF subjects compared with paroxysmal AF subjects (P < 0.001). Intraventricular dyssynchrony was found in both persistent AF patients and paroxysmal AF patients, and it’s worse in persistent AF patients (52 ± 18 ms in controls, 61 ± 17 ms in paroxysmal AF, and 70 ± 28 ms in persistent AF, P < 0.05). Multivariate regression analysis revealed AF types were independent risk factors of GLS, GCS, and intraventricular dyssynchrony.ConclusionAF types were not only associated with impaired longitudinal and circumferential left ventricle mechanics but also intra-ventricular mechanical dyssynchrony. Worse systolic mechanics and intra-ventricular dyssynchrony were found in patients with persistent AF compared with these in patients with paroxysmal AF.
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26
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Trifunović-Zamaklar D, Jovanović I, Vratonjić J, Petrović O, Paunović I, Tešić M, Boričić-Kostić M, Ivanović B. The basic heart anatomy and physiology from the cardiologist's perspective: Toward a better understanding of left ventricular mechanics, systolic, and diastolic function. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:1026-1040. [PMID: 36218206 DOI: 10.1002/jcu.23316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/16/2023]
Abstract
A comprehensive understanding of the cardiac structure-function relationship is essential for proper clinical cardiac imaging. This review summarizes the basic heart anatomy and physiology from the perspective of a heart imager focused on myocardial mechanics. The main issues analyzed are the left ventricular (LV) architecture, the LV myocardial deformation through the cardiac cycle, the LV diastolic function basic parameters and the basic parameters of the LV deformation used in clinical practice for the LV function assessment.
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Affiliation(s)
- Danijela Trifunović-Zamaklar
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Jovanović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Jelena Vratonjić
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Olga Petrović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - Ivana Paunović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
| | - Milorad Tešić
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | | | - Branislava Ivanović
- Clinic for Cardiology, University Clinical Center of Serbia, Belgrade, Serbia
- School of Medicine, University of Belgrade, Belgrade, Serbia
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27
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Ke S, Weng K, Chang M, Wu M, Li Y, Chien K, Lin C, Hsieh K, Chang M, Pan J, Peng H. Differential Adaptation of Biventricular Myocardial Kinetic Energy in Patients With Repaired Tetralogy of Fallot Assessed by
MR
Tissue Phase Mapping. J Magn Reson Imaging 2022; 57:1492-1504. [PMID: 36094105 DOI: 10.1002/jmri.28420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The myocardial kinetic energy (KE) and its association with pulmonary regurgitation (PR) have yet to be investigated in repaired tetralogy of Fallot (rTOF) patients. PURPOSE To evaluate the adaptation of myocardial KE in rTOF patients by tissue phase mapping (TPM). STUDY TYPE Prospective. POPULATION A total of 49 rTOF patients (23 ± 5 years old; male = 32), 47 normal controls (22 ± 1 year old; male = 29). FIELD STRENGTH/SEQUENCE 3-T/2D dark-blood three-directional velocity-encoded gradient-echo sequence. ASSESSMENT Left and right ventricle (LV, RV) myocardial KE in radial (KEr ), circumferential (KEø ), longitudinal (KEz ) directions. The proportions of KE in each direction to the sum of all KE (KErøz ): %KEr , %KEø , %KEz . PR fraction. STATISTICAL TEST Student's t test, multivariable regression. Statistical significance: P < 0.05. RESULTS In rTOF group, LV KEz remained normal in systole (P = 0.565) and diastole (P = 0.210), whereas diastolic LV %KEz (62% ± 14% vs. 72% ± 7%) and systolic LV %KEø (9% ± 6% vs. 20% ± 7%) were significantly decreased. The KEr and %KEr of both ventricles significantly increased in the rTOF group (RV in diastole: 6 ± 3 vs. 3 ± 1 μJ and 54% ± 13% vs. 27% ± 7%). The rTOF group exhibited significantly higher RV/LV ratios of %KEr (systole: 1.3 ± 0.3 vs. 1.0 ± 0.3) and %KEø (systole: 1.6 ± 0.8 vs. 1.0 ± 0.3) and significantly lower ratios of %KEz in systole (0.7 ± 0.2 vs. 1.0 ± 0.1) and diastole (0.5 ± 0.2 vs. 0.9 ± 0.1). In multivariable regression analysis, the RV peak systolic KErøz , RV systolic KEz , and LV diastolic %KEø were independently associated with PR fraction in the rTOF group (adjusted R2 = 0.479). DATA CONCLUSION In rTOF patients, the adaptation of the KE proportion occurred earlier than that of the KE amplitude, and the biventricular balance of %KE was disrupted. PR may cause differential KE adaptation in RV and LV. TPM-derived KE may be useful in investigation of myocardial adaptation in rTOF patients. EVIDENCE LEVEL 2 TECHNICAL EFFICACY: Stage 3.
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Affiliation(s)
- Shi‐Ying Ke
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
| | - Ken‐Pen Weng
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Meng‐Chu Chang
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
| | - Ming‐Ting Wu
- School of Medicine National Yang Ming Chiao Tung University Taipei Taiwan
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Institute of Clinical Medicine National Yang Ming Chiao Tung University Taipei Taiwan
| | - Yi‐He Li
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Kuang‐Jen Chien
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Chu‐Chuan Lin
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Kai‐Sheng Hsieh
- Department of Pediatrics China Medical University Children's Hospital Taichung Taiwan
| | - Ming‐Hua Chang
- Department of Radiology Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Jun‐Yen Pan
- Congenital Structural Heart Disease Center, Department of Pediatrics Kaohsiung Veterans General Hospital Kaohsiung Taiwan
- Department of Cardiovascular Surgery Kaohsiung Veterans General Hospital Kaohsiung Taiwan
| | - Hsu‐Hsia Peng
- Department of Biomedical Engineering and Environmental Sciences National Tsing Hua University Hsinchu Taiwan
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28
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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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29
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Okhovatian S, Mohammadi MH, Rafatian N, Radisic M. Engineering Models of the Heart Left Ventricle. ACS Biomater Sci Eng 2022; 8:2144-2160. [PMID: 35523206 DOI: 10.1021/acsbiomaterials.1c00636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Despite capturing the imagination of scientists for decades, the goal of creating an artificial heart for transplantation proved to be significantly more challenging than initially anticipated. Toward this goal, recent ground-breaking studies demonstrate the development of functional left ventricular (LV) models. LV models are artificially constructed 3D chambers that are capable of containing liquid within the engineered cavity and exhibit the functionality of native LV including contraction, ejection of fluid, and electrical impulse propagation. Various hydrogels and polymers have been used in manufacturing of LV models, relying on techniques such as electrospinning, bioprinting, casting, and molding. Most studies scaled down the models based on the dimensions of the human or rat ventricle. Initially, neonatal rat cardiomyocytes were the cell type of choice for construction the LV models. Yet, as the stem cell biology field advanced, recent studies focused on the use of cardiomyocytes derived from human induced pluripotent stem cells. In this review, we first describe the physiological characteristics of the human heart, to establish the parameter space for modeling. We then elaborate on current advances in the field and compare recently developed LV models among themselves and with the native human left ventricle. Fabrication methods, cell types, biomaterials, functional properties, and disease modeling capability are some of the major parameters that have distinguished these models. We also highlight some of the current challenges in this field, such as vascularization, cell composition and fidelity, and discuss potential solutions to overcome them.
