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Omar AMS, Murphy S, Felker GM, Piña I, Butler J, Liu Y, Mohebi R, Bhatia K, Ward JH, Williamson KM, Solomon SD, Januzzi JL, Contreras J. Isovolumic Contraction Velocity in Heart Failure With Reduced Ejection Fraction and Effect of Sacubitril/Valsartan: the PROVE-HF Study. J Card Fail 2024; 30:653-665. [PMID: 37816446 DOI: 10.1016/j.cardfail.2023.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/12/2023]
Abstract
OBJECTIVES To assess tissue Doppler-derived mitral annular isovolumic contraction velocity (ICV) after starting sacubitril/valsartan (sac/val) for the treatment of heart failure with reduced ejection fraction (HFrEF) and left ventricular [LV] EF < 40%). BACKGROUND ICV may inform load-independent systolic function; combining ICV and LVEF may improve assessment of LV contractility. METHODS Among 651 participants with HFrEF treated with sac/val, echocardiograms were performed at baseline, 6 and 12 months. Pretreatment median ICVs and LVEFs were used for classification to predict LV reverse remodeling, health status using the Kansas City Cardiomyopathy Questionnaire, and biomarker concentrations. RESULTS The mean age was 64.6 ± 12.4 years, and 28% were women, baseline LVEF: 28.9% ± 6.9%. Compared to baseline, median ICV increased post sac/val therapy (4.6 [3.5, 6.1] vs 4.9 [3.6, 6.4]; P = 0.005). ICV added value to separate and combined models of biomarkers and clinical and echocardiographic variables for prediction of post-therapy EF recovery. Classification using baseline ICV/EF yielded relatively equal numbers in 4 groups based on low/high ICV or LVEF. Most deleterious results for remodeling, health status and biomarkers were found in patients with low ICV/low EF, whereas patients with high ICV/high EF had the best profiles; other groups were intermediate. Significant shifts toward better ICV/EF profiles were noted post sac/val treatment compared to baseline, with doubling of high ICV/high EF (241 [60%] vs 123 [31%]) and 78% reduction of low ICV/low EF (28 [7%] vs 125 [32%]). CONCLUSIONS In HFrEF, ICV adds to the profiling of systolic function and represents an independent predictor of reverse cardiac remodeling after treatment with sac/val. ICV changes may be used for assessment of treatment responses.
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Affiliation(s)
| | | | | | - Ileana Piña
- Thomas Jefferson University, Philadelphia, PA
| | - Javed Butler
- Baylor Scott and White Research Institute, Dallas, TX; University of Mississippi, Jackson, MS
| | - Yuxi Liu
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Reza Mohebi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Kirtipal Bhatia
- Department of Cardiovascular Medicine, Mount Sinai Morningside, New York, NY
| | | | | | - Scott D Solomon
- Harvard Medical School, Brigham and Women's Hospital, Boston, MA
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Boston, MA; Harvard Medical School, Boston. Baim Institute for Clinical Research, Boston, MA.
| | - Johanna Contreras
- Department of Cardiovascular Medicine, Mount Sinai Health System, New York, NY
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Omar AMS, Botero DMR, Caraballo JA, Kim GH, Khachatoorian Y, Kliewer J, Rahman MAA, Rifaie O, Bella JN, Argulian E, Contreras J. Tissue Doppler derived biphasic velocities during the pre and post-ejection phases: patterns, concordance and hemodynamic significance in health and disease. Cardiovasc Ultrasound 2022; 20:17. [PMID: 35836184 PMCID: PMC9281174 DOI: 10.1186/s12947-022-00287-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pre-(PRE) and post-ejection (POE) velocities by mitral annular tissue Doppler (TD) are biphasic and may be related to myocardial deformations. We investigated the predominance and concordance of TD-PRE and POE velocities and their effect on myocardial functions in controls and in heart failure (HF) patients. METHODS Retrospectively, 84 HF patients [57.6 years, 28(33%) females, NYHA: 2.3 ± 0.6, EF: 55 ± 15%, 52(62%) preserved EF, and 32(38%) reduced EF], 42 normal young controls, and 26 asymptomatic age matched controls were included. Echocardiography was done and from mitral annular tissue Doppler recordings, the biphasic PRE and POE velocity signals were identified and compared between groups. RESULTS While controls had almost always predominantly positive PRE and negative POE, HF had more negative PRE and positive POE. Moreover, almost all controls exhibited normal concordance (positive PRE and negative POE). HF exhibited more abnormal concordance which was significantly associated with worse NYHA, and parameters of diastolic and systolic functions. Opposite PRE and POE velocities correlated significantly in all groups (PREp vs POEn: young:r = 0.52, p < 0.001, age controls:r = 0.79, p < 0.001, HFpEF: r = 0.56, p < 0.001, HFrEF: r = 0.42, p = 0.018; PREn vs POEp: young: r = 0.25,p = 0.1, age controls: r = 0.42, p = 0.04, HFpEF: r = 0.43, p = 0.004, HFrEF: r = 0.61, p < 0.001) and the ratios PRE-P/N and POE-N/P correlated significantly with E/e' in HF only. CONCLUSIONS In physiological state, TD signals are predominantly positive during PRE and negative during POE. Opposite PRE and POE velocities corelate, representing the PRE-generation and POE-reversal of shortening-stretch relationships, the attenuation of which in HF may be related to elevated LV filling pressures. In HF, partially or completely reversed concordance of PRE and POE is associated with progressive worsening of clinical and hemodynamic profiles.
