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Reiter C, Reiter U, Kräuter C, Kolesnik E, Scherr D, Schmidt A, Fuchsjäger M, Reiter G. MR 4D flow-derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction. Eur Radiol 2024; 34:4065-4076. [PMID: 37953367 PMCID: PMC11166802 DOI: 10.1007/s00330-023-10386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The magnetic resonance (MR) 4D flow imaging-derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. METHODS Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. RESULTS Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958-1.000), yielding sensitivity of 100% (95% CI: 84-100%) and specificity of 99% (95% CI: 93-100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976-1.000) at cut-off α ≥ 2.14. CONCLUSION The 4D flow-derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. CLINICAL RELEVANCE STATEMENT As a single continuous parameter, the 4D flow-derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. KEY POINTS • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow-derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.
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Affiliation(s)
- Clemens Reiter
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria.
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
- Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria
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Abd-Elmoniem KZ, Ishaq H, Purdy J, Matta J, Hamimi A, Hannoush H, Hadigan C, Gharib AM. Association of Coronary Wall Thickening and Diminished Diastolic Function in Asymptomatic, Low Cardiovascular Disease-Risk Persons Living with HIV. Radiol Cardiothorac Imaging 2024; 6:e230102. [PMID: 38573125 PMCID: PMC11056756 DOI: 10.1148/ryct.230102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 12/19/2023] [Accepted: 02/14/2024] [Indexed: 04/05/2024]
Abstract
Purpose To assess early subclinical coronary artery disease (CAD) burden and its relation to myocardial function in asymptomatic persons living with HIV (PLWH) who are at low risk for cardiovascular disease (CVD). Materials and Methods In this prospective, HIPAA-compliant study (ClinicalTrials.gov NCT01656564 and NCT01399385) conducted from April 2010 to May 2013, 74 adult PLWH without known CVD and 25 matched healthy controls underwent coronary MRI to measure coronary vessel wall thickness (VWT) and echocardiography to assess left ventricular function. Univariable and multivariable linear regression analyses were used to evaluate statistical associations. Results For PLWH, the mean age was 49 years ± 11 (SD), and the median Framingham risk score was 3.2 (IQR, 0.5-6.6); for matched healthy controls, the mean age was 46 years ± 8 and Framingham risk score was 2.3 (IQR, 0.6-6.1). PLWH demonstrated significantly greater coronary artery VWT than did controls (1.47 mm ± 0.22 vs 1.34 mm ± 0.18; P = .006) and a higher left ventricular mass index (LVMI) (77 ± 16 vs 70 ± 13; P = .04). Compared with controls, PLWH showed altered association between coronary artery VWT and both E/A (ratio of left ventricular-filling peak blood flow velocity in early diastole [E wave] to that in late diastole [A wave]) (P = .03) and LVMI (P = .04). In the PLWH subgroup analysis, coronary artery VWT increase was associated with lower E/A (P < .001) and higher LVMI (P = .03), indicating restricted diastolic function. In addition, didanosine exposure was associated with increased coronary artery VWT and decreased E/A ratio. Conclusion Asymptomatic low-CVD-risk PLWH demonstrated increased coronary artery VWT in association with impaired diastolic function, which may be amenable to follow-up studies of coronary pathogenesis to identify potential effects on the myocardium and risk modification strategies. Keywords: Coronary Vessel Wall Thickness, Diastolic Function, HIV, MRI, Echocardiography, Atherosclerosis Clinical trial registration nos. NCT01656564 and NCT01399385 Supplemental material is available for this article. © RSNA, 2024.
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Affiliation(s)
- Khaled Z. Abd-Elmoniem
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Hadjira Ishaq
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Julia Purdy
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Jatin Matta
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Ahmed Hamimi
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Hwaida Hannoush
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Colleen Hadigan
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
| | - Ahmed M. Gharib
- From the Biomedical and Metabolic Imaging Branch, National Institute
of Diabetes and Digestive and Kidney Diseases (K.Z.A.E., H.I., J.M., A.H.,
A.M.G.), Critical Care Medicine Department, National Institutes of Health
Clinical Center (J.P.), National Human Genome Research Institute (H.H.), and
National Institute of Allergy and Infectious Diseases (C.H.), National
Institutes of Health, 10 Center Dr, Bethesda, MD 20892; and Department of
Radiology, University of Chicago, Chicago, Ill (A.H.)