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Affiliation(s)
- Sargol Okhovatian
- Institute of Biomaterials Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Mohammad Hossein Mohammadi
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada
| | - Naimeh Rafatian
- Institute of Biomaterials Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
| | - Milica Radisic
- Department of Chemical Engineering and Applied Chemistry, University of Toronto, Toronto, Ontario M5S 3E5, Canada.,Institute of Biomaterials Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada.,Toronto General Research Institute, Toronto, Ontario M5G 2C4, Canada
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30
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Isaak A, Kravchenko D, Mesropyan N, Endler C, Bischoff LM, Vollbrecht T, Thomas D, Dabir D, Zimmer S, Attenberger U, Kuetting D, Luetkens JA. Layer-specific Strain Analysis with Cardiac MRI Feature Tracking in Acute Myocarditis. Radiol Cardiothorac Imaging 2022; 4:e210318. [PMID: 35833169 PMCID: PMC9274313 DOI: 10.1148/ryct.210318] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/20/2022] [Accepted: 05/10/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To evaluate the diagnostic performance of layer-specific cardiac MRI feature-tracking (FT) strain analysis in patients with acute myocarditis. MATERIALS AND METHODS Seventy patients (mean age, 43 years ± 19 [SD]; 46 men) with clinically defined acute myocarditis and 42 healthy controls who underwent cardiac MRI from March 2014 to November 2018 were retrospectively analyzed. FT-based left ventricular peak systolic global longitudinal strain (GLS) and global circumferential strain (GCS) were assessed at subendocardial, midmyocardial, and subepicardial layers. The 2018 Lake Louise criteria (LLC) were assessed. Patients with myocarditis were dichotomized into two groups: those with preserved and those with reduced ejection fraction. For statistical analysis, unpaired t test, one-way analysis of variance, Pearson correlation, and receiver operating characteristic analysis were used. RESULTS GLS and GCS values of all layers (eg, midmyocardial GCS: -21.3% ± 5.5 vs -28.0% ± 4.3; P < .001) were impaired in patients with myocarditis compared with controls. Only subepicardial GLS (-20.0% ± 3.3 vs -17.5% ± 3.3; P < .001) and midmyocardial GCS values (-28.0% ± 4.3 vs -23.1% ± 4.3; P < .001) could differentiate between controls and patients with preserved ejection fraction. Midmyocardial GCS correlated with inflammatory myocardial parameters (eg, late gadolinium enhancement percentage, r = 0.48, P < .001). Midmyocardial GCS (area under the receiver operating characteristic curve [AUC], 0.82) and subepicardial GLS (AUC, 0.77) had the highest diagnostic performance for acute myocarditis diagnosis (P < .05 against all other strain parameters). The diagnostic performance of the 2018 LLC was significantly improved by inclusion of these two strain parameters (AUC, 0.92 vs 0.97; P = .04). CONCLUSION Diagnostic performance of cardiac MRI FT strain was different between myocardial layers in acute myocarditis, with midmyocardial GCS and subepicardial GLS providing the highest diagnostic performance.Keywords: MRI, Cardiac, Heart, Left Ventricle, Inflammation, Tissue Characterization, MR-Functional Imaging, Feature-Tracking Strain, Acute Myocarditis Supplemental material is available for this article. © RSNA, 2022.
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31
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Mah K, Mertens L. Echocardiographic Assessment of Right Ventricular Function in Paediatric Heart Disease: A Practical Clinical Approach. CJC PEDIATRIC AND CONGENITAL HEART DISEASE 2022; 1:136-157. [PMID: 37970496 PMCID: PMC10642122 DOI: 10.1016/j.cjcpc.2022.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 05/05/2022] [Indexed: 11/17/2023]
Abstract
As the right ventricle (RV) plays an integral role in different paediatric heart diseases, the accurate assessment of RV size and function is essential in the diagnosis, management, and prognostication of congenital and acquired cardiac lesions. Yet, echocardiographic evaluation of the RV is challenging because of its complex and variable morphology, its different physiology compared with the left ventricle, and its capability to adapt to different loading conditions associated with congenital and acquired heart diseases within certain ranges. Reliable echocardiographic detection of RV systolic and diastolic dysfunction remains challenging while important for patient management. This review provides an updated, practical approach to assessing RV function in structurally normal hearts and in children with common congenital heart defects and in those with pulmonary hypertension. We also review the impact of tricuspid valve function on RV functional parameters. There is no single functional RV parameter that uniquely describes RV function; instead a combination of different parameters is recommended in clinical practice. Qualitative and quantitative analysis of RV function will be reviewed including more recent techniques such as speckle tracking and 3D echocardiography.
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Affiliation(s)
- Kandice Mah
- Division of Cardiology, BC Children’s Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Luc Mertens
- Department of Paediatrics, Labatt Family Heart Centre, the Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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32
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Huang H, Chang WT, Huang CC. High-Spatiotemporal-Resolution Visualization of Myocardial Strains Through Vector Doppler Estimation: A Small-Animal Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2022; 69:1859-1870. [PMID: 35108204 DOI: 10.1109/tuffc.2022.3148873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
High-frequency ultrasound (HFUS) imaging is extensively used for cardiac diseases in small animals due to its high spatial resolution. However, there is a lack of a system that can provide a 2-D high-spatiotemporal dynamic visualization of mouse myocardial strains. In this article, a dynamic HFUS (40 MHz) high-resolution strain imaging was developed through the vector Doppler imaging. Following in vitro tests using a rubber balloon phantom, in vivo experiments were performed on wild-type (WT) and myocardial infarction (MI) mice. High-resolution dynamic images of myocardial strains were obtained in the longitudinal, radial, and circumferential directions at a frame rate of 1 kHz. Global peak strain values for WT mice were -19.3% ± 1.3% (longitudinal), 31.4% ± 1.7% (radial in the long axis), -19.9% ±.8% (circumferential), and 34.4% ± 1.9% (radial in the short axis); those for the MI mice were -16.1% ±.9% (longitudinal), 26.8% ± 2.9% (radial in the long axis), -15.2% ± 2.7% (circumferential), and 21.6% ± 4.8% (radial in the short axis). These results indicate that the strains for MI mice are significantly lower than those for WT mice. Regional longitudinal strain curves in the epicardial, midcardial, and endocardial layers were measured and the peak strain values for WT mice were -22.% and -16.8% in the endocardial and epicardial layers, respectively. However, no significant difference in the layer-based values was noted for the MI mice. Regional analysis results revealed obvious myocardial strain variation in the apical anterior region in the MI mice. The experimental results demonstrate that the proposed dynamic cardiac strain imaging can be useful in high-performance imaging of small-animal cardiac diseases.
