1
|
Bashir Z, Chen EW, Tori K, Ghosalkar D, Aurigemma GP, Dickey JB, Haines P. Insight into different phenotypic presentations of heart failure with preserved ejection fraction. Prog Cardiovasc Dis 2023; 79:80-88. [PMID: 37442358 DOI: 10.1016/j.pcad.2023.07.003] [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: 07/10/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
Heart failure (HF) with preserved ejection fraction (HFpEF) accounts for half of all HF diagnoses, and its prevalence is increasing at an alarming rate. Lately, it has been recognized as a clinical syndrome due to diverse underlying etiology and pathophysiological mechanisms. The classic echocardiographic features of HFpEF have been well described as preserved ejection fraction (≥50%), left ventricular hypertrophy, and left atrial enlargement. However, echocardiography can play a key role in identifying the principal underlying mechanism responsible for HFpEF in the individual patient. The recognition of different phenotypic presentations of HFpEF (infiltrative, metabolic, genetic, and inflammatory) can assist the clinician in tailoring the appropriate management, and offer prognostic information. The goal of this review is to highlight several key phenotypes of HFpEF and illustrate the classic clinical scenario and echocardiographic features of each phenotype with real patient cases.
Collapse
Affiliation(s)
- Zubair Bashir
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Edward W Chen
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | | | - Dhairyasheel Ghosalkar
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University Hospital, NY, USA
| | - Gerard P Aurigemma
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - John B Dickey
- Division of Cardiovascular Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Philip Haines
- Department of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI, USA
| |
Collapse
|
2
|
Excimer laser coronary angioplasty versus manual aspiration thrombectomy in patients with ST-segment elevation myocardial infarction: analyzed by nuclear scintigraphy. Int J Cardiovasc Imaging 2022; 39:831-842. [PMID: 36508056 DOI: 10.1007/s10554-022-02771-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
Clinical outcomes concerning the efficacy of excimer laser coronary angioplasty (ELCA) in real-world cases of acute myocardial infarction (MI) are limited. We evaluated and compared the impact of ELCA with manual aspiration thrombectomy on myocardial salvage and left ventricular (LV) systolic/diastolic function in patients with ST-segment elevation MI (STEMI) using nuclear scintigraphy. We enrolled 143 consecutive patients with STEMI treated with ELCA (63 patients) or manual aspiration thrombectomy (80 patients) between September 2016 and December 2020 in a single-center hospital. We evaluated the peak creatine kinase (CK)/ creatine kinase-myocardial band (CK-MB) levels and performed single-photon emission computed tomography (SPECT) analyses with Quantitative Gated SPECT and Quantitative Perfusion SPECT (Auto QUANT 7.2) at 3-10 days using 123I-BMIPP and 3 months following percutaneous coronary intervention using 99mTc-tetrofosmin to evaluate myocardial salvage and LV systolic/diastolic function. No significant difference was observed in the patient and periprocedural characteristics. Peak CK-MB level was significantly different between the groups (ELCA group, 190.0 [70.5-342.0] IU/L vs. aspiration group, 256.5 [157.0-354.8] IU/L, p = 0.047). Although no significant difference was observed in myocardial salvage, significant improvement in the LV ejection fraction (14.1 [6.2-19.8]% vs. 9.5 [3.9-15.3]%, respectively, p = 0.018) and peak emptying rate (-0.54 [-1.02- (-0.27)] mL/s vs. -0.38 [-0.76- (-0.05)] mL/s, respectively, p = 0.017) were detected. ELCA could suppress the myocardial deviation enzymes and potentially improve systolic function compared to manual aspiration thrombectomy in patients with STEMI.
Collapse
|
3
|
Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | | | | |
Collapse
|
4
|
John JE, Claggett B, Skali H, Solomon SD, Cunningham JW, Matsushita K, Konety SH, Kitzman DW, Mosley TH, Clark D, Chang PP, Shah AM. Coronary Artery Disease and Heart Failure With Preserved Ejection Fraction: The ARIC Study. J Am Heart Assoc 2022; 11:e021660. [PMID: 36000416 PMCID: PMC9496411 DOI: 10.1161/jaha.121.021660] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
Background Whether coronary artery disease (CAD) is a significant risk factor for heart failure (HF) with preserved ejection fraction (HFpEF) is unclear. Methods and Results Among 9902 participants in the ARIC (Atherosclerosis Risk in Communities) study, we assessed the association of incident CAD with subsequent incident HFpEF (left ventricular ejection fraction [≥50%]) and HF with reduced ejection fraction (HFrEF; left ventricular ejection fraction <50%) using survival models with time-updated variables. We also assessed the extent to which echocardiographic correlates of prevalent CAD account for the relationship between CAD and incident HFpEF. Over 13-year follow-up, incident CAD developed in 892 participants and 178 subsequently developed HF (86 HFrEF, 71 HFpEF). Incident HFrEF and HFpEF risk were both greatest early after the CAD event. At >1 year post-CAD event, adjusted incidence of HFrEF and HFpEF were similar (7.2 [95% CI, 5.2-10.0] and 6.7 [4.8-9.2] per 1000 person-years, respectively) and CAD remained predictive of both (HFrEF: hazard ratio, 2.76 [95% CI, 1.99-3.84]; HFpEF: 1.85 [1.35-2.54]) after adjusting for demographics and common comorbidities. Among 4779 HF-free participants at Visit 5 (2011-2013), the 490 with prevalent CAD had lower left ventricular ejection fraction and higher left ventricular mass index, E/e', and left atrial volume index (all P<0.01). The association of prevalent CAD with incident HFpEF post-Visit 5 was not significant after adjusting for echocardiographic measures, with the greatest attenuation observed for left ventricular diastolic function. Conclusions CAD is a significant risk factor for incident HFpEF after adjustment for demographics and common comorbidities. This relationship is partially accounted for by echocardiographic alterations, particularly left ventricular diastolic function.
Collapse
Affiliation(s)
- Jenine E. John
- Noninvasive Cardiovascular Imaging ProgramDepartments of Medicine and RadiologyBrigham and Women’s HospitalBostonMA
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| | - Brian Claggett
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| | - Hicham Skali
- Noninvasive Cardiovascular Imaging ProgramDepartments of Medicine and RadiologyBrigham and Women’s HospitalBostonMA
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| | | | - Jonathan W. Cunningham
- Noninvasive Cardiovascular Imaging ProgramDepartments of Medicine and RadiologyBrigham and Women’s HospitalBostonMA
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| | | | - Suma H. Konety
- Division of Cardiovascular MedicineUniversity of MinnesotaMinneapolisMN
| | - Dalane W. Kitzman
- Cardiovascular Medicine SectionWake Forest School of MedicineWinston‐SalemNC
| | - Thomas H. Mosley
- Department of MedicineUniversity of Mississippi Medical CenterJacksonMS
| | - Donald Clark
- Division of CardiologyUniversity of Mississippi Medical CenterJacksonMS
| | - Patricia P. Chang
- Division of CardiologyUniversity of North Carolina at Chapel HillChapel HillNC
| | - Amil M. Shah
- Cardiovascular DivisionBrigham and Women’s HospitalBostonMA
| |
Collapse
|
5
|
Impact of Pulse Wave Velocity and Parameters Reflecting Android Type Fat Distribution on Left Ventricular Diastolic Dysfunction in Patients with Chronic Coronary Syndromes. J Clin Med 2020; 9:jcm9123924. [PMID: 33287316 PMCID: PMC7761650 DOI: 10.3390/jcm9123924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 11/27/2020] [Accepted: 12/01/2020] [Indexed: 01/12/2023] Open
Abstract
Background: Left ventricular diastolic dysfunction (LVDD) is caused by a decreased left ventricle relaxation and is associated with an increased risk of symptomatic heart failure (HF) and excessive mortality. Aim: To evaluate the frequency and factors related to LVDD in the population with chronic coronary syndromes (CCS). Methods: 200 patients (mean age 63.18 ± 8.12 years, 75.5% male) with CCS were included. LVDD was diagnosed based on the recent echocardiography guidelines. Results: LVDD was diagnosed in 38.5% of CCS population. From the studied factors, after adjustment for age, sex, and N-terminal pro-brain natriuretic peptide (NT-proBNP), LVDD associated positively with android/gynoid (A/G) fat mass ratio, left ventricular mass index (LVMI), and negatively with Z-score and left ventricular ejection fraction (LVEF). In stepwise backward logistic regression analysis, the strongest factors associated with LVDD were pulse wave velocity value, handgrip strength and waist to hip ratio (WHR). Conclusions: LVDD is common among CCS patients and it is associated with parameters reflecting android type fat distribution regardless of NT-proBNP and high-sensitivity troponin T concentrations. Deterioration in diastolic dysfunction is linked with increased aortic stiffness independently of age and sex. Further studies evaluating the effects of increasing physical fitness and lowering abdominal fat accumulations on LVDD in CCS patients should be considered.