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Du Y, Yuan N, Yan J, Han G, Hu X, Zhang Y, Tian J. Identification of echocardiographic subgroups in patients with coronary heart disease combined with heart failure based on latent variable stratification. Int J Cardiol 2023; 373:90-98. [PMID: 36442673 DOI: 10.1016/j.ijcard.2022.11.038] [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: 09/01/2022] [Revised: 11/18/2022] [Accepted: 11/22/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND The prognosis of chronic heart failure is poor, and it remains a challenge to classify patients for better personalized intervention. This study aimed to explore potential subgroups in patients with coronary heart disease and chronic heart failure using comprehensive echocardiographic indices. METHODS 5126 patients with coronary heart disease with chronic heart failure were included. Latent class analysis was applied to identify the grouping patterns of patients based on echocardiographic indices. Network maps and radar charts of echocardiographic indices were drawn to visualize the distribution of echocardiographic findings. The incidence of adverse outcomes was presented on the Kaplan-Meier curve and compared using the log-rank test. The Cox regression model was used to analyze the relationship between subgroups and mortality. RESULTS Three groups were identified: eccentric hypertrophy, concentric hypertrophy, and decreased diastolic function. Network plots showed a higher correlation between left atrial diameter, left ventricular mass index, and left ventricle ejection fraction in the eccentric hypertrophy group than in the other groups. The Kaplan-Meier curve showed a significant difference in mortality between the three subgroups (P < 0.001). Multivariate Cox analysis indicated that the eccentric hypertrophy group had the highest risk of death (HR = 1.586, 95% CI: 1.310-1.921, P < 0.001) compared with the other groups. CONCLUSION Patients with coronary heart disease and chronic heart failure can be classified into three subgroups based on echocardiographic indices. This grouping has been shown to be an independent risk factor for mortality in these patients. Accurate subgrouping based on echocardiographic indices is important for identifying high-risk patients.
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Affiliation(s)
- Yutao Du
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China
| | - Na Yuan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China
| | - Jingjing Yan
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China
| | - Gangfei Han
- Department of Cardiology, the 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001, China
| | - Xiaojuan Hu
- Department of Cardiology, the 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001, China
| | - Yanbo Zhang
- Department of Health Statistics, School of Public Health, Shanxi Medical University, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China; Shanxi University of Chinese Medicine, 121 University Street, Jinzhong, Shanxi Province 030619, China.
| | - Jing Tian
- Department of Cardiology, the 1st Hospital of Shanxi Medical University, 85 South Jiefang Road, Taiyuan, Shanxi Province 030001, China; Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, 56 South XinJian Road, Taiyuan, Shanxi Province 030001, China.
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Hong D, Lee SH, Shin D, Choi KH, Kim HK, Ha SJ, Joh HS, Park TK, Yang JH, Song YB, Hahn J, Choi S, Gwon H, Lee JM. Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function on Cardiovascular Death. J Am Heart Assoc 2023; 12:e027690. [PMID: 36695307 PMCID: PMC9973631 DOI: 10.1161/jaha.122.027690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Background Coronary microvascular dysfunction (CMD) has been considered as a possible cause of cardiac diastolic dysfunction. The current study evaluated the association between cardiac diastolic dysfunction and CMD, and their prognostic implications in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Methods and Results A total of 330 patients without left ventricular systolic dysfunction (ejection fraction ≥50%) and significant epicardial coronary stenosis (fractional flow reserve >0.80) were analyzed. Cardiac diastolic dysfunction was defined by echocardiographic parameters (early diastolic transmitral flow velocity/early diastolic mitral annular velocity, e' velocity, tricuspid regurgitation velocity, and left atrial volume index). Overt CMD was defined as coronary flow reserve <2.0 and index of microcirculatory resistance ≥25 U. The primary end point was cardiovascular death or admission for heart failure during 5 years of follow-up. In patients without left ventricular systolic dysfunction and significant epicardial coronary stenosis, prevalence of cardiac diastolic dysfunction and overt CMD was 25.5% and 11.2%, respectively. Overt CMD was independently associated with cardiac diastolic dysfunction (adjusted odds ratio, 3.440 [95% CI, 1.599-7.401]; P=0.002). Patients with cardiac diastolic dysfunction showed significantly higher risk of the primary outcome than those without (adjusted hazard ratio [HR], 2.996 [95% CI, 1.888-4.755]; P<0.001). Patients with overt CMD also showed significantly higher risk of the primary outcome than those without (adjusted HR, 2.939 [95% CI, 1.642-5.261]; P<0.001). Presence of overt CMD was associated with significantly increased risk of cardiovascular death among the patients with cardiac diastolic dysfunction (43.8% versus 14.5%; P=0.006) but not in patients without cardiac diastolic dysfunction (interaction P<0.001). Inclusion of overt CMD into the model with cardiac diastolic dysfunction significantly improved predictive ability for cardiovascular death or heart failure admission (conconrdance index, 0.719 versus 0.737; P for comparison=0.034). Conclusions There was significant association between the presence of cardiac diastolic dysfunction and overt CMD. Both cardiac diastolic dysfunction and overt CMD were associated with increased risk of cardiovascular death or admission for heart failure. Integration of overt CMD into cardiac diastolic dysfunction showed improvement of the risk stratification in patients without significant left ventricular systolic dysfunction and epicardial coronary stenosis. Registration DIAST-CMD (Prognostic Impact of Cardiac Diastolic Function and Coronary Microvascular Function) registry; Unique identifier: NCT05058833.