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Anderson RD, Rodriguez Padilla J, Joens C, Masse S, Bhaskaran A, Magtibay K, Niri A, Asta J, Lai P, Azam MA, Vigmond E, Nanthakumar K. On the Electrophysiology and Mapping of Intramural Arrhythmic Focus. Circ Arrhythm Electrophysiol 2022; 15:e010384. [PMID: 35323037 DOI: 10.1161/circep.121.010384] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Conventional mapping of focal ventricular arrhythmias relies on unipolar electrogram characteristics and early local activation times. Deep intramural foci are common and associated with high recurrence rates following catheter-based radiofrequency ablation. We assessed the accuracy of unipolar morphological patterns and mapping surface indices to predict the site and depth of ventricular arrhythmogenic focal sources. METHODS An experimental beating-heart model used Langendorff-perfused, healthy swine hearts. A custom 56-pole electrode array catheter was positioned on the left ventricle. A plunge needle was placed perpendicular in the center of the grid to simulate arrhythmic foci at variable depths. Unipolar electrograms and local activation times were generated. Simulation models from 2 human hearts were also included with grids positioned simultaneously on the endocardium-epicardium from multiple left ventricular, septal, and outflow tract sites. RESULTS A unipolar Q or QS complex lacks specificity for superficial arrhythmic foci, as this morphology pattern occupies a large surface area and is the predominant pattern as intramural depth increases without developing a R component. There is progressive displacement from the arrhythmic focus to the surface exit as intramural focus depth increases. A shorter total activation time over the overlying electrode array, larger surface area within initial 20 ms activation, and a dual surface breakout pattern all indicate a deep focus. CONCLUSIONS Displacement from the focal intramural origin to the exit site on the mapping surface could lead to erroneous lesion delivery strategies. Traditional unipolar electrogram features lack specificity to predict the intramural arrhythmic source; however, novel endocardial-epicardial mapping surface indices can be used to determine the depth of arrhythmic foci.
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Affiliation(s)
- Robert D Anderson
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | | | - Christian Joens
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Stephane Masse
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Abhishek Bhaskaran
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Karl Magtibay
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Ahmed Niri
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - John Asta
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Patrick Lai
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Mohammed Ali Azam
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
| | - Edward Vigmond
- IHU Liryc, Hôpital Xavier Arnozan, Pessac Cedex, France (J.R.P., E.V.)
| | - Kumaraswamy Nanthakumar
- Hull Family Cardiac Fibrillation Management Laboratory, Division of Cardiology, University Health Network, Toronto General Hospital, Ontario, Canada (R.D.A., C.J., S.M., A.B., K.M., A.N., J.A., P.L., M.A.A., K.N.)
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Jeon YK, Kwon JW, Jang J, Choi SW, Woo J, Cho SH, Yu BI, Chun YS, Youm JB, Zhang YH, Kim SJ. Lower troponin expression in the right ventricle of rats explains interventricular differences in E-C coupling. J Gen Physiol 2022; 154:212990. [PMID: 35099502 PMCID: PMC8823606 DOI: 10.1085/jgp.202112949] [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: 04/26/2021] [Accepted: 01/06/2022] [Indexed: 12/12/2022] Open
Abstract
Despite distinctive functional and anatomic differences, a precise understanding of the cardiac interventricular differences in excitation–contraction (E–C) coupling mechanisms is still lacking. Here, we directly compared rat right and left cardiomyocytes (RVCM and LVCM). Whole-cell patch clamp, the IonOptix system, and fura-2 fluorimetry were used to measure electrical properties (action potential and ionic currents), single-cell contractility, and cytosolic Ca2+ ([Ca2+]i), respectively. Myofilament proteins were analyzed by immunoblotting. RVCM showed significantly shorter action potential duration (APD) and higher density of transient outward K+ current (Ito). However, the triggered [Ca2+]i change (Ca2+ transient) was not different, while the decay rate of the Ca2+ transient was slower in RVCM. Although the relaxation speed was also slower, the sarcomere shortening amplitude (ΔSL) was smaller in RVCM. SERCA activity was ∼60% lower in RVCM, which is partly responsible for the slower decay of the Ca2+ transient. Immunoblot analysis revealed lower expression of the cardiac troponin complex (cTn) in RVCM, implying a smaller Ca2+ buffering capacity (κS), which was proved by in situ analysis. The introduction of these new levels of cTn, Ito, and SERCA into a mathematical model of rat LVCM reproduced the similar Ca2+ transient, slower Ca2+ decay, shorter APD, and smaller ΔSL of RVCM. Taken together, these data show reduced expression of cTn proteins in the RVCM, which provides an explanation for the interventricular difference in the E–C coupling kinetics.
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Affiliation(s)
- Young Keul Jeon
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Won Kwon
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jihyun Jang
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Department of Surgery, Center for Vascular and Inflammatory Disease, University of Maryland School of Medicine, Baltimore, MD
| | - Seong Woo Choi
- Department of Physiology and Ion Channel Disease Research Center, Dongguk University College of Medicine, Seoul, Republic of Korea.,Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joohan Woo
- Department of Physiology and Ion Channel Disease Research Center, Dongguk University College of Medicine, Seoul, Republic of Korea
| | - Su Han Cho
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Byeong Il Yu
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yang Sook Chun
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae Boum Youm
- Cardiovascular and Metabolic Disease Center, Department of Physiology, College of Medicine, Inje University, Busan, Republic of Korea
| | - Yin Hua Zhang
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Yanbian University Hospital, Yanji, China.,Institute of Cardiovascular Sciences, Faculty of Biology, Medicine and Health Sciences, University of Manchester, Manchester, UK
| | - Sung Joon Kim
- Department of Physiology, Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Ischemic/Hypoxic Disease Institute, Seoul National University College of Medicine, Seoul, Republic of Korea.,Wide River Institute of Immunology, Seoul National University College of Medicine, Hongcheon, Republic of Korea
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Tulunay Kaya C, Gerede DM, Akhundova J. Acute effects of energy drink consumption on left and right ventricular function - a 2-dimensional speckle tracking echocardiographic study. KARDIOLOGIIA 2022; 62:28-35. [PMID: 35272605 DOI: 10.18087/cardio.2022.2.n1899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/24/2021] [Indexed: 06/14/2023]
Abstract
Aim Energy drinks (ED) contain high levels of caffeine and taurine and are associated with several cardiovascular effects. We investigated acute effects of consuming low caffeine and taurine content ED on left ventricular (LV) and right ventricular (RV) function assessed by conventional and two-dimensional speckle tracking echocardiography.Material and methods In this crossover study, 34 healthy adults, age 19-48 yrs, drank an ED containing 53.25 milligrams of caffeine, 284 mg of taurine, or an equal volume of control drink (CD) on two separate sessions, 7-10 days apart. Standard echocardiographic and speckle tracking imaging were performed before and 60 min after consumption of the study beverages.Results Compared to CD, ED caused a significant increase in tricuspid annular plane systolic excursion (p=0.04) and RV systolic wave velocity (p=0.01) with no effect on global longitudinal strain when compared to CD. LV systolic function was not altered, but mitral early diastolic velocity by tissue Doppler imaging was significantly higher (p=0.031), and early diastolic strain rate, as measured by speckle tracking echocardiography, was significantly lower (p=0.022).Conclusion Reduced caffeine and taurine content ED does not affect LV systolic function, but increases RV longitudinal contractility and improves LV early diastolic filling.