Collapse
|
6
|
Santos-Gallego CG, Requena-Ibanez JA, San Antonio R, Garcia-Ropero A, Ishikawa K, Watanabe S, Picatoste B, Vargas-Delgado AP, Flores-Umanzor EJ, Sanz J, Fuster V, Badimon JJ. Empagliflozin Ameliorates Diastolic Dysfunction and Left Ventricular Fibrosis/Stiffness in Nondiabetic Heart Failure: A Multimodality Study. JACC Cardiovasc Imaging 2020; 14:393-407. [PMID: 33129742 DOI: 10.1016/j.jcmg.2020.07.042] [Citation(s) in RCA: 122] [Impact Index Per Article: 30.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Revised: 07/08/2020] [Accepted: 07/31/2020] [Indexed: 01/09/2023]
Abstract
OBJECTIVES The purpose of this study was to investigate the effect of empagliflozin on diastolic function in a nondiabetic heart failure with reduced ejection fraction (HFrEF) scenario and on the pathways causing diastolic dysfunction. BACKGROUND This group demonstrated that empagliflozin ameliorates adverse cardiac remodeling, enhances myocardial energetics, and improves left ventricular systolic function in a nondiabetic porcine model of HF. Whether empagliflozin also improves diastolic function remains unknown. Hypothetically, empagliflozin would improve diastolic function in HF mediated both by a reduction in interstitial myocardial fibrosis and an improvement in cardiomyocyte stiffness (titin phosphorylation). METHODS HF was induced in nondiabetic pigs by 2-h balloon occlusion of proximal left anterior descending artery. Animals were randomized to empagliflozin or placebo for 2 months. Cardiac function was evaluated with cardiac magnetic resonance (CMR), 3-dimensional echocardiography, and invasive hemodynamics. In vitro relaxation of cardiomyocytes was studied in primary culture. Myocardial samples were obtained for histological and molecular evaluation. Myocardial metabolite consumption was analyzed by simultaneous blood sampling from coronary artery and coronary sinus. RESULTS Despite similar initial ischemic myocardial injury, the empagliflozin group showed significantly improved diastolic function at 2 months, assessed by conventional echocardiography (higher e' and color M-mode propagation velocity, lower E/e' ratio, myocardial performance Tei index, isovolumic relaxation time, and left atrial size), echocardiography-derived strain imaging (strain imaging diastolic index, strain rate at isovolumic relaxation time and during early diastole, and untwisting), and CMR (higher peak filling rate, larger first filling volume). Invasive hemodynamics confirmed improved diastolic function with empagliflozin (better peak LV pressure rate of decay (-dP/dt), shorter Tau, lower end-diastolic pressure-volume relationship (EDPVR), and reduced filling pressures). Empagliflozin reduced interstitial myocardial fibrosis at the imaging, histological and molecular level. Empagliflozin improved nitric oxide signaling (endothelial nitric oxide synthetase [eNOS] activity, nitric oxide [NO] availability, cyclic guanosine monophosphate (cGMP) content, protein kinase G [PKG] signaling) and enhanced titin phosphorylation (which is responsible for cardiomyocyte stiffness). Indeed, isolated cardiomyocytes exhibited better relaxation in empagliflozin-treated animals. Myocardial consumption of glucose and ketone bodies negatively and positively correlated with diastolic function, respectively. CONCLUSIONS Empagliflozin ameliorates diastolic function in a nondiabetic HF porcine model, mitigates histological and molecular remodeling, and reduces both left ventricle and cardiomyocyte stiffness.
Collapse
Affiliation(s)
| | | | - Rodolfo San Antonio
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Alvaro Garcia-Ropero
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Kiyotake Ishikawa
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Shin Watanabe
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Belen Picatoste
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | | | | | - Javier Sanz
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Valentin Fuster
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA
| | - Juan J Badimon
- Department of Cardiology, Mount Sinai School of Medicine, New York, New York, USA.
| |
Collapse
|
7
|
Beladan CC, Botezatu S, Popescu BA. Reversible left ventricular diastolic dysfunction—Overview and clinical implications. Echocardiography 2020; 37:1957-1966. [DOI: 10.1111/echo.14838] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/05/2020] [Accepted: 08/05/2020] [Indexed: 12/15/2022] Open
Affiliation(s)
- Carmen C. Beladan
- Euroecolab Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Simona Botezatu
- Euroecolab Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| | - Bogdan A. Popescu
- Euroecolab Emergency Institute for Cardiovascular Diseases “Prof. Dr. C. C. Iliescu” University of Medicine and Pharmacy “Carol Davila” Bucharest Romania
| |
Collapse
|
8
|
Cadeddu Dessalvi C, Deidda M, Farci S, Longu G, Mercuro G. Early ischemia identification employing 2D speckle tracking selective layers analysis during dobutamine stress echocardiography. Echocardiography 2019; 36:2202-2208. [PMID: 31742770 DOI: 10.1111/echo.14535] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 08/30/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Two-dimensional (2D) strain derived from speckle tracking proved to be feasible and accurate in the quantitative evaluation of myocardial ischemia during stress echocardiography. We compared the accuracy in detecting myocardial ischemia of the transmural segmental analysis with an endocardial specific evaluation in 20 patients undergoing dobutamine stress echocardiography (DSE) and coronary angiography. METHODS Peak systolic global strain (G-ε) and at the subendocardial level (Endo-ε) were measured off-line at rest, a low dose, and peak stress; then, we compared the results with wall-motion analysis and significant coronary artery disease (CAD > 70% diameter stenosis). Endocardial strain variation from basal to low and peak dose was computed both for global or subendocardial analysis. The utilization of the ROC curve allowed us to derive optimal cutoffs, sensibility and specificity for ischemic segments. RESULTS The subendocardial analysis at high dose showed to be able to increase significantly the accuracy of the test to detect the ischemic segments (sens 90.2% vs 85.4%; spec 93.1% vs 92.2%). Moreover, at the low dose, the subendocardial analysis showed to be able to increase significantly, mostly the specificity of the test (sens 69.6% vs 68.3%; spec 92.2% vs 86.2%). Notably, the strain subendocardial analysis at low dose showed to reach a high specificity, similar to the peak dose transmural analysis. CONCLUSIONS Measurement of subendocardial strain during DSE is feasible and can increase the accuracy of the test. Moreover, the subendocardial strain during DSE can reach a high specificity, even limiting the test at a low dose infusion.
Collapse
Affiliation(s)
| | - Martino Deidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Salvatore Farci
- Azienda Ospedaliero-Universitaria di Cagliari - Clinica Cardiologica, Monserrato-Cagliari, Italy
| | - Giorgio Longu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Giuseppe Mercuro
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| |
Collapse
|
9
|
Walsh JL, AlJaroudi WA, Lamaa N, Abou Hassan OK, Jalkh K, Elhajj IH, Sakr G, Isma'eel H. A speckle-tracking strain-based artificial neural network model to differentiate cardiomyopathy type. SCAND CARDIOVASC J 2019; 54:92-99. [PMID: 31623474 DOI: 10.1080/14017431.2019.1678764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Objectives. In heart failure, invasive angiography is often employed to differentiate ischaemic from non-ischaemic cardiomyopathy. We aim to examine the predictive value of echocardiographic strain features alone and in combination with other features to differentiate ischaemic from non-ischaemic cardiomyopathy, using artificial neural network (ANN) and logistic regression modelling. Design. We retrospectively identified 204 consecutive patients with an ejection fraction <50% and a diagnostic angiogram. Patients were categorized as either ischaemic (n = 146) or non-ischaemic cardiomyopathy (n = 58). For each patient, left ventricular strain parameters were obtained. Additionally, regional wall motion abnormality, 13 electrocardiographic (ECG) features and six demographic features were retrieved for analysis. The entire cohort was randomly divided into a derivation and a validation cohort. Using the parameters retrieved, logistic regression and ANN models were developed in the derivation cohort to differentiate ischaemic from non-ischaemic cardiomyopathy, the models were then tested in the validation cohort. Results. A final strain-based ANN model, full feature ANN model and full feature logistic regression model were developed and validated, F1 scores were 0.82, 0.79 and 0.63, respectively. Conclusions. Both ANN models were more accurate at predicting cardiomyopathy type than the logistic regression model. The strain-based ANN model should be validated in other cohorts. This model or similar models could be used to aid the diagnosis of underlying heart failure aetiology in the form of the online calculator (https://cimti.usj.edu.lb/strain/index.html) or built into echocardiogram software.