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Affiliation(s)
- David Hong
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Seung Hun Lee
- Department of Internal Medicine and Cardiovascular CenterChonnam National University Hospital, Chonnam National University Medical SchoolGwangjuSouth Korea
| | - Doosup Shin
- Division of Cardiology, Department of Internal MedicineDuke University Medical CenterDurhamNC
| | - Ki Hong Choi
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hyun Kuk Kim
- Department of Internal Medicine and Cardiovascular CenterChosun University Hospital, University of Chosun College of MedicineGwangjuSouth Korea
| | - Sang Jin Ha
- Division of Cardiology, Department of Internal Medicine, Gangneung Asan HospitalUniversity of Ulsan College of MedicineGangneungRepublic of Korea
| | - Hyun Sung Joh
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Taek Kyu Park
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jeong Hoon Yang
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Young Bin Song
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Joo‐Yong Hahn
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Seung‐Hyuk Choi
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Hyeon‐Cheol Gwon
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
| | - Joo Myung Lee
- Division of Cardiology, Department of Internal MedicineHeart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of MedicineSeoulSouth Korea
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Veugen MGJ, Linssen PBC, Henry RMA, Koster A, Kroon AA, Stehouwer CDA, Brunner-La Rocca HP. Measures of Left Ventricular Diastolic Function and Cardiorespiratory Fitness According to Glucose Metabolism Status: The Maastricht Study. J Am Heart Assoc 2021; 10:e020387. [PMID: 34121414 PMCID: PMC8403322 DOI: 10.1161/jaha.120.020387] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background This cross‐sectional study evaluated associations between structural and functional measures of left ventricular diastolic function and cardiorespiratory fitness (CRF) in a well‐characterized population‐based cohort stratified according to glucose metabolism status. Methods and Results Six hundred seventy‐two participants from The Maastricht Study (mean±SD age, 61±9 years; 17.4% prediabetes and 25.4% type 2 diabetes mellitus) underwent both echocardiography to determine left atrial volume index, left ventricular mass index, maximum tricuspid flow regurgitation, average e′ and E/e′ ratio; and submaximal cycle ergometer test to determine CRF as maximum power output per kilogram body mass. Associations were examined with linear regression adjusted for cardiovascular risk and lifestyle factors, and interaction terms. After adjustment, in normal glucose metabolism but not (pre)diabetes, higher left atrial volume index (per 1 mL/m2), left ventricular mass index (per 1 g/m2.7), maximum tricuspid regurgitation flow (per 1 m/s) were associated with higher CRF (maximum power output per kilogram body mass; β in normal glucose metabolism 0.015 [0.008–0.023], Pinteraction (pre)diabetes <0.10; 0.007 [−0.001 to 0.015], Pinteraction type 2 diabetes mellitus <0.10; 0.129 [0.011–0.246], Pinteraction >0.10; for left atrial volume index, left ventricular mass index, maximum tricuspid regurgitation flow, respectively). Furthermore, after adjustment, in all individuals, higher average E/e′ ratio (per unit), but not average e′, was associated with lower CRF (normal glucose metabolism −0.044 [−0.071 to −0.016]), Pinteraction >0.10). Conclusions In this population‐based study, structural and functional measures of left ventricular diastolic function were independently differentially associated with CRF over the strata of glucose metabolism status. This suggests that deteriorating left ventricular diastolic function, although of small effect, may contribute to the pathophysiological process of impaired CRF in the general population. Moreover, the differential effects in these structural measures may be the consequence of cardiac structural adaptation to effectively increase CRF in normal glucose metabolism, which is absent in (pre)diabetes.