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Affiliation(s)
| | | | - Javidan Akhundova
- Cardiology Department, Ankara University School of Medicine, Ankara, Turkey
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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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Wolf M, Lucina SB, Silva VBC, Tuleski GLR, Sarraff AP, Komatsu EY, Sousa MG. Assessment of longitudinal systolic function using tissue motion annular displacement in dogs with degenerative mitral valve disease. J Vet Cardiol 2021; 38:44-58. [PMID: 34800922 DOI: 10.1016/j.jvc.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 10/10/2021] [Accepted: 10/13/2021] [Indexed: 01/27/2023]
Abstract
INTRODUCTION Although degenerative mitral valve disease (DMVD) is essentially a disorder of the valve, the progression of the disease leads to structural myocardial changes that may compromise left ventricular systolic function. Tissue motion annular displacement (TMAD) is a surrogate for longitudinal fiber function based on speckle tracking assessment of the movement of the mitral annulus toward the apex during systole. The aim of this study was to evaluate longitudinal systolic function with TMAD in dogs with DMVD. ANIMALS Ninety-four dogs with DMVD and 32 healthy dogs. METHODS Prospective cross-sectional observational study. Dogs with DMVD of various American College of Veterinary Internal Medicine classification stages and healthy control dogs underwent physical examination, electrocardiography, systolic blood pressure measurement, as well as a standard and speckle tracking echocardiography. Global longitudinal strain (GLS) and TMAD were used to assess longitudinal systolic function. RESULTS The global TMADmm and global TMAD% were higher in American College of Veterinary Internal Medicine B2 animals than in the stage CD. Global TMAD (mm/kg,mm/bodyweight3, mm/m2) were correlated with GLS and ejection fraction. Global TMAD (mm/kg,mm/m2,%) and GLS were influenced by sex. In addition, systolic blood pressure influenced GLS (P < 0.01; r = -0.23), global TMADmm/kg (P = 0.017; r = -0.21) and global TMADmm/m2 (P = 0.031; r = -0.19). Tissue motion annular displacement was fast to be performed and produced good repeatability in dogs with DMVD. CONCLUSIONS Global TMAD (mm,%), was reduced in DMVD dogs with clinical signs of heart failure compared with stage B2. Tissue motion annular displacement was shown to be a repeatable technique for evaluation of longitudinal systolic function in dogs with DMVD.
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Affiliation(s)
- M Wolf
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil.
| | - S B Lucina
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - V B C Silva
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - G L R Tuleski
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - A P Sarraff
- School of Life Sciences, Pontifical Catholic University of Paraná (PUC-PR), Rua Rockfeller 1311, Curitiba, 80230-130, Brazil
| | - E Y Komatsu
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
| | - M G Sousa
- Laboratory of Comparative Cardiology, Department of Veterinary Medicine, Federal University of Paraná (UFPR), Rua dos Funcionários 1540, Curitiba, 80035-050, Brazil
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Yang K, Wu S, Samuel OW, Zhang H, Ghista DN, Yang D, Wong KKL. A Hybrid Approach for Cardiac Blood Flow Vortex Ring Identification Based on Optical Flow and Lagrangian Averaged Vorticity Deviation. Front Physiol 2021; 12:698405. [PMID: 34539430 PMCID: PMC8440940 DOI: 10.3389/fphys.2021.698405] [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: 04/21/2021] [Accepted: 08/05/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: The measurement of cardiac blood flow vortex characteristics can help to facilitate the analysis of blood flow dynamics that regulates heart function. However, the complexity of cardiac flow along with other physical limitations makes it difficult to adequately identify the dominant vortices in a heart chamber, which play a significant role in regulating the heart function. Although the existing vortex quantification methods can achieve this goal, there are still some shortcomings: such as low precision, and ignoring the center of the vortex without the description of vortex deformation processes. To address these problems, an optical flow Lagrangian averaged vorticity deviation (Optical flow-LAVD) method is proposed. Methodology: We examined the flow within the right atrium (RA) of the participants’ hearts, by using a single set of scans pertaining to a slice at two-chamber short-axis orientation. Toward adequate extraction of the vortex ring characteristics, a novel approach driven by the Lagrangian averaged vorticity deviation (LAVD) was implemented and applied to characterize the trajectory integral associated with vorticity deviation and the spatial mean of rings, by using phase-contrast magnetic resonance imaging (PC-MRI) datasets as a case study. To interpolate the time frames between every larger discrete frame and minimize the error caused by constructing a continuous velocity field for the integral process of LAVD, we implemented the optical flow as an interpolator and introduced the backward warping as an intermediate frame synthesis basis, which is then used to generate higher quality continuous velocity fields. Results: Our analytical study results showed that the proposed Optical flow-LAVD method can accurately identify vortex ring and continuous velocity fields, based on optical flow information, for yielding high reconstruction outcomes. Compared with the linear interpolation and phased-based frame interpolation methods, our proposed algorithm can generate more accurate synthesized PC-MRI. Conclusion: This study has developed a novel Optical flow-LAVD model to accurately identify cardiac vortex rings, and minimize the associated errors caused by the construction of a continuous velocity field. Our paper presents a superior vortex characteristics detection method that may potentially aid the understanding of medical experts on the dynamics of blood flow within the heart.
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Affiliation(s)
- Ke Yang
- Key Laboratory of Metallurgical Equipment and Control Technology, Ministry of Education, Wuhan University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Mechanical Transmission and Manufacturing Engineering, Wuhan University of Science and Technology, Wuhan, China
| | - Shiqian Wu
- School of Information Science and Engineering, Wuhan University of Science and Technology, Wuhan, China
| | - Oluwarotimi W Samuel
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Hui Zhang
- Ultrasound Department, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dhanjoo N Ghista
- University 2020 Foundation, Inc., California City, CA, United States
| | - Di Yang
- Key Laboratory of Metallurgical Equipment and Control Technology, Ministry of Education, Wuhan University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Mechanical Transmission and Manufacturing Engineering, Wuhan University of Science and Technology, Wuhan, China
| | - Kelvin K L Wong
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Speckle Tracking Echocardiography Verified the Efficacy of Qianyangyuyin Granules in Alleviating Left Ventricular Remodeling in a Hypertensive Rat Model. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2021; 2021:5862361. [PMID: 34484396 PMCID: PMC8410389 DOI: 10.1155/2021/5862361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/14/2021] [Accepted: 08/06/2021] [Indexed: 01/19/2023]
Abstract
Background Global longitudinal strain (GLS) can be assessed by speckle tracking echocardiography (STE) to express the degree of cardiac fibrosis. Qianyangyuyin (QYYY) granules can effectively improve GLS in hypertensive patients. Using a hypertensive rat model, we carried out speckle tracking echocardiography to validate the effect of QYYY in diminishing LV remodeling. Methods We randomly divided 16 spontaneously hypertensive rats (SHRs) into SHR, SHR + valsartan (SHR + V), SHR + low-dose QYYY (SHR + QL), and SHR + high-dose QYYY (SHR + QH) groups, with four rats in each group. Another group of 4 Wistar-Kyoto (WKY) rats were selected into a normal control (WKY) group. At the 8th week, conventional echocardiographic parameters were measured by GE Vivid E95 ultrasound (12S probe, 10-12 MHz) and GLS by speckle tracking echocardiography with EchoPAC (version 203) software. HE and Masson's trichrome staining were performed to detect the cardiomyocyte width and collagen volume fraction after rat sacrifice. Collagen I, α-SMA, S100A4, TGF-β, Smad 3, MYH6, and MYH7 were further analyzed by Western blot. Results The absolute values of GLS significantly increased in the SHR + QH group compared to the SHR group, while the CVF and CW values significantly decreased. In addition, Collagen I, α-SMA, S100A4, TGF-β, Smad3, MYH7, and MYH7/MYH6 ratio remarkably reduced in the SHR + QH group. The value of GLS could be repetitively measured and positively correlated with the collagen volume fraction of the myocardium and the cardiomyocyte width of the left ventricular free wall. Conclusions GLS is a reliable indicator to evaluate the therapeutic effect on left ventricular remodeling in hypertension. QYYY granules can inhibit the development of cardiac fibrosis in the hypertensive rat model.