Collapse
Affiliation(s)
- Jason Leo Walsh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Wael A AlJaroudi
- Division of Cardiovascular Medicine, Clemenceau Medical Center, Beirut, Lebanon
| | - Nader Lamaa
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ossama K Abou Hassan
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Khalil Jalkh
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Imad H Elhajj
- Department of Electrical and Computer Engineering, American University of Beirut, Beirut, Lebanon
| | - George Sakr
- Computer Engineering Department, St Joseph University of Beirut, Beirut, Lebanon
| | - Hussain Isma'eel
- Vascular Medicine Program, Division of Cardiology, American University of Beirut Medical Center, Beirut, Lebanon
| |
Collapse
|
10
|
Trivedi SJ, Altman M, Stanton T, Thomas L. Echocardiographic Strain in Clinical Practice. Heart Lung Circ 2019; 28:1320-1330. [DOI: 10.1016/j.hlc.2019.03.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 03/17/2019] [Accepted: 03/22/2019] [Indexed: 01/07/2023]
|
11
|
Fatima T, Hashmi S, Iqbal A, Siddiqui AJ, Sami SA, Basir N, Bokhari SS, Sharif H, Musharraf SG. Untargeted metabolomic analysis of coronary artery disease patients with diastolic dysfunction show disturbed oxidative pathway. Metabolomics 2019; 15:98. [PMID: 31236740 DOI: 10.1007/s11306-019-1559-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Accepted: 06/17/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Left ventricular diastolic dysfunction (LVDD) is common in patients with coronary artery disease (CAD) with prevalence estimates of 34% and constitutes a predictor of all-cause mortality. Although diastolic dysfunction is induced by myocardial ischemia and has been shown to alter the clinical course, the role of coronary artery disease in the diastolic dysfunction and its progression into heart failure has not been completely elucidated. OBJECTIVE The present study was conducted to identify possible metabolites in coronary artery disease patients that are differentially regulated in patients with diastolic dysfunction. METHODS The serum of CAD (n = 75) patients and young healthy volunteers (n = 43) were analysed by using gas chromatography mass spectrometry (GC-MS) technique. Pre-processing of data results in 1547 features; among them 1064 features were annotated using NIST library. RESULTS AND CONCLUSION Fifteen metabolites were found to be statistically different between cases and control. Variation in metabolites were identified and correlated with several clinically important echocardiography parameters i.e. LVDD grades, ejection fraction (EF) and E/e' values. The results suggested that metabolic products of fatty acid oxidation and glucose oxidation pathways such as oleic acid, stearic acid, palmitic acid, linoleic acid, galactose, pyruvic and lactic acids are predominantly up regulated in patients with coronary artery disease and severity of diastolic dysfunction appears to be linked to increase in fatty acid oxidation and inflammation. The metabolic fingerprints of these patients give us an insight into the pathophysiological mechanism of diastolic dysfunction in coronary artery disease patients although it did not identify validated novel markers.
Collapse
Affiliation(s)
- Tamkeen Fatima
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Satwat Hashmi
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Ayesha Iqbal
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Amna Jabbar Siddiqui
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan
| | - Shahid A Sami
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Najeeb Basir
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Hasanat Sharif
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Syed Ghulam Musharraf
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
- H.E.J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, 75270, Pakistan.
| |
Collapse
|
12
|
Stein PD. Implications of Faint Heart Sounds After Acute Myocardial Infarction. Am J Cardiol 2019; 123:1555-1556. [PMID: 30797560 DOI: 10.1016/j.amjcard.2019.01.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/15/2019] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Paul D Stein
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan.
| |
Collapse
|
13
|
Shin SH, Jang JH, Baek YS, Kwon SW, Park SD, Woo SI, Kim DH, Kwan J. Relation of blood pressure variability to left ventricular function and arterial stiffness in hypertensive patients. Singapore Med J 2019; 60:427-431. [PMID: 30854570 DOI: 10.11622/smedj.2019030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Variability of blood pressure (BP) has been reported to be related to worse cardiovascular outcomes. We examined the impact of daytime systolic BP variability on left ventricular (LV) function and arterial stiffness in hypertensive patients. METHODS Ambulatory BP monitoring (ABPM) and echocardiography were performed in 116 hypertensive patients. We assessed BP variability as standard deviations of daytime systolic BP on 24-hour ABPM. Conventional echocardiographic parameters, area strain and three-dimensional diastolic index (3D-DI) using 3D speckle tracking were measured. Arterial stiffness was evaluated by acquiring pulse wave velocity (PWV) and augmentation index. RESULTS Patients with higher BP variability showed significantly increased left ventricular mass index (LVMI) and late mitral inflow velocity, as well as decreased E/A (early mitral inflow velocity/late mitral inflow velocity) ratio, area strain and 3D-DI than those with lower BP variability (LVMI: p = 0.02; A velocity: p < 0.001; E/A ratio: p < 0.001; area strain: p = 0.02; 3D-DI: p = 0.04). In addition, increased BP variability was associated with higher PWV and augmentation index (p < 0.001). Even among patients whose BP was well controlled, BP variability was related to LV mass, diastolic dysfunction and arterial stiffness. CONCLUSION Increased BP variability was associated with LV mass and dysfunction, as well as arterial stiffness, suggesting that BP variability may be an important determinant of target organ damage in hypertensive patients.
Collapse
Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Ji-Hoon Jang
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Yong-Soo Baek
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Sung-Woo Kwon
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Sang-Don Park
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Seong-Ill Woo
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Dae-Hyeok Kim
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| | - Jun Kwan
- Division of Cardiology, Inha University College of Medicine, Incheon, South Korea
| |
Collapse
|
14
|
|
15
|
Lairez O, Agostini D. One year of nuclear cardiology in Europe. Ann Nucl Med 2016; 30:594-599. [PMID: 27637179 PMCID: PMC5272875 DOI: 10.1007/s12149-016-1126-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/08/2016] [Indexed: 11/26/2022]
Affiliation(s)
- Olivier Lairez
- Department of Nuclear Medicine, Rangueil University Hospital, Toulouse, France
- Cardiac Imaging Center, Toulouse University Hospital, Toulouse, France
| | - Denis Agostini
- Department of Nuclear Medicine, Caen University Hospital, Caen, France.
- Normandy University, EA 4650, Caen, France.
| |
Collapse
|
16
|
Oki T, Miyoshi H, Oishi Y, Mizuguchi Y, Iuchi A, Yamada H, Nakatani S. Challenges for 'diastology': contributions from Japanese researchers. J Echocardiogr 2016; 14:93-103. [PMID: 27539160 DOI: 10.1007/s12574-016-0307-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 01/08/2023]
Abstract
Diastology is a study to treat diastole of the heart. Transmitral flow and pulmonary venous flow velocities recorded by pulsed Doppler echocardiography provide more important information about left ventricular (LV) diastolic dysfunction [left atrial (LA)-LV coupling] than cardiac catheterization in clinical practice; however, these waveforms are influenced by loading conditions, particularly preload. The early diastolic mitral annular and LV wall motion indices measured by tissue Doppler echocardiography can evaluate LV relaxation abnormality and filling pressure by being relatively preload independent. In addition, the role of concomitant systolic longitudinal dysfunction is well characterized in asymptomatic patients and in patients with heart failure and preserved ejection fraction. Two-dimensional speckle tracking echocardiography is an angle-independent method, and has the potential to evaluate the contraction and relaxation abnormalities in the longitudinal, circumferential, and radial directions of the LV myocardium as well as LV torsion/untwisting and, moreover, deformation of the LA myocardium and large arterial wall. As a result, this new technique can facilitate the early detection of impaired LA-LV-arterial coupling in patients before occurrence of overt heart failure symptoms.