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Affiliation(s)
- Alaa Mabrouk Salem Omar
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA. .,Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, USA.
| | | | - Javier Arreaza Caraballo
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA
| | - Ga Hee Kim
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA
| | - Yeraz Khachatoorian
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA
| | - Jaclyn Kliewer
- Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, USA.,Department of General Surgery, HCA Florida Kendall Hospital, Miami, Florida, USA
| | | | - Osama Rifaie
- Depratment of Cardiology, Ain Shams University Hospital, Cairo, Egypt
| | - Jonathan N Bella
- Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Internal Medicine, BronxCare Hospital Center, Bronx, NY, USA
| | - Edgar Argulian
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA.,Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Johanna Contreras
- Department of Cardiology, Mount Sinai Morningside, 1111 Amsterdam avenue, NY, 10025, New York, USA.,Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Kotb MA, Abd El Satar I, Badr AM, Anis NH, Abd El Rahman Ismail H, Hamza AF, Abdelkader HM. Pulmonary hypertension and cardiac hypertrophy in children recipients of orthotopic living related liver transplantation. J Adv Res 2017; 8:663-668. [PMID: 28879059 PMCID: PMC5581852 DOI: 10.1016/j.jare.2017.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 12/17/2022] Open
Abstract
Surgical stress, liberation of cytokines associated with re-perfusion injury, and long standing use of immune suppressive medications in children recipients of orthotopic living related liver transplantation (OLRLT) pose cardiovascular risk. Reported cardiovascular adverse effects vary from left ventricular wall thickening, hypertrophic cardiomyopathy to resting ECG abnormalities, asymptomatic ST depression following increased heart rate and ventricular arrhythmias. Twenty-five consecutive children recipients of OLRLT were assessed by conventional 2-D, M-mode echocardiography and Doppler. The mean age ± SD at transplantation and at enrollment in study was 6.3 ± 4.5 and 13.5 ± 5.6 years respectively. All children were on immunosuppressive medications, with tacrolimus being constant among all. Long-term post-transplant echocardiography revealed statistically significant interventricular septal hypertrophy among all (mean thickness 0.89 ± 0.16 cm), (P = 0.0001) in comparison to reference range for age, 24 had pulmonary hypertension (mean mPAP 36.43 ± 5.60 mm Hg, P = 0.0001), and early diastolic dysfunction with a mean Tei index of 0.40 ± 0.10. However cardiac function was generally preserved. Children recipients of OLRLT have cardiac structural and functional abnormalities that can be asymptomatic. Pulmonary hypertension, increased cardiac mass, de novo aortic stenosis and diastolic heart failure were among abnormalities encountered in the studied population. Echocardiography is indispensible in follow-up of children recipients of OLRLT.
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Affiliation(s)
- Magd A Kotb
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O. Box: 11461, Cairo, Egypt
| | - Inas Abd El Satar
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O. Box: 11461, Cairo, Egypt
| | - Ahmed M Badr
- Department of Pediatrics, Faculty of Medicine, Cairo University, P.O. Box: 11461, Cairo, Egypt
| | - Nancy H Anis
- Ghamra Military Hospital, P.O. Box: 11674, Cairo, Egypt
| | | | - Alaa F Hamza
- Pediatric Surgery Department, Ain Shams University, P.O. Box: 11588, Cairo, Egypt
| | - Hesham M Abdelkader
- Pediatric Surgery Department, Ain Shams University, P.O. Box: 11588, Cairo, Egypt
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Koenig TR, Mitchell KJ, Schwarzwald CC. Echocardiographic Assessment of Left Ventricular Function in Healthy Horses and in Horses with Heart Disease Using Pulsed-Wave Tissue Doppler Imaging. J Vet Intern Med 2017; 31:556-567. [PMID: 28109132 PMCID: PMC5354014 DOI: 10.1111/jvim.14641] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Revised: 09/14/2016] [Accepted: 11/21/2016] [Indexed: 12/31/2022] Open
Abstract
Background Assessment of left ventricular (LV) function by tissue Doppler imaging (TDI) is not well established in horses with heart disease. Objectives To describe the use of pulsed‐wave (PW) TDI for the assessment of LV function, establish reference intervals, investigate effects of mitral regurgitation (MR), aortic regurgitation (AR), and primary myocardial disease (MD), and provide proof of concept for the use of PW TDI in Warmblood horses with heart disease. Animals Thirty healthy horses, 38 horses with MR, 25 with AR, 8 with MD. Methods Echocardiograms were retrospectively analyzed. Reference intervals were calculated. PW TDI indices of healthy horses and horses with MR, AR, and MD were compared by one‐way ANOVA and Dunnett's test. Results A complete set of PW TDI variables could be obtained in 94 of 101 horses. Variables corresponding to isovolumic intervals were most difficult to measure. Valvular regurgitation influenced variables describing isovolumic contraction and ejection. Horses with MD had significantly shortened ETm (−118.5 [−154.1 to −82.9] ms; mean difference [95% CI of difference of means]), increased PEPm/ETm (0.11 [0.05 to 0.17]), prolonged IMPm (0.28 [0.18 to 0.37]), increased S1 (8.9 [5.2 to 12.6] cm/s), and decreased E1 (−2.6 [−4.7 to −0.5] cm/s), Em (−14.2 [−19.9 to −8.5] cm/s), and Em/Am ratio (−1.6 [−2.6 to −0.6]). Conclusions and Clinical Importance Pulsed‐wave TDI might be useful for detection of LV dysfunction in horses with primary MD. The clinical value of TDI in horses with MR and AR remains uncertain.
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Affiliation(s)
- T R Koenig
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - K J Mitchell
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
| | - C C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland
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