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Affiliation(s)
- Marja G J Veugen
- Department of Internal MedicineMaastricht University Medical Centre+ Maastricht The Netherlands.,CARIM School for Cardiovascular DiseasesMaastricht University Maastricht The Netherlands
| | - Pauline B C Linssen
- Department of Internal MedicineMaastricht University Medical Centre+ Maastricht The Netherlands.,CARIM School for Cardiovascular DiseasesMaastricht University Maastricht The Netherlands
| | - Ronald M A Henry
- Department of Internal MedicineMaastricht University Medical Centre+ Maastricht The Netherlands.,Heart and Vascular CentreMaastricht University Medical Centre+ Maastricht The Netherlands.,CARIM School for Cardiovascular DiseasesMaastricht University Maastricht The Netherlands
| | - Annemarie Koster
- CAPHRI Care and Public Health Research InstituteMaastricht University Maastricht The Netherlands.,Department of Social Medicine Maastricht University Maastricht The Netherlands
| | - Abraham A Kroon
- Department of Internal MedicineMaastricht University Medical Centre+ Maastricht The Netherlands.,Heart and Vascular CentreMaastricht University Medical Centre+ Maastricht The Netherlands.,CARIM School for Cardiovascular DiseasesMaastricht University Maastricht The Netherlands
| | - Coen D A Stehouwer
- Department of Internal MedicineMaastricht University Medical Centre+ Maastricht The Netherlands.,CARIM School for Cardiovascular DiseasesMaastricht University Maastricht The Netherlands
| | - Hans-Peter Brunner-La Rocca
- Department of Cardiology Maastricht University Medical Centre+ Maastricht The Netherlands.,CARIM School for Cardiovascular DiseasesMaastricht University Maastricht The Netherlands
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Hwang IC, Cho GY, Choi HM, Yoon YE, Park JJ, Park JB, Park JH, Lee SP, Kim HK, Kim YJ. H2FPEF Score Reflects the Left Atrial Strain and Predicts Prognosis in Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail 2020; 27:198-207. [PMID: 33035685 DOI: 10.1016/j.cardfail.2020.09.474] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 09/06/2020] [Accepted: 09/29/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The H2FPEF score is a validated algorithm for the diagnosis of heart failure with preserved ejection fraction (HFpEF). We investigated the associations of the H2FPEF score with echocardiographic parameters and prognosis in patients with HFpEF admitted for acute heart failure. METHODS AND RESULTS In total, 4312 patients at 3 tertiary centers were identified. Among 1335 patients with HFpEF, the H2FPEF score was available in 1105 patients (39% male) with a median age of 77 years (interquartile range 69-82). The median H2FPEF score was 4 (interquartile range 3-6). Patients with higher H2FPEF scores had worse left atrial (LA) size, peak atrial longitudinal strain of the left atrium, mitral E/e' ratio, and peak tricuspid regurgitation velocity. Peak atrial longitudinal strain of the left atrium demonstrated a significant association with the H2FPEF score, in patients without atrial fibrillation and those without atrial fibrillation. After adjustment for clinical factors and echocardiographic parameters, patients with higher H2FPEF scores had a higher risk of mortality and hospitalization for heart failure, regardless of the presence of atrial fibrillation. CONCLUSIONS The H2FPEF score reflects left atrial function in patients with HFpEF admitted for acute heart failure. This association supports the clinical usefulness of the H2FPEF score as an indicator of diastolic dysfunction, a diagnostic algorithm for HFpEF, and a prognostic factor in patients with HFpEF.