Collapse
Affiliation(s)
- Takashi Oki
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan.
| | - Hirokazu Miyoshi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yoshifumi Oishi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Yukio Mizuguchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Arata Iuchi
- Cardiovascular Section, Higashi Tokushima Medical Center, National Hospital Organization, Tokushima, Japan
| | - Hirotsugu Yamada
- Department of Cardiovascular Medicine, Tokushima University Hospital, Tokushima, Japan
| | - Satoshi Nakatani
- Division of Functional Diagnostics, Department of Health Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
17
|
Ozawa K, Funabashi N, Nishi T, Takahara M, Fujimoto Y, Kamata T, Kobayashi Y. Resting multilayer 2D speckle-tracking TTE for detection of ischemic segments confirmed by invasive FFR part-2, using post-systolic-strain-index and time from aortic-valve-closure to regional peak longitudinal-strain. Int J Cardiol 2016; 217:149-55. [DOI: 10.1016/j.ijcard.2016.04.153] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Revised: 04/14/2016] [Accepted: 04/20/2016] [Indexed: 10/21/2022]
|
18
|
Jamiel A, Ahmed AM, Farah I, Al-Mallah MH. Correlation Between Diastolic Dysfunction and Coronary Artery Disease on Coronary Computed Tomography Angiography. Heart Views 2016; 17:13-8. [PMID: 27293524 PMCID: PMC4879799 DOI: 10.4103/1995-705x.182649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Aims: We investigated the relationship between coronary artery calcium score (CACS) and coronary artery disease (CAD) on coronary computed tomography angiography (CCTA), and measures of left ventricular diastolic function (DD). Methods: We included 429 consecutive patients (39% women; mean age 49 ± 12 years) without known CAD, who underwent CCTA and transthoracic echocardiography (TTE) within 1-month. Evaluation of CCTA was per vessel, and per segment basis for intraluminal diameter stenosis. We also used the 16-segment model to determine overall coronary plaque burden with segment involvement score (SIS). DD on TTE was assessed using mitral inflow E wave-to-A wave ratio (EAR) and tissue Doppler early mitral annual tissue velocity axial excursion. Results: A total of 293 (68.4%) patients had DD, 15.4% had more than stage 2 DD. The presence of DD was associated with increasing CACS (P < 0.001). Similarly, there was a statistically significant correlation between EAR and CCS (r = −0.147, P = 0.004) and SIS (r = 0.536, P < 0.001). The prevalence of more than stage 2 DD was associated with higher prevalence of obstructive CAD (26.2% vs. 11.7%, P < 0.0001). In multivariable analyses, the independent predictors of more than stage 1 DD are the age (P < 0.001), and diabetes (P = 0.010), while the CACS and SIS were not independently associated with DD. Conclusion: Our analysis suggests that CACS, as well as CAD by CCTA, are not independently associated with measures of DD on echocardiography.
Collapse
Affiliation(s)
- Abdelrahman Jamiel
- King Saud bin Abdulaziz, University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; King Abdulaziz Medical City for National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Amjad M Ahmed
- King Abdulaziz Medical City for National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Iyad Farah
- King Abdulaziz Medical City for National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia
| | - Mouaz H Al-Mallah
- King Saud bin Abdulaziz, University for Health Sciences, Riyadh, Kingdom of Saudi Arabia; King Abdulaziz Medical City for National Guard - Health Affairs, Riyadh, Kingdom of Saudi Arabia; King Abdulaziz Cardiac Center, Riyadh, Kingdom of Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Kingdom of Saudi Arabia
| |
Collapse
|
19
|
Balmain B, Stewart GM, Yamada A, Chan J, Haseler LJ, Sabapathy S. The impact of an experimentally induced increase in arterial blood pressure on left ventricular twist mechanics. Exp Physiol 2015; 101:124-34. [DOI: 10.1113/ep085423] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 10/20/2015] [Indexed: 11/08/2022]
Affiliation(s)
- B. Balmain
- Menzies Health Institute Queensland, Gold Coast Campus; Griffith University; Queensland Australia
| | - G. M. Stewart
- Menzies Health Institute Queensland, Gold Coast Campus; Griffith University; Queensland Australia
| | - A. Yamada
- Menzies Health Institute Queensland, Gold Coast Campus; Griffith University; Queensland Australia
| | - J. Chan
- Menzies Health Institute Queensland, Gold Coast Campus; Griffith University; Queensland Australia
- Cardiology Division; The Prince Charles Hospital; Brisbane Queensland Australia
| | - L. J. Haseler
- Menzies Health Institute Queensland, Gold Coast Campus; Griffith University; Queensland Australia
| | - S. Sabapathy
- Menzies Health Institute Queensland, Gold Coast Campus; Griffith University; Queensland Australia
| |
Collapse
|
20
|
Nagueh SF, Quiñones MA. Important advances in technology: echocardiography. Methodist Debakey Cardiovasc J 2015; 10:146-51. [PMID: 25574341 DOI: 10.14797/mdcj-10-3-146] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Echocardiography has evolved over the past 45 years from a simple M-mode tracing to an array of technologies that include two-dimensional imaging, pulsed and continuous wave spectral Doppler, color flow and tissue Doppler, and transesophageal echocardiography. Together, these modalities provide a comprehensive anatomic and functional evaluation of cardiac chambers and valves, pericardium, and ascending and descending aorta. The switch from analog to digital signal processing revolutionized the field of ultrasound, resulting in improved image resolution, smaller instrumentation that allows bedside evaluation and diagnosis of patients, and digital image storage for more accurate quantification and comparison with previous studies. It also opened the door for new advances such as harmonic imaging, automated border detection and quantification, 3-dimensional imaging, and speckle tracking. This article offers an overview of some newer developments in echocardiography and their promising applications.
Collapse
Affiliation(s)
- Sherif F Nagueh
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Miguel A Quiñones
- Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas
| |
Collapse
|
21
|
Stress-echocardiography is underused in clinical practice: a nationwide survey in Austria. Wien Klin Wochenschr 2015; 127:514-20. [PMID: 26162465 DOI: 10.1007/s00508-015-0828-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2015] [Accepted: 06/06/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND The wide area of application, including coronary artery disease, valvular heart disease, or pulmonary hypertension makes stress echocardiography (SE) a powerful, cost-effective imaging modality in cardiology. The role of this technique in clinical practice in Austria is unknown. METHODS A nationwide survey included all departments for cardiology and/or internal medicine in the years 2008 and 2013. By electronic questionnaire demographics, indication for the test, the numbers of examined cases per year, operators, and various applied techniques of SE were interrogated and completed by telephone interviews. RESULTS Data could be obtained from all 117 departments. In the year 2007 in 58 (50%) and in 2012 57 (49%) departments SE was available in Austrian hospitals. More than 100 SEs per year were performed by only four (7%) units in the year 2007 and by five (8%) in 2012. Physical exercise, dobutamine, and dipyridamole SE were available in 27 (46%), 52 (90%), and six (10%) units in 2007, and in 15 (27%), 52 (91%), and five (9%) units in 2012, respectively. In 2007 41 (71%) and in 2012 26 (46%) echo-labs administered contrast agents during SE. Transesophageal SE and 3D-echo was performed in one (2%) and three (5%) units in 2007, and in six (10%) and four (7%) echo-labs in 2012. CONCLUSIONS This representative survey demonstrates the underuse of SE in clinical practice in Austria. Even in established application fields performance is low, examination frequencies as recommended by the cardiology societies are fulfilled only by a minority of institutions.