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Chaumont C, Suffee N, Gandjbakhch E, Balse E, Anselme F, Hatem SN. Epicardial origin of cardiac arrhythmias: clinical evidences and pathophysiology. Cardiovasc Res 2021; 118:1693-1702. [PMID: 34152392 PMCID: PMC9215195 DOI: 10.1093/cvr/cvab213] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/18/2021] [Indexed: 11/16/2022] Open
Abstract
Recent developments in imaging, mapping, and ablation techniques have shown that the epicardial region of the heart is a key player in the occurrence of ventricular arrhythmic events in several cardiac diseases, such as Brugada syndrome, arrhythmogenic cardiomyopathy, or dilated cardiomyopathy. At the atrial level as well, the epicardial region has emerged as an important determinant of the substrate of atrial fibrillation, pointing to common underlying pathophysiological mechanisms. Alteration in the gradient of repolarization between myocardial layers favouring the occurrence of re-entry circuits has largely been described. The fibro-fatty infiltration of the subepicardium is another shared substrate between ventricular and atrial arrhythmias. Recent data have emphasized the role of the epicardial reactivation in the formation of this arrhythmogenic substrate. There are new evidences supporting this structural remodelling process to be regulated by the recruitment of epicardial progenitor cells that can differentiate into adipocytes or fibroblasts under various stimuli. In addition, immune-inflammatory processes can also contribute to fibrosis of the subepicardial layer. A better understanding of such ‘electrical fragility’ of the epicardial area will open perspectives for novel biomarkers and therapeutic strategies. In this review article, a pathophysiological scheme of epicardial-driven arrhythmias will be proposed.
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Affiliation(s)
- Corentin Chaumont
- Cardiology Department, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, F76000, France
| | - Nadine Suffee
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Estelle Gandjbakhch
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Elise Balse
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
| | - Frédéric Anselme
- Cardiology Department, Rouen University Hospital, Rouen, France.,FHU REMOD-VHF, UNIROUEN, INSERM U1096, F76000, France
| | - Stéphane N Hatem
- INSERM UMRS1166, ICAN-Institute of CardioMetabolism and Nutrition, Sorbonne University, Institute of Cardiology, Pitié-Salpêtrière Hospital, Paris, France
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Clinical factors associated with reduced global longitudinal strain in subjects with normal left ventricular ejection fraction. Int J Cardiovasc Imaging 2021; 37:3225-3232. [PMID: 34061263 DOI: 10.1007/s10554-021-02304-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/29/2021] [Indexed: 10/24/2022]
Abstract
Characteristics of subjects with reduced GLS but no overt left ventricular dysfunction have been poorly characterized. We sought to find clinical factors associated with reduced GLS despite having normal LVEF. Subjects without documented cardiovascular disease who underwent measurement of GLS using 2D speckle-tracking echocardiography were retrospectively reviewed. All subjects had normal LVEF (≥ 55%). Because GLS is a negative value, we took the absolute value |x| for a simpler interpretation. Reduced GLS was defined as < 18%, and normal GLS was defined as ≥ 18%. Of 690 study subjects (mean age, 58 years and females, 51.2%), 208 (30.1%) had reduced GLS. Subjects with reduced GLS were more frequently male, and had more cardiovascular risk factors than those with normal GLS. In multivariable binary logistic regression analysis, male sex (odds ratio [OR] 3.02; 95% confidence interval [CI] 2.02‒4.50; P < 0.001), hypertension (OR 1.52; 95% CI 1.02‒2.28; P = 0.043) and cigarette smoking (OR 1.80; 95% CI 1.14‒2.85; P = 0.012) were independently associated with reduced GLS. The greater the number of these 3 risk factors (male sex, hypertension and cigarette smoking), the higher the probability of having reduced GLS (P < 0.001). In subjects without overt cardiovascular disease who had normal LVEF, a relevant proportion (30.1%) of subjects had reduced GLS. Male sex, hypertension and cigarette smoking were independently associated with reduced GLS. GLS measurement should be emphasized for subjects with these clinical characteristics.
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Clinical characteristics of early and late drug-eluting stent in-stent restenosis and mid-term prognosis after repeated percutaneous coronary intervention. Chin Med J (Engl) 2021; 133:2674-2681. [PMID: 33009028 PMCID: PMC7647500 DOI: 10.1097/cm9.0000000000001135] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The mechanism and characteristics of early and late drug-eluting stent in-stent restenosis (DES-ISR) have not been fully clarified. Whether there are different outcomes among those patients being irrespective of their repeated treatments remain a knowledge gap. Methods: A total of 250 patients who underwent initial stent implantation in our hospital, and then were readmitted to receive treatment for the reason of recurrent significant DES-ISR in 2016 were involved. The patients were categorized as early ISR (<12 months; E-ISR; n = 32) and late ISR (≥12 months; L-ISR; n = 218). Associations between patient characteristics and clinical performance, as well as clinical outcomes after a repeated percutaneous coronary intervention (PCI) were evaluated. Primary composite endpoint of major adverse cardiac events (MACEs) included cardiac death, non-fatal myocardial infarction (MI), or target lesion revascularization (TLR). Results: Most baseline characteristics are similar in both groups, except for the period of ISR, initial pre-procedure thrombolysis in myocardial infarction, and some serum biochemical indicators. The incidence of MACE (37.5% vs. 5.5%; P < 0.001) and TLR (37.5% vs. 5.0%; P < 0.001) is higher in the E-ISR group. After multivariate analysis, E-ISR (odds ratio [OR], 13.267; [95% CI 4.984–35.311]; P < 0.001) and left ventricular systolic dysfunction (odds ratio [OR], 6.317; [95% CI 1.145–34.843]; P = 0.034) are the independent predictors for MACE among DES-ISR patients in the mid-term follow-up of 12 months. Conclusions: Early ISR and left ventricular systolic dysfunction are associated with MACE during the mid-term follow-up period for DES-ISR patients. The results may benefit the risk stratification and secondary prevention for DES-ISR patients in clinical practice.
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Lee S, Lee M, Hor KN. The role of imaging in characterizing the cardiac natural history of Duchenne muscular dystrophy. Pediatr Pulmonol 2021; 56:766-781. [PMID: 33651923 DOI: 10.1002/ppul.25227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/19/2020] [Accepted: 11/12/2020] [Indexed: 01/11/2023]
Abstract
Duchene muscular dystrophy (DMD) is a rare but devastating disease resulting in progressive loss of ambulation, respiratory failure, DMD-associated cardiomyopathy (DMD-CM), and premature death. The use of corticosteroids and supportive respiratory care has improved outcomes, such that DMD-CM is now the leading cause of death. Historically, most programs have focused on skeletal myopathy with less attention to the cardiac phenotype. This omission is rather astonishing since patients with DMD possess an absolute genetic risk of developing cardiomyopathy. Unfortunately, heart failure signs and symptoms are vague due to skeletal muscle myopathy leading to limited ambulation. Traditional assessment of cardiac symptoms by the New York Heart Association American College of Cardiology/American Heart Association Staging (ACC/AHA) classification is of limited utility, even in advanced stages. Echocardiographic assessment can detect cardiac dysfunction late in the disease course, but this has proven to be a poor surrogate marker of early cardiovascular disease and an inadequate predictor of DMD-CM. Indeed, one explanation for the paucity of cardiac therapeutic trials for DMD-CM has been the lack of a suitable end-point. Improved outcomes require a better proactive treatment strategy; however, the barrier to treatment is the lack of a sensitive and specific tool to assess the efficacy of treatment. The use of cardiac imaging has evolved from echocardiography to cardiac magnetic resonance imaging to assess cardiac performance. The purpose of this article is to review the role of cardiac imaging in characterizing the cardiac natural history of DMD-CM, highlighting the prognostic implications and an outlook on how this field might evolve in the future.