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Affiliation(s)
- In-Chang Hwang
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo-Yeong Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea.
| | - Hong-Mi Choi
- Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Gyeonggi, South Korea
| | - Yeonyee E Yoon
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin Joo Park
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, South Korea; Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jun-Bean Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Jae-Hyeong Park
- Department of Cardiology, Internal Medicine, Chungnam National University Hospital, Daejeon, South Korea
| | - Seung-Pyo Lee
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Hyung-Kwan Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, South Korea; Cardiovascular Center and Department of Internal Medicine, Seoul National University Hospital, Seoul, South Korea
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7
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Litwin SE. Left Atrial Strain. JACC Cardiovasc Imaging 2020; 13:2114-2116. [DOI: 10.1016/j.jcmg.2020.07.037] [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: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
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8
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Kachenoura N, Bollache E, Soulat G, Clément-Guinaudeau S, Ashrafpoor G, Perdrix L, Diebold B, Ladouceur M, Mousseaux E. Right ventricular diastolic function in aging: a head-to-head comparison between phase-contrast MRI and Doppler echocardiography. Int J Cardiovasc Imaging 2020; 37:663-674. [PMID: 32980983 DOI: 10.1007/s10554-020-02040-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 09/18/2020] [Indexed: 12/20/2022]
Abstract
To evaluate right ventricle (RV) diastolic function from phase-contrast MRI (PC-MRI) in aging. 89 healthy individuals (50 men, 43 ± 15 years) underwent cardiac MRI including 2D PC-MRI (1.5T) and reference Doppler echocardiography of both ventricles on the same day. Conventional echocardiographic parameters were estimated: early (E, cm/s) and atrial (A) peak velocities as well as myocardial early peak longitudinal velocity (E'). PC-MRI images were analyzed using custom software, providing: E', E and A waves along with respective peak flow rates (Ef, Af, mL/s) and filling volume (mL), for both ventricles. Intra- and inter-observer reproducibility was studied in 30 subjects and coefficients of variation (CoV) as well as intra-class correlation coefficients (ICC) were provided. RV diastolic function indices derived from PC-MRI data were reproducible (CoV ≤ 21%, ICC ≥ 0.75) and reliable as reflected by significant associations with left ventricular diastolic function indices assessed using both echocardiography (linear regression Pearson correlation coefficient r ≤ 0.59) and PC-MRI (r ≤ 71). Despite the fair associations between RV echocardiography and PC-MRI (r ≤ 0.25), the highest correlation with age was obtained for MRI Ef/Af ratio (r = - 0.64, p < 0.0001 vs. r = - 0.40, p = 0.0001 for echocardiographic E/A). Among PC-MRI E/A ratios, highest correlations with age were observed for flow rate and mean velocity ratios (r = - 0.61, p < 0.0001) as compared to maximal velocity ratios (r = - 0.56, p < 0.0001). Associations with age for E' were equivalent between PC-MRI (mean velocity: r = - 0.40, p < 0.0001; maximal velocity: r = - 0.36, p = 0.0005) and echocardiography (r = - 0.36, p = 0.0006). Finally, the significant and age-independent associations between RV mass/end-diastolic volume and E' were stronger for PC-MRI (mean velocity: r = - 0.36, p = 0.0006; maximal velocity: r = - 0.28, p = 0.007) than echocardiography (r = - 0.09, p = 0.38). PC-MRI tricuspid inflow and annulus myocardial velocity parameters were reproducible and able to characterize age-related variations in RV diastolic function.
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Affiliation(s)
- Nadjia Kachenoura
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France.
| | - Emilie Bollache
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France
| | - Gilles Soulat
- PARCC, INSERM, Université de Paris, 75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | | | - Golmehr Ashrafpoor
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Ludivine Perdrix
- Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Benoit Diebold
- Laboratoire d'Imagerie Biomédicale, LIB, INSERM, CNRS, Sorbonne Université, 15 rue de l'école de médecine, 75006, Paris, France.,PARCC, INSERM, Université de Paris, 75015, Paris, France
| | - Magalie Ladouceur
- PARCC, INSERM, Université de Paris, 75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
| | - Elie Mousseaux
- PARCC, INSERM, Université de Paris, 75015, Paris, France.,Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou, 75015, Paris, France
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Nagueh SF, Chandrashekhar Y. Noninvasive Imaging for the Evaluation of Diastolic Function. JACC Cardiovasc Imaging 2020; 13:339-342. [DOI: 10.1016/j.jcmg.2019.12.006] [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: 10/25/2022]
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