Collapse
|
22
|
Kaseno H, Toyama T, Okaniwa H, Toide H, Yamashita E, Kawaguchi R, Adachi H, Hoshizaki H, Oshima S. Diastolic Stunning as a Marker of Severe Coronary Artery Stenosis: Analysis by Speckle Tracking Radial Strain in the Resting Echocardiogram. Echocardiography 2015; 33:30-7. [PMID: 26120955 DOI: 10.1111/echo.12999] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Hiroyo Kaseno
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Takuji Toyama
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hiroki Okaniwa
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hiroyuki Toide
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Eiji Yamashita
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Ren Kawaguchi
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hitoshi Adachi
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Hiroshi Hoshizaki
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| | - Shigeru Oshima
- Division of Cardiology; Gunma Prefectural Cardiovascular Center; Maebashi Japan
| |
Collapse
|
23
|
Mishra RK, Tietjens J, Regan M, Whooley MA, Schiller NB. The Prognostic Utility of Echo-Estimated Left Ventricular End-Diastolic Pressure-Volume Relationship in Stable Coronary Artery Disease: The Heart and Soul Study. Echocardiography 2015; 32:1639-46. [PMID: 25959601 DOI: 10.1111/echo.12955] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND While changes in the left ventricular end-diastolic pressure-volume relationship (LV-EDPVR) can be estimated using echocardiography, their prognostic utility in stable coronary artery disease (CAD) is unknown. METHODS Using echo-estimated LV end-diastolic volume index and diastolic function category, the relative position of the LV-EDPVR was defined in 901 participants with stable CAD as: (1) left-shifted, (2) right-shifted, or (3) intermediate. We then evaluated the association of LV-EDPVR position relative to the intermediate category with time to hospitalization for heart failure (HF) or cardiovascular (CV) death using Cox proportional hazards models. RESULTS During 7.0 ± 3.1 years of follow-up, there were 207 admissions for HF or CV deaths. Both leftward and rightward shifts of LV-EDPVR were associated with a significantly higher risk of HF or CV death (HR 1.73, 95% CI 1.15-2.62 and HR 6.75, 95% CI 4.02-11.31, respectively). In multivariable-adjusted models, these associations were attenuated but remained significant (HR 1.66, 95% CI 1.08-2.55 for left-shifted and HR 4.19, 95% CI 2.32-7.55 for right-shifted). The association of LV-EDPVR with HF or CV death was no longer significant after inclusion of N-terminal pro-brain natriuretic peptide level as a covariate. CONCLUSIONS In stable CAD, echo-estimated leftward and rightward shifts in the LV-EDPVR are associated with HF and CV death. The loss of these associations after adjustment for N-terminal pro-brain natriuretic peptide level suggests that echo-estimated LV-EDPVR captures changes in LV filling pressure at any given LV end-diastolic volume.
Collapse
Affiliation(s)
- Rakesh K Mishra
- University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Jeremy Tietjens
- University of California, San Francisco, San Francisco, California
| | - Mathilda Regan
- San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Mary A Whooley
- University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| | - Nelson B Schiller
- University of California, San Francisco, San Francisco, California.,San Francisco Veterans Affairs Medical Center, San Francisco, California
| |
Collapse
|
24
|
Gimelli A, Liga R, Giorgetti A, Kusch A, Pasanisi EM, Marzullo P. Relationships between myocardial perfusion abnormalities and poststress left ventricular functional impairment on cadmium-zinc-telluride imaging. Eur J Nucl Med Mol Imaging 2015; 42:994-1003. [DOI: 10.1007/s00259-015-3008-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/22/2015] [Indexed: 11/29/2022]
|
25
|
Maragiannis D, Nagueh SF. Echocardiographic Evaluation of Left Ventricular Diastolic Function: an Update. Curr Cardiol Rep 2015; 17:3. [DOI: 10.1007/s11886-014-0561-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
26
|
|
27
|
Ueki C, Sakaguchi G, Akimoto T, Shintani T, Ohashi Y, Sato H. Influence of previous percutaneous coronary intervention on clinical outcome of coronary artery bypass grafting: a meta-analysis of comparative studies. Interact Cardiovasc Thorac Surg 2015; 20:531-7; discussion 537. [DOI: 10.1093/icvts/ivu449] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
28
|
Hwang HJ, Lee HM, Yang IH, Lee JL, Pak HY, Park CB, Jin ES, Cho JM, Kim CJ, Sohn IS. The value of assessing myocardial deformation at recovery after dobutamine stress echocardiography. J Cardiovasc Ultrasound 2014; 22:127-33. [PMID: 25309689 PMCID: PMC4192410 DOI: 10.4250/jcu.2014.22.3.127] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/08/2023] Open
Abstract
Background The purpose of this study was to evaluate whether performing an assessment of myocardial deformation using speckle tracking imaging during the recovery period after dobutamine stress echocardiography (DSE) allows detection of significant coronary artery disease (CAD) in patients with chest discomfort. Methods DSE and coronary angiography were performed in 44 patients with chest discomfort. The mean global longitudinal peak systolic strain (GLS) was measured at rest, at low stress (dobutamine infusion rate of 10 µg/kg/min) and at recovery (5 min after cessation of dobutamine infusion) of DSE using automated function imaging with apical views. Fractional flow reserve (FFR) was also performed in patients with intermediate coronary stenosis. CAD was defined as having a ≥ 70% diameter stenosis on coronary angiography or as having a FFR < 0.8. Patients were divided two groups based on the absence or presence of CAD [CAD (-) group vs. CAD (+) group]. Results There were no significant differences in the clinical characteristics and results of conventional echocardiography between the two groups. GLS at recovery was lower in the CAD (+) group than in the CAD (-) group (-18.0 ± 3.4% vs. -21.0 ± 1.9%, p = 0.003). The optimal cutoff of GLS at recovery for detection of CAD was -19% (sensitivity of 70.6%, specificity of 83.3%). Conclusion Assessment of GLS at recovery of DSE is a reliable and objective method for detection of CAD. This finding may suggest that systolic myocardial stunning remains even after recovery of wall motion abnormalities in patients with CAD.
Collapse
Affiliation(s)
- Hui-Jeong Hwang
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyae-Min Lee
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - In-Ho Yang
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jung Lok Lee
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Hyun Young Pak
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chang-Bum Park
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Eun-Sun Jin
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Jin-Man Cho
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Chong-Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| |
Collapse
|
29
|
Park SM, Ahn CM, Hong SJ, Kim YH, Park JH, Shim WJ, Lim DS. Acute changes of left ventricular hemodynamics and function during percutaneous coronary intervention in patients with unprotected left main coronary artery disease. Heart Vessels 2014; 30:432-40. [DOI: 10.1007/s00380-014-0495-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Accepted: 02/28/2014] [Indexed: 11/30/2022]
|
30
|
Changes in Right Ventricular Free Wall Strain in Patients with Coronary Artery Disease Involving the Right Coronary Artery. J Am Soc Echocardiogr 2014; 27:230-8. [DOI: 10.1016/j.echo.2013.11.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Indexed: 11/20/2022]
|
31
|
Chiang SJ, Daimon M, Ishii K, Kawata T, Miyazaki S, Hirose K, Ichikawa R, Miyauchi K, Yeh MH, Chang NC, Daida H. Assessment of Elevation of and Rapid Change in Left Ventricular Filling Pressure Using a Novel Global Strain Imaging Diastolic Index. Circ J 2014; 78:419-27. [DOI: 10.1253/circj.cj-13-0513] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Masao Daimon
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Takayuki Kawata
- Department of Cardiology, Juntendo University School of Medicine
| | - Sakiko Miyazaki
- Department of Cardiology, Juntendo University School of Medicine
| | - Kuniaki Hirose
- Department of Cardiology, Juntendo University School of Medicine
| | - Ryoko Ichikawa
- Department of Cardiology, Juntendo University School of Medicine
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine
| | - Mei-Hsiu Yeh
- Division of Cardiology, Department of Internal Medicine, Taipei Medical University Hospital
| | - Nen-Chung Chang
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine
| |
Collapse
|
32
|
Shin SH, Park SD, Woo SI, Kim DH, Park KS, Kwan J. Utility of global strain by two-dimensional and three-dimensional speckle tracking for assessing left ventricular diastolic function: comparison with pressure wire analysis. Korean Circ J 2013; 43:615-21. [PMID: 24174962 PMCID: PMC3808857 DOI: 10.4070/kcj.2013.43.9.615] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 12/03/2022] Open
Abstract
Background and Objectives We evaluated the utility of two-dimensional (2D) and three-dimensional (3D) left ventricular (LV) global myocardial deformity parameters for assessing LV diastolic function by comparing invasive measures of LV performance. Subjects and Methods Echocardiography and LV pressure were assessed in 39 patients. Myocardial LV longitudinal, circumferential, and radial deformations, as well as area strain, were evaluated utilizing 2D and 3D speckle tracking software. The 2D early diastolic strain rate (2D-SRe) was measured from the 3 apical and 3 short axis views. The 3D diastolic index (3D-DI) was calculated by the % change of global strain during the first one-third of the diastolic period. LV end diastolic pressure (LVEDP) and the rate of LV pressure change (dP/dt) were collected using a pressure-conducted catheter and tau was calculated. Results dP/dtmin were related to early mitral annular velocity (e'), 2D-SRelong, 2D-SReradial, as well as 3D-DIlong, and 3D-DIas. Additionally, LVEDP was associated with the ratio of mitral early diastolic velocity (E) to 2D-SRelong, 2D-SRecirc, 2D-SReradial, 3D-DIlong, 3D-DIcirc, and 3D-DIas. E/2D-SRelong, E/2D-SReradial, E/3D-DIlong, and E/3D-DIas were comparable with E/e' in predicting patients with elevated LVEDP. Among those patients with E/e' of 8 to 15, E/3D-DIlong provided incremental value in identifying those with LVEDP ≥15 mm Hg. Conclusion 2D-SRelong, 2D-SReradial, 3D-DIlong, and 3D-DIas were related to LV relaxation, and the ratios of E to those parameters were associated with LVEDP. In addition, among patients with indeterminate E/e', E/3D-DIlong offered incremental value in predicting elevated LVEDP, suggesting it may provide supplementary information in the evaluation of LV diastolic function.