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Affiliation(s)
- Simon Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Marc Lee
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
| | - Kan N Hor
- Department of Pediatrics, The Heart Center, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
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Weichert J, Weichert A. A "holistic" sonographic view on congenital heart disease: How automatic reconstruction using fetal intelligent navigation echocardiography eases unveiling of abnormal cardiac anatomy part II-Left heart anomalies. Echocardiography 2021; 38:777-789. [PMID: 33778977 DOI: 10.1111/echo.15037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 02/27/2021] [Accepted: 03/06/2021] [Indexed: 12/19/2022] Open
Abstract
Volume ultrasound has been shown to provide valid complementary information on fetal anatomy. Four-dimensional assessment (4D) of the fetal cardiovascular system using spatial-temporal image correlation (STIC) allows for detailed examination of a highly complex organ from the early second trimester onward. There is compelling evidence that this technique harbors quite a number of diagnostic opportunities, but manual navigation through STIC volume datasets is highly operator dependent. In fact, STIC is not incorporated yet into daily practice. Application of the novel fetal intelligent navigation echocardiography (FINE) considerably simplifies fetal cardiac volumetric examinations. This automatic technique applied on cardiac volume datasets reportedly has both high sensitivity and specificity for the detection of congenital heart defects (CHDs). Part I reviewed current data regarding detection rates of CHDs and illustrated the additional value of an automatic approach in delineating cardiac anatomy exemplified by congenital lesions of the right heart. In part II of this pictorial essay, we focused on left heart anomalies and aimed to tabulate recent findings on the quantification of normal and abnormal cardiac anatomy.
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Affiliation(s)
- Jan Weichert
- Division of Prenatal Medicine, Department of Gynecology and Obstetrics, University Hospital of Schleswig-Holstein, Luebeck, Germany.,Elbe Center of Prenatal Medicine and Human Genetics, Hamburg, Germany
| | - Alexander Weichert
- Department of Obstetrics, Charité-Universitätsmedizin Berlin - CCM, Berlin, Germany.,Prenatal Medicine Bergmannstrasse, Berlin, Germany
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Orszulak M, Filipecki A, Wrobel W, Berger-Kucza A, Orszulak W, Urbanczyk-Swic D, Kwasniewski W, Mizia-Stec K. Left ventricular global longitudinal strain in predicting CRT response: one more J-shaped curve in medicine. Heart Vessels 2021; 36:999-1008. [PMID: 33550426 PMCID: PMC8175293 DOI: 10.1007/s00380-021-01770-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 01/08/2021] [Indexed: 11/20/2022]
Abstract
The aim of the study was: (1) to verify the hypothesis that left ventricular global longitudinal strain (LVGLS) may be of additive prognostic value in prediction CRT response and (2) to obtain such a LVGLS value that in the best optimal way enables to characterize potential CRT responders. Forty-nine HF patients (age 66.5 ± 10 years, LVEF 24.9 ± 6.4%, LBBB 71.4%, 57.1% ischemic aetiology of HF) underwent CRT implantation. Transthoracic echocardiography was performed prior to and 15 ± 7 months after CRT implantation. Speckle-tracking echocardiography was performed to assess longitudinal left ventricular function as LVGLS. The response to CRT was defined as a ≥ 15% reduction in the left ventricular end-systolic volume (∆LVESV). Thirty-six (73.5%) patients responded to CRT. There was no linear correlation between baseline LVGLS and ∆LVESV (r = 0.09; p = 0.56). The patients were divided according to the percentile of baseline LVGLS: above 80th percentile; between 80 and 40th percentile; below 40th percentile. Two peripheral groups (above 80th and below 40th percentile) formed “peripheral LVGLS” and the middle group was called “mid-range LVGLS”. The absolute LVGLS cutoff values were − 6.07% (40th percentile) and − 8.67% (80th percentile). For the group of 20 (40.8%) “mid-range LVGLS” patients mean ΔLVESV was 33.3 ± 16.9% while for “peripheral LVGLS” ΔLVESV was 16.2 ± 18.8% (p < 0.001). Among non-ischemic HF etiology, all “mid-range LVGLS” patients (100%) responded positively to CRT (in “peripheral LVGLS”—55% responders; p = 0.015). Baseline LVGLS may have a potential prognostic value in prediction CRT response with relationship of inverted J-shaped pattern. “Mid-range LVGLS” values should help to select CRT responders, especially in non-ischemic HF etiology patients.
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Affiliation(s)
- Michal Orszulak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland.
| | - Artur Filipecki
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Wojciech Wrobel
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Adrianna Berger-Kucza
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Witold Orszulak
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Dagmara Urbanczyk-Swic
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Wojciech Kwasniewski
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
| | - Katarzyna Mizia-Stec
- First Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia, ul Ziolowa 45/47, 40-635, Katowice, Poland
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Assessment of Myocardial Fibrosis Using Two-Dimensional and Three-Dimensional Speckle Tracking Echocardiography in Dilated Cardiomyopathy With Advanced Heart Failure. J Card Fail 2021; 27:651-661. [PMID: 33454418 DOI: 10.1016/j.cardfail.2021.01.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/02/2021] [Accepted: 01/02/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND This study aimed to depict strain parameters derived from 2-dimensional (2D)- and 3-dimensional (3D) speckle tracking echocardiography and to explore which may best reflect myocardial fibrosis (MF) in dilated cardiomyopathy with advanced heart failure by comparing with histologic fibrosis. METHODS AND RESULTS We analyzed 75 patients with dilated cardiomyopathy with advanced heart failure who underwent echocardiographic examination before heart transplantation. Strain parameters derived from 2D- and 3D speckle tracking echocardiography were as follows: left ventricular global longitudinal strain (GLS), global circumferential strain (GCS), global radial strain (GRS) and tangential strain (TS). The degree of MF was quantified using Masson's staining in left ventricular myocardial samples obtained from all patients. Seventy-five patients were divided into 3 groups according to the tertiles of histologic MF (mild, moderate, and severe MF groups). Patients with severe MF had lower 3DGLS, 3DGRS, 3DTS, and 2DGLS than those with mild and moderate MF. MF strongly correlated with 3DGLS (r = 0.72, P < .001), weakly with 3DGRS (r = -0.39, P = .001), 3DGCS (r = 0.30, P = .009), 3DTS (r = 0.47, P < .001), and 2DGLS (r = 0.44, P < .001), but did not correlate with 2DGCS and 2DGRS. Receiver operating characteristic analysis revealed that the area under the curve of 3DGLS for detecting severe MF was significantly larger than that of other strain parameters (0.86 vs 0.59-0.70, P < .05 for all). The multivariate linear regression models using 3DGLS (R2 = 0.76; Akaike information criterion = 331) was found to be a more accurate indicator to predict MF than that with 3DTS (R2 = 0.65, Akaike information criterion = 354) and 2DGLS (R2 = 0.66, Akaike information criterion = 352). CONCLUSIONS Three-dimensional GLS may be an optimal surrogate marker for reflecting MF in patients with dilated cardiomyopathy with advanced heart failure.