Collapse
Affiliation(s)
- Sung-Hee Shin
- Division of Cardiology, Inha University College of Medicine, Incheon, Korea
| | | | | | | | | | | |
Collapse
|
33
|
Risk stratification of patients with non-ST-elevation acute coronary syndromes by assessing global longitudinal strain. Heart Vessels 2013; 29:300-7. [PMID: 23666363 DOI: 10.1007/s00380-013-0361-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Accepted: 04/26/2013] [Indexed: 10/26/2022]
Abstract
Noninvasive detection of left main/three-vessel diseases (LM/3VD) among patients with non-ST-elevation acute coronary syndromes (NSTEACS) has been difficult using echocardiography. However, two-dimensional (2D) strain/strain-rate analysis is more sensitive in quantitatively assessing contractile abnormality. Accordingly, we aimed to clarify the usefulness of 2D strain/strain-rate analysis for risk stratification of NSTEACS. A total of 50 patients with NSTEACS underwent echocardiography and coronary angiography. We evaluated global longitudinal peak strain (global PS), peak systolic strain rate (global SSR), early diastolic global peak strain rate (global ESR), time from aortic valve closure to peak strain (TAVC-global PS), and global ESR (TAVC-global ESR) in apical four-, two-, and three-chamber views. Patients were divided into two groups according to coronary angiographic findings, the high-risk group (n = 15) with either of left main or three-vessel disease, and the low-risk group (n = 35). There were no significant differences in global SSR and global ESR between the two groups. The amplitude of global PS was significantly reduced in high-risk patients with LM/3VD in comparison with low-risk patients (-17.5 ± 2.4% vs -19.8 ± 2.7%, P = 0.007, respectively). TAVC-global PS and TAVC-global ESR were significantly prolonged in high-risk patients with LM/3VD in comparison with low-risk patients (15.3 ± 25.7 ms vs -36.8 ± 32.7 ms, P < 0.0001 and 162.8 ± 32.7 ms vs 135.7 ± 41.5 ms, P < 0.03, respectively). Receiver-operating characteristic analysis demonstrated that TAVC-global PS most strongly detected high-risk patients with sensitivity of 100% and specificity of 74.3% (area under the curve = 0.938, 95 % confidence interval 0.832-0.986, P = 0.0001). Temporal analysis of 2D strain appeared to be useful in detecting high-risk patients with LM/3VD among patients with NSTEACS.
Collapse
|
34
|
Bartko PE, Heinze G, Graf S, Clavel MA, Khorsand A, Bergler-Klein J, Burwash IG, Dumesnil JG, Sénéchal M, Baumgartner H, Rosenhek R, Pibarot P, Mundigler G. Two-Dimensional Strain for the Assessment of Left Ventricular Function in Low Flow–Low Gradient Aortic Stenosis, Relationship to Hemodynamics, and Outcome. Circ Cardiovasc Imaging 2013; 6:268-76. [DOI: 10.1161/circimaging.112.980201] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Philipp Emanuel Bartko
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Georg Heinze
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Senta Graf
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Marie-Annick Clavel
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Aliasghar Khorsand
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Jutta Bergler-Klein
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Ian Gordon Burwash
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Jean Gaston Dumesnil
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Mario Sénéchal
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Helmut Baumgartner
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Raphael Rosenhek
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Philippe Pibarot
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| | - Gerald Mundigler
- From the Department of Internal Medicine II, Division of Cardiology, (P.E.B., S.G., A.K., J.B.-K., R.R., G.M.) and Center for Medical Statistics, Informatics and Intelligent Systems (G.H.), Medical University of Vienna, Vienna, Austria; Laval Hospital/Québec Heart Institute, Laval University, Québec, Canada (M.A.C., J.G.D., M.S., P.P.); University of Ottawa Heart Institute, Ottawa, Ontario, Canada (I.G.B.); and Department of Cardiovascular Medicine, Divsion of Adult Congenital and Valvular Heart
| |
Collapse
|
35
|
Han SY, Li HX, Ma X, Zhang K, Ma ZZ, Jiang Y, Tu PF. Evaluation of the anti-myocardial ischemia effect of individual and combined extracts of Panax notoginseng and Carthamus tinctorius in rats. JOURNAL OF ETHNOPHARMACOLOGY 2013; 145:722-727. [PMID: 23237935 DOI: 10.1016/j.jep.2012.11.036] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Revised: 11/12/2012] [Accepted: 11/25/2012] [Indexed: 06/01/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The decoction of combined Panax notoginseng (Burk) F.H. Chen and Carthamus tinctorius L. has a history of use in traditional medicine for the prevention and treatment of cardiovascular diseases such as angina pectoris and myocardial infarction. AIM OF THE STUDY In this study, we investigated the effects of individual herbal extracts and combined extracts on anti-myocardial ischemia injuries in vivo, and determined the proper dosage of Panax notoginseng (EPN) combined with Carthamus tinctorius (ECT) that could strengthen their cardio-protective effects. Meanwhile, their potential anti-oxidative stress and anti-inflammation effect were assessed. MATERIAL AND METHODS SD rats were orally given individual EPN 50, 100mg/kg, ECT 100, 200mg/kg, and different combinations between them. Myocardial infarction was produced by occlusion of the left anterior descending coronary artery for 24h. Infarct area was determined with 2,3,5-triphenyltetrazolium chloride (TTC) staining. The biomarkers related to myocardial ischemia injury were determined. Simultaneously, hemodynamic parameters were monitored as left ventricular systolic pressure (LVSP), LV end-diastolic pressure (LVEDP) and maximal rate of increase and decrease of left ventricular pressure (dP/dt(max)). The oxidative stress indicators and inflammatory factors were also evaluated. RESULTS The results showed EPN or ECT significantly reduced infarct size, improved cardiac function, decreased levels of creatine kinase (CK) and lactate dehydrogenase (LDH) (all P<0.05 vs. control ). EPN or ECT alone also restrained the oxidative stress related to myocardial ischemia injury as evidenced by decreased malondialdehyde (MDA) and elevated superoxide dismutase (SOD) activity (all P<0.05 vs. control). However, this cardio-protective effect was further strengthened by their combinations. Among all the combinations, EPN 50mg/kg plus ECT 200mg/kg showed predominant potential to reduce infarct size (22.21±1.72%, P<0.05 vs. each single, respectively), preserve cardiac function (P<0.05 vs. ECT 200mg/kg for LVEDP and -dP/dt(max)) after myocardial ischemia injury in rats. This heart protection was confirmed with the lowered cardiac troponin I (cTnI) (P<0.05 vs. ECT 200mg/kg and EPN 50mg/kg, respectively). Oxidative stress and inflammation are the two key factors in the pathogenesis of myocardial ischemia injury. In the present study, EPN 50mg/kg plus ECT 200mg/kg markedly increased SOD and GSH-Px activity (475.30±23.60U/ml, P<0.05 vs. each single, respectively), while elevated MDA level was significantly depressed. Meanwhile, the inflammatory cascade was inhibited as evidenced by decreased cytokines such as tumor necrosis factor-α (TNF-α), C-reactive protein (CRP) and interleukin-1β (IL-1β). CONCLUSION These results demonstrated EPN, ECT and their combinations exhibited significant cardio-protective effects. The findings suggest EPN combined with ECT may be therapeutically more useful for ameliorating anti-myocardial ischemia injuries than individual herbal extract, and EPN 50mg/kg plus ECT 200mg/kg is the appropriate combination in the present research. The cardio-protective effect of this combination was achieved partially by decreasing oxidative stress and repressing inflammatory cascade.
Collapse
Affiliation(s)
- Shu-Yan Han
- State Key Laboratory of Natural and Biomimetic Drugs, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, PR China
| | | | | | | | | | | | | |
Collapse
|
36
|
Arbeille P, Angoulvant D, Zuj K, Patier J, Desveaux B, Quilliet L, Charbonnier B. Four-dimensional speckle tracking for assessing improvement in left ventricular contractility after coronary angioplasty. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:102-110. [PMID: 23122638 DOI: 10.1016/j.ultrasmedbio.2012.08.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2012] [Revised: 08/19/2012] [Accepted: 08/24/2012] [Indexed: 06/01/2023]
Abstract
The objective of the study was to identify and quantify the potential improvement of left ventricular contractility after percutaneous transluminal coronary angioplasty (PTCA) using 4-dimensional (4D) speckle tracking echocardiography (4D STE). We investigated 41 patients with coronary disease by 4D STE pre- and 24 hours postcoronarography with (n = 18) or without (n = 23) PTCA. The 4D STE visualizes in real time the myocardium strain on 2- and 4-chamber apical views and on 3 transverse views of the left ventricle. Average and total strain of the left ventricle were measured. Of the 18 PTCA patients, 15 showed significant increase in left ventricle mean (+15 ± 6) and total strain (240 ± 100), which corresponded to an increase of 93% ± 55% from precoronarography, whereas the remainder showed no change. The total strain corresponded to 33% ± 10% (before PTCA) and 59% ± 11% (post PTCA) of the estimated normal strain for each patient. Strain improved in 70% of the segment downstream from the stent, and there was a negative correlation between the amplitude of the mean and total strain improvements after 24 hours and the mean and total strain values before PTCA. In the non-PTCA group, 21 of the 23 patients showed no changes in strain, whereas 2 showed improvement. The 4D STE showed significant improvements in left ventricular contractility in more than 70% of the areas downstream from the PTCA segment. This corresponded to an increase in the initial contractility by approximately 93% ± 55%; however, the myocardium contractility remained approximately 59% of normal level. No changes were seen in patients without PTCA.
Collapse
Affiliation(s)
- Philippe Arbeille
- Science de Médecine Nucléaire et Ultrasons, CHU Trousseau, Tours, France.
| | | | | | | | | | | | | |
Collapse
|
37
|
Yang B, Daimon M, Ishii K, Kawata T, Miyazaki S, Hirose K, Ichikawa R, Chiang SJ, Suzuki H, Miyauchi K, Daida H. Prediction of Coronary Artery Stenosis at Rest in Patients With Normal Left Ventricular Wall Motion. Int Heart J 2013; 54:266-72. [DOI: 10.1536/ihj.54.266] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Bei Yang
- Department of Cardiology, Juntendo University School of Medicine
- Department of Cardiology, The Fourth Hospital of Kunming Medical College
| | - Masao Daimon
- Department of Cardiology, Juntendo University School of Medicine
| | | | - Takayuki Kawata
- Department of Cardiology, Juntendo University School of Medicine
| | - Sakiko Miyazaki
- Department of Cardiology, Juntendo University School of Medicine
| | - Kuniaki Hirose
- Department of Cardiology, Juntendo University School of Medicine
| | - Ryoko Ichikawa
- Department of Cardiology, Juntendo University School of Medicine
| | - Shuo-Ju Chiang
- Department of Cardiology, Juntendo University School of Medicine
| | - Hiromasa Suzuki
- Department of Cardiology, Juntendo University School of Medicine
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine
| |
Collapse
|
38
|
Prasad SB, See V, Tan T, Brown P, McKay T, Kovoor P, Thomas L. Serial Doppler Echocardiographic Assessment of Diastolic Dysfunction during Acute Myocardial Infarction. Echocardiography 2012; 29:1164-71. [DOI: 10.1111/j.1540-8175.2012.01788.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Sandhir B. Prasad
- Department of Cardiology; Westmead Hospital; Westmead; Sydney; Australia
| | - Valerie See
- Department of Cardiology; Westmead Hospital; Westmead; Sydney; Australia
| | - Timothy Tan
- Department of Cardiology; Westmead Hospital; Westmead; Sydney; Australia
| | - Paula Brown
- Department of Cardiology; Westmead Hospital; Westmead; Sydney; Australia
| | - Tania McKay
- Department of Cardiology; Westmead Hospital; Westmead; Sydney; Australia
| | - Pramesh Kovoor
- Department of Cardiology; Westmead Hospital; Westmead; Sydney; Australia
| | | |
Collapse
|
39
|
Chan YH, Kuo CT, Yeh YH, Wu LS, Wang CL, Ho WJ, Hsu LA. Incremental value of radial discoordination index for the prediction of response to cardiac resynchronization therapy. ACTA ACUST UNITED AC 2012; 14:213-22. [DOI: 10.1093/ehjci/jes112] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|
40
|
Chiang SJ, Daimon M, Ishii K, Miyazaki S, Koiso Y, Suzuki H, Miyauchi K, Yang B, Yeh MH, Hwang B, Daida H. A novel global strain diastolic index correlates with plasma NT-proBNP levels in asymptomatic hypertensive patients with preserved left ventricular ejection fraction. J Echocardiogr 2012; 10:56-64. [PMID: 27278045 DOI: 10.1007/s12574-012-0122-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2012] [Revised: 03/23/2012] [Accepted: 04/02/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND The strain imaging diastolic index (SI-DI) was reported to be a sensitive marker of regional left ventricular (LV) delayed relaxation induced by ischemia. However, the clinical usefulness of the global SI-DI has not been evaluated. N-terminal pro-brain natriuretic peptide (NT-proBNP) is a sensitive biomarker for the detection of asymptomatic diastolic LV dysfunction. This study investigated the ability of a novel parameter, the global SI-DI, obtained using 2D speckle tracking imaging (2DSI) to correlate with the plasma NT-proBNP levels in asymptomatic hypertensive patients with preserved LV ejection fraction. METHODS We performed 2D echocardiography and 2DSI in 83 asymptomatic hypertensive patients with preserved ejection fraction (>45 %) and in 37 control subjects. In 2DSI, the LV longitudinal peak strain and the SI-DI of 18 LV segments were measured. NT-proBNP was measured in all subjects. The data were compared between hypertensive patients and normal controls. RESULTS The average peak strain and global SI-DI of 18 LV segments were significantly reduced in hypertensive patients compared with control subjects (P < 0.05); however, only the global SI-DI was significantly correlated with log10 NT-proBNP (r = -0.469, P = 0.001). In Pearson's correlation analyses, log10 NT-proBNP was significantly correlated with E/e', E/A ratio, early diastolic mitral annular velocity (e'), global peak strain, deceleration time of the E-wave, and LV ejection fraction. In the multiple stepwise regression analysis, the global SI-DI was the strongest independent determinant of log10 NT-proBNP (β = -0.386, P = 0.008). CONCLUSIONS The global SI-DI derived from 2DSI correlates well with plasma NT-proBNP levels and may have prognostic value in asymptomatic hypertensive patients with preserved ejection fraction.
Collapse
Affiliation(s)
- Shuo-Ju Chiang
- Division of Cardiology, Department of Internal Medicine and Pediatrics, Taipei City Hospital Zhongxiao Branch, National Yang-Ming University, Taipei, Taiwan
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Masao Daimon
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan.