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Morra S, Hossein A, Rabineau J, Gorlier D, Racape J, Migeotte PF, van de Borne P. Assessment of left ventricular twist by 3D ballistocardiography and seismocardiography compared with 2D STI echocardiography in a context of enhanced inotropism in healthy subjects. Sci Rep 2021; 11:683. [PMID: 33436841 PMCID: PMC7804966 DOI: 10.1038/s41598-020-79933-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 12/14/2020] [Indexed: 12/17/2022] Open
Abstract
Ballistocardiography (BCG) and Seismocardiography (SCG) assess the vibrations produced by cardiac contraction and blood flow, respectively, by means of micro-accelerometers and micro-gyroscopes. From the BCG and SCG signals, maximal velocities (VMax), integral of kinetic energy (iK), and maximal power (PMax) can be computed as scalar parameters, both in linear and rotational dimensions. Standard echocardiography and 2-dimensional speckle tracking imaging echocardiography were performed on 34 healthy volunteers who were infused with increasing doses of dobutamine (5-10-20 μg/kg/min). Linear VMax of BCG predicts the rates of left ventricular (LV) twisting and untwisting (both p < 0.0001). The linear PMax of both SCG and BCG and the linear iK of BCG are the best predictors of the LV ejection fraction (LVEF) (p < 0.0001). This result is further confirmed by mathematical models combining the metrics from SCG and BCG signals with heart rate, in which both linear PMax and iK strongly correlate with LVEF (R = 0.7, p < 0.0001). In this setting of enhanced inotropism, the linear VMax of BCG, rather than the VMax of SCG, is the metric which best explains the LV twist mechanics, in particular the rates of twisting and untwisting. PMax and iK metrics are strongly associated with the LVEF and account for 50% of the variance of the LVEF.
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Affiliation(s)
- Sofia Morra
- Department of Cardiovascular Diseases, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Amin Hossein
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium.
| | - Jérémy Rabineau
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Damien Gorlier
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Judith Racape
- Research Centre in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Pierre-François Migeotte
- Laboratory of Physic and Physiology (LPHYS), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philippe van de Borne
- Department of Cardiovascular Diseases, Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
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Pofi R, Giannetta E, Galea N, Francone M, Campolo F, Barbagallo F, Gianfrilli D, Venneri MA, Filardi T, Cristini C, Antonini G, Badagliacca R, Frati G, Lenzi A, Carbone I, Isidori AM. Diabetic Cardiomiopathy Progression is Triggered by miR122-5p and Involves Extracellular Matrix: A 5-Year Prospective Study. JACC Cardiovasc Imaging 2020; 14:1130-1142. [PMID: 33221242 DOI: 10.1016/j.jcmg.2020.10.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The purpose of this study was to follow the long-term progression of diabetic cardiomyopathy by combining cardiac magnetic resonance (CMR) and molecular analysis. BACKGROUND The evolution of diabetic cardiomyopathy to heart failure affects patients'morbidity and mortality. CMR is the gold standard to assess cardiac remodeling, but there is a lack of markers linked to the mechanism of diabetic cardiomyopathy progression. METHODS Five-year longitudinal study on patients with type 2 diabetes mellitus (T2DM) enrolled in the CECSID (Cardiovascular Effects of Chronic Sildenafil in Men With Type 2 Diabetes) trial compared with nondiabetic age-matched controls. CMR with tagging together with metabolic and molecular assessments were performed at baseline and 5-year follow-up. RESULTS A total of 79 men (age 64 ± 8 years) enrolled, comprising 59 men with T2DM compared with 20 nondiabetic age-matched controls. Longitudinal CMR with tagging showed an increase in ventricular mass (ΔLVMi = 13.47 ± 29.66 g/m2; p = 0.014) and a borderline increase in end-diastolic volume (ΔEDVi = 5.16 ± 14.71 ml/m2; p = 0.056) in men with T2DM. Cardiac strain worsened (Δσ = 1.52 ± 3.85%; p = 0.033) whereas torsion was unchanged (Δθ = 0.24 ± 4.04°; p = 0.737), revealing a loss of the adaptive equilibrium between strain and torsion. Contraction dynamics showed a decrease in the systolic time-to-peak (ΔTtP = -35.18 ± 28.81 ms; p < 0.001) and diastolic early recoil-rate (ΔRR = -20.01 ± 19.07 s-1; p < 0.001). The ejection fraction and metabolic parameters were unchanged. Circulating miR microarray revealed an up-regulation of miR122-5p. Network analysis predicted the matrix metalloproteinases (MMPs) MMP-16 and MMP-2 and their regulator (tissue inhibitors of metalloproteinases) as targets. In db/db mice we demonstrated that miR122-5p expression is associated with diabetic cardiomyopathy, that in the diabetic heart is overexpressed, and that, in vitro, it regulates MMP-2. Finally, we demonstrated that miR122-5p overexpression affects the extracellular matrix through MMP-2 modulation. CONCLUSIONS Within 5 years of diabetic cardiomyopathy onset, increasing cardiac hypertrophy is associated with progressive impairment in strain, depletion of the compensatory role of torsion, and changes in viscoelastic contraction dynamics. These changes are independent of glycemic control and paralleled by the up-regulation of specific microRNAs targeting the extracellular matrix. (Cardiovascular Effects of Chronic Sildenafil in Men With Type 2 Diabetes [CECSID]; NCT00692237).
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Affiliation(s)
- Riccardo Pofi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Elisa Giannetta
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Nicola Galea
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Marco Francone
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Federica Campolo
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Federica Barbagallo
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Daniele Gianfrilli
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Mary Anna Venneri
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Tiziana Filardi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Cristiano Cristini
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Gabriele Antonini
- Department of Obstetrical and Gynaecological Sciences and Urological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Roberto Badagliacca
- Department of Cardiovascular and Respiratory Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Giacomo Frati
- Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Istituti di Ricovero e Cura a Carattere Scientifico (IRCCS) NEUROMED, Pozzilli, Italy
| | - Andrea Lenzi
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy
| | - Iacopo Carbone
- Department of Radiological, Oncological and Pathological Sciences, "Sapienza" University of Rome, Rome, Italy
| | - Andrea M Isidori
- Department of Experimental Medicine, "Sapienza" University of Rome, Rome, Italy.