| | - Katsuhisa Ishii
- Department of Cardiology, Kansai Electric Power Hospital, Osaka, Japan
| | - Sakiko Miyazaki
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Yoko Koiso
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hiromasa Suzuki
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Katsumi Miyauchi
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Bei Yang
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Mei-Hsiu Yeh
- Division of Cardiology, Department of Internal Medicine and Pediatrics, Taipei City Hospital Zhongxiao Branch, National Yang-Ming University, Taipei, Taiwan
| | - Betau Hwang
- Division of Cardiology, Department of Internal Medicine and Pediatrics, Taipei City Hospital Zhongxiao Branch, National Yang-Ming University, Taipei, Taiwan
| | - Hiroyuki Daida
- Department of Cardiology, Juntendo University School of Medicine, Hongo 2-1-1, Bunkyo-ku, Tokyo, 113-8421, Japan
| |
Collapse
|
41
|
Belohlavek M. Post-systolic shortening: a functional window into ischemic memory? JACC Cardiovasc Imaging 2012; 5:12-4. [PMID: 22239887 DOI: 10.1016/j.jcmg.2011.09.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 09/27/2011] [Indexed: 10/14/2022]
|
42
|
Effect of embolic particles during coronary interventional procedures on regional wall motion in patients with stable angina pectoris. Am J Cardiol 2012; 109:1142-7. [PMID: 22245408 DOI: 10.1016/j.amjcard.2011.11.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Revised: 11/28/2011] [Accepted: 11/28/2011] [Indexed: 11/21/2022]
Abstract
Microembolization during percutaneous coronary intervention (PCI) causes minor myocardial injury, and a Doppler guidewire can detect embolic particles as high-intensity transient signals (HITS). The present study investigated the effect of microembolization during PCI on regional wall motion using a Doppler guidewire and myocardial strain analysis. We performed PCI to the left anterior descending coronary artery in 25 patients (18 men and 7 women, 68 ± 8 years old) with stable angina pectoris. Coronary flow spectrums were obtained with a Doppler guidewire to count the total number of HITS throughout the PCI procedures. On the days before and after PCI, we recorded echocardiography and measured the longitudinal peak systolic strain, peak strain rate, and early diastolic strain rate in the left anterior descending territory using a 2-dimensional speckle tracking method. PCI was successfully performed, and 10 ± 6 HITS (range 0 to 22, median 9) were recognized during PCI. The echocardiographic study showed no visible wall motion abnormalities in the left anterior descending territory either after or before PCI. In cases in which the total number of HITS was ≥10, the peak systolic strain, peak strain rate, and early diastolic strain rate worsened on the day after PCI compared with those on the day before PCI (p <0.01). The rates of change in peak systolic strain and early diastolic strain rate, defined as the ratios of those parameters after PCI to those before PCI, had modest to strong inverse correlations with the total number of HITS (R(2) = 0.35 and R(2) = 0.46, respectively). In conclusion, periprocedural microembolization during PCI reduces subclinical cardiac function in patients with stable angina pectoris.
Collapse
|
43
|
Postsystolic strain index is associated with delayed diastolic lengthening and diastolic dysfunction of the left ventricle in untreated hypertension. J Hypertens 2012; 30:787-93. [DOI: 10.1097/hjh.0b013e32834f6b2b] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
44
|
Chen D, Liao Y, Xu Q, Li Y, Wu W, Wu J, Liao W, Xu D, Liu Y, Wu P, Bin J. Persistence of systolic and diastolic regional dysfunction after brief episodes of myocardial ischemia evaluated with velocity vector imaging. Int J Cardiol 2012; 167:987-94. [PMID: 22445875 DOI: 10.1016/j.ijcard.2012.03.081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 02/01/2012] [Accepted: 03/03/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The time course and characteristics of persistent regional dysfunction after ischemia remain unclear. Velocity vector imaging (VVI) allows accurate quantification of regional myocardial function. The aim of this study was to characterize the time course of regional diastolic and systolic abnormality after recovery from different durations of ischemia by VVI. METHODS 72 rats underwent brief left coronary occlusion (3, 5, 10 and 15 min, respectively) followed by reperfusion for 4-8h. Hemodynamic measurements and VVI were performed at various time points. Regional systolic and diastolic functions were estimated from peak diastolic and systolic circumferential strain rate (SR-d and SR-s) of the left ventricle, respectively. RESULTS Both SR-d and SR-s were significantly decreased in the ischemic segment during occlusion compared to non-ischemic segment. With the increase in occlusive time, the duration of reduced SR-d and SR-s after reperfusion was prolonged. Both SR-d and SR-s returned to pre-occlusion values in less than 30 min after reperfusion in the 3 min and 5 min ischemia groups. However, in the 10- and 15-min ischemia groups, SR-d did not fully recovered even at 240 min after reperfusion despite complete recovery of SR-s. The left ventricular hemodynamics during occlusion were significantly changed in all groups and returned to baseline immediately after reperfusion. CONCLUSION The persistence of diastolic regional dysfunction is longer than systolic regional dysfunction after a relative longer ischemic event, suggesting that recent myocardial ischemic insult mimicking variant angina may be recognized with the evaluation of regional diastolic function.
Collapse
Affiliation(s)
- Dongdong Chen
- Organ Failure Key Laboratory of Ministry of Education, Department of Cardiology, Nanfang Hospital, Southern Medical University, Guangzhou 510515, China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Asanuma T, Fukuta Y, Masuda K, Hioki A, Iwasaki M, Nakatani S. Assessment of Myocardial Ischemic Memory Using Speckle Tracking Echocardiography. JACC Cardiovasc Imaging 2012; 5:1-11. [DOI: 10.1016/j.jcmg.2011.09.019] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2011] [Revised: 09/14/2011] [Accepted: 09/27/2011] [Indexed: 11/26/2022]
|
46
|
Taillard V, Sardinoux M, Oudot C, Fesler P, Rugale C, Raingeard I, Renard E, Ribstein J, du Cailar G. Early detection of isolated left ventricular diastolic dysfunction in high-risk differentiated thyroid carcinoma patients on TSH-suppressive therapy. Clin Endocrinol (Oxf) 2011; 75:709-14. [PMID: 21645022 DOI: 10.1111/j.1365-2265.2011.04138.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE L-Thyroxine-suppressive therapy benefits high-risk differentiated thyroid cancer patients by decreasing recurrence rates and cancer-related mortality. However, fully suppressed serum thyroid-stimulating hormone (TSH) implies a state of subclinical hyperthyroidism (SCH) with associated adverse cardiac effects. Because left ventricular (LV) diastolic dysfunction may be the first manifestation of more severe LV failure, and to balance the risks from thyroid cancer recurrence with risks of cardiac failure, the purpose of this study was to analyse new parameters of LV function in asymptomatic patients with exogenous SCH. DESIGN Case-control study with 24 patients on TSH-suppressive therapy of short duration (≤ 4 years) after thyroid ablative therapy for differentiated thyroid carcinoma and 20 age- and sex-matched subjects. MEASUREMENTS LV function [LV global strain and strain rate (SR) curves] was assessed by speckle tracking imaging echocardiography in each subject. RESULTS Patients and controls do not differ in body mass index, systolic blood pressure and heart rate. No significant differences were observed in LV morphology (LV mass and relative wall thickness), cardiac output and parameters of LV systolic function between patients on suppressive therapy and controls. When compared with controls, patients with exogenous SCH had a significantly impaired longitudinal protodiastolic strain, SR and strain diastolic index but preserved radial strain and SR function. CONCLUSIONS In subjects with SCH at the early phase of TSH-suppressive therapy, evidence of isolated longitudinal LV diastolic dysfunction was observed, despite a normal LV morphology. Further prospective studies to clarify the prognosis of picking-up early diastolic dysfunction in asymptomatic patients are needed before serial measurements could be recommended.
Collapse
Affiliation(s)
- Véronique Taillard
- Department of Internal Medicine, CHU Montpellier, Hôpital Lapeyronie, Montpellier Cedex 5, France
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Grenne B, Eek C, Sjøli B, Dahlslett T, Hol PK, Ørn S, Skulstad H, Smiseth OA, Edvardsen T, Brunvand H. Mean Strain Throughout the Heart Cycle by Longitudinal Two-Dimensional Speckle-Tracking Echocardiography Enables Early Prediction of Infarct Size. J Am Soc Echocardiogr 2011; 24:1118-25. [DOI: 10.1016/j.echo.2011.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2010] [Indexed: 10/18/2022]
|
48
|
Oh JK, Park SJ, Nagueh SF. Established and novel clinical applications of diastolic function assessment by echocardiography. Circ Cardiovasc Imaging 2011; 4:444-55. [PMID: 21772012 DOI: 10.1161/circimaging.110.961623] [Citation(s) in RCA: 111] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
- Jae K Oh
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
| | | | | |
Collapse
|
49
|
D’Annunzio V, Donato M, Fellet A, Buchholz B, Arciuch VGA, Carreras MC, Valdez LB, Zaobornyj T, Morales C, Boveris A, Poderoso JJ, Balaszczuk AM, Gelpi RJ. Diastolic function during hemorrhagic shock in rabbits. Mol Cell Biochem 2011; 359:169-76. [DOI: 10.1007/s11010-011-1011-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Accepted: 07/27/2011] [Indexed: 10/17/2022]
|
50
|
Eleid MF, Appleton CP, Lopez AG, Cha S, Hurst RT. Coronary Artery Plaque Burden Does Not Affect Left Ventricular Diastolic Function in Asymptomatic Adults with Normal Ejection Fraction. J Am Soc Echocardiogr 2011; 24:909-14. [DOI: 10.1016/j.echo.2011.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2011] [Indexed: 01/07/2023]
|