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49
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Siddiqui S, Alsaied T, Henson SE, Gandhi J, Patel P, Khoury P, Villa C, Ryan TD, Wittekind SG, Lang SM, Taylor MD. Left Ventricular Magnetic Resonance Imaging Strain Predicts the Onset of Duchenne Muscular Dystrophy-Associated Cardiomyopathy. Circ Cardiovasc Imaging 2020; 13:e011526. [PMID: 33190531 DOI: 10.1161/circimaging.120.011526] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Early detection of left ventricular (LV) dysfunction before the onset of overt Duchenne muscular dystrophy-associated cardiomyopathy (DMDAC) may direct clinical management to slow onset of dysfunction. We aimed to assess whether LV strain will predict those who develop DMDAC. METHODS We performed a single center retrospective case control study of patients with Duchenne muscular dystrophy who underwent serial cardiac magnetic resonance between 2006 and 2019. Patients with Duchenne muscular dystrophy with an LV ejection fraction ≥55% on ≥1 cardiac magnetic resonance were identified and grouped into age-matched +DMDAC and -DMDAC. Within 3 years, +DMDAC had a subsequent cardiac magnetic resonance with a decline in LV ejection fraction ≥10% and absolute LV ejection fraction ≤50%. -DMDAC maintained an LV ejection fraction ≥55% on serial cardiac magnetic resonances. Two-dimensional and 3-dimensional global radial strain, global circumferential strain (GCS), and global longitudinal strain were measured using tissue tracking software and their ability to predict DMDAC onset was assessed. Multivariable analysis adjusted for late gadolinium enhancement. RESULTS Thirty +DMDAC and 30 age-matched -DMDAC patients were included with a total of 164 studies analyzed. Before DMDAC onset, 2-dimensional global radial strain and GCS were significantly worse in +DMDAC compared with -DMDAC (25.1±6.0 versus 29.0±6.3, P=0.011; -15.4%±2.4 versus -17.3%±2.6, P=0.003). Three-dimensional GCS and global radial strain had similar findings. Among strain measures, 3-dimensional GCS had the highest area under the curve to predict DMDAC in our cohort. These findings persisted after adjusting for the presence of late gadolinium enhancement. CONCLUSIONS Reduced global radial strain and GCS may predict those at risk for developing DMDAC before onset of LV dysfunction and its clinical utility warrants further exploration.
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Affiliation(s)
- Saira Siddiqui
- The Heart Institute (S.S., T.A., S.E.H., C.V., T.D.R., S.W., S.M.L., M.D.T.), Cincinnati Children's Hospital Medical Center, OH
| | - Tarek Alsaied
- The Heart Institute (S.S., T.A., S.E.H., C.V., T.D.R., S.W., S.M.L., M.D.T.), Cincinnati Children's Hospital Medical Center, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, OH (T.A., C.V., T.D.R., S.G.W., S.M.L., M.D.T.)
| | - Sarah E Henson
- The Heart Institute (S.S., T.A., S.E.H., C.V., T.D.R., S.W., S.M.L., M.D.T.), Cincinnati Children's Hospital Medical Center, OH
| | | | | | - Philip Khoury
- Heart Institute Research Core (P.K.), Cincinnati Children's Hospital Medical Center, OH
| | - Chet Villa
- The Heart Institute (S.S., T.A., S.E.H., C.V., T.D.R., S.W., S.M.L., M.D.T.), Cincinnati Children's Hospital Medical Center, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, OH (T.A., C.V., T.D.R., S.G.W., S.M.L., M.D.T.)
| | - Thomas D Ryan
- The Heart Institute (S.S., T.A., S.E.H., C.V., T.D.R., S.W., S.M.L., M.D.T.), Cincinnati Children's Hospital Medical Center, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, OH (T.A., C.V., T.D.R., S.G.W., S.M.L., M.D.T.)
| | - Samuel G Wittekind
- Department of Pediatrics, University of Cincinnati College of Medicine, OH (T.A., C.V., T.D.R., S.G.W., S.M.L., M.D.T.)
| | - Sean M Lang
- The Heart Institute (S.S., T.A., S.E.H., C.V., T.D.R., S.W., S.M.L., M.D.T.), Cincinnati Children's Hospital Medical Center, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, OH (T.A., C.V., T.D.R., S.G.W., S.M.L., M.D.T.)
| | - Michael D Taylor
- The Heart Institute (S.S., T.A., S.E.H., C.V., T.D.R., S.W., S.M.L., M.D.T.), Cincinnati Children's Hospital Medical Center, OH.,Department of Pediatrics, University of Cincinnati College of Medicine, OH (T.A., C.V., T.D.R., S.G.W., S.M.L., M.D.T.)
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50
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Barssoum K, Altibi AM, Rai D, Kumar A, Kharsa A, Chowdhury M, Thakkar S, Shahid S, Abdelazeem M, Abuzaid AS, Baibhav B, Parikh V, Feitell SC, Balmer-Swain M, Rao M, Amsallem M, Nanda NC. Speckle tracking echocardiography can predict subclinical myocardial involvement in patients with sarcoidosis: A meta-analysis. Echocardiography 2020; 37:2061-2070. [PMID: 33058271 DOI: 10.1111/echo.14886] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/09/2020] [Accepted: 09/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND This meta-analysis aims to evaluate the utility of speckle tracking echocardiography (STE) as a tool to evaluate for cardiac sarcoidosis (CS) early in its course. Electrocardiography and echocardiography have limited sensitivity in this role, while advanced imaging modalities such as cardiac magnetic resonance (CMR) and 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) are limited by cost and availability. METHODS We compiled English language articles that reported left ventricular global longitudinal strain (LVGLS) or global circumferential strain (GCS) in patients with confirmed extra-cardiac sarcoidosis versus healthy controls. Studies that exclusively included patients with probable or definite CS were excluded. Continuous data were pooled as a standard mean difference (SMD), comparing sarcoidosis group with healthy controls. A random-effect model was adopted in all analyses. Heterogeneity was assessed using Q and I2 statistics. RESULTS Nine studies were included in our final analysis with an aggregate of 967 patients. LVGLS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD -3.98, 95% confidence interval (CI): -5.32, -2.64, P < .001, also was significantly lower in patients who suffered major cardiac events (MCE), -3.89, 95% CI -6.14, -1.64, P < .001. GCS was significantly lower in the extra-cardiac sarcoidosis group as compared with controls, SMD: -3.33, 95% CI -4.71, -1.95, P < .001. CONCLUSION LVGLS and GCS were significantly lower in extra-cardiac sarcoidosis patients despite not exhibiting any cardiac symptoms. LVGLS correlates with MCEs in CS. Further studies are required to investigate the role of STE in the early screening of CS.
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Affiliation(s)
- Kirolos Barssoum
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | - Ahmed M Altibi
- Department of Internal Medicine, Henry Ford Allegiance Health, Jackson, MI, USA
| | - Devesh Rai
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Ashish Kumar
- Department of Critical Care, St. John's Medical College, Bangalore, India
| | - Adnan Kharsa
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - Medhat Chowdhury
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | | | - Sara Shahid
- Department of Internal Medicine, Unity Hospital, Rochester Regional Health System, Rochester, NY, USA
| | | | - Ahmed Sami Abuzaid
- Department of Cardiology, Alaska and Vascular Institute LLC, Anchorage, AK, USA
| | - Bipul Baibhav
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Vishal Parikh
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Scott C Feitell
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Mallory Balmer-Swain
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Mohan Rao
- Department of Cardiology, Sands Constellation Heart Institute, Rochester Regional Health, Rochester, NY, USA
| | - Myriam Amsallem
- Department of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Navin C Nanda
- Division of Cardiovascular Disease, University of Alabama, Birmingham, AL, USA
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