1
|
Bogaert J, Bekhuis Y, Rosseel T, Laveaux S, Dausin C, Voigt JU, Claessen G, Dresselaers T. Use of Real-Time Cine MRI to Assess the Respirophasic Variation of the Inferior Vena Cava-Proof-of-Concept and Validation Against Transthoracic Echocardiography. J Magn Reson Imaging 2024; 59:1809-1817. [PMID: 37427759 DOI: 10.1002/jmri.28863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/26/2023] [Accepted: 05/30/2023] [Indexed: 07/11/2023] Open
Abstract
BACKGROUND In clinical practice, the right heart filling status is assessed using the respirophasic variation of the inferior vena cava (IVC) assessed by transthoracic echocardiography (TTE) showing moderate correlations with the catheter-based reference standard. PURPOSE To develop and validate a similar approach using MRI. STUDY TYPE Prospective. POPULATION 37 male elite cyclists (mean age 26 ± 4 years). FIELD STRENGTH/SEQUENCE Real-time balanced steady-state free-precession cine sequence at 1.5 Tesla. ASSESSMENT Respirophasic variation included assessment of expiratory size of the upper hepatic part of the IVC and degree of inspiratory collapse expressed as collapsibility index (CI). The IVC was studied either in long-axis direction (TTE) or using two transverse slices, separated by 30 mm (MRI) during operator-guided deep breathing. For MRI, in addition to the TTE-like diameter, IVC area and major and minor axis diameters were also assessed, together with the corresponding CIs. STATISTICAL TESTS Repeated measures ANOVA test with Bonferroni correction. Intraclass correlation coefficient (ICC) and Bland-Altman analysis for intrareader and inter-reader agreement. A P value <0.05 was considered statistically significant. RESULTS No significant differences in expiratory IVC diameter were found between TTE and MRI, i.e., 25 ± 4 mm vs. 25 ± 3 mm (P = 0.242), but MRI showed a higher CI, i.e., 76% ± 14% vs. 66% ± 14% (P < 0.05). As the IVC presented a noncircular shape, i.e., major and minor expiratory diameter of 28 ± 4 mm and 21 ± 4 mm, respectively, the CI varied according to the orientation, i.e., 63% ± 27% vs. 75% ± 16%, respectively. Alternatively, expiratory IVC area was 4.3 ± 1.1 cm2 and showed a significantly higher CI, i.e., 86% ± 14% than diameter-based CI (P < 0.05). All participants showed a CI >50% with MRI versus 35/37 (94%) with TTE. ICC values ranged 0.546-0.841 for MRI and 0.545-0.704 for TTE. CONCLUSION Assessment of the respirophasic IVC variation is feasible with MRI. Adding this biomarker may be of particular use in evaluating heart failure patients. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY STAGE: 2.
Collapse
Affiliation(s)
- Jan Bogaert
- Department of Radiology, UZ Leuven, Leuven, Belgium
- Department of Imaging and Pathology, KU Leuven, Leuven, Belgium
| | - Youri Bekhuis
- Department of Cardiology, UZ Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | | | | | | | - Jens-Uwe Voigt
- Department of Cardiology, UZ Leuven, Leuven, Belgium
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
- Department of Cardiology, Hartcentrum, Jessa Ziekenhuis, Hasselt, Belgium
| | | |
Collapse
|
2
|
Hammoud S, van den Bemt BJF, Jaber A, Kurdi M. Impaired cardiac structure and systolic function in athletes using supra-physiological doses of anabolic androgenic steroids. J Sci Med Sport 2023; 26:514-521. [PMID: 37758530 DOI: 10.1016/j.jsams.2023.08.180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 07/26/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023]
Abstract
OBJECTIVES Athletes are increasingly using supra-physiological doses of anabolic androgenic steroids without weighing health side effects. This study aims to conjointly evaluate the effect of supraphysiological doses of anabolic androgenic steroids on global cardiovascular structure and functional capacity. DESIGN Cross-sectional study. METHODS 92 males enrolled in the study, including 18 sedentary subjects, 26 anabolic androgenic steroid non-user athletes, and 48 anabolic androgenic steroid-user athletes. Two-dimensional echocardiography was done to evaluate the cardiovascular structure and function. RESULTS Anabolic androgenic steroid-users presented increased cardiac remodeling of the left ventricle and left atrium compared to control groups (p < 0.001). Anabolic androgenic steroid-users showed increased left ventricular mass/body surface area versus control groups (p < 0.001), with 28 steroid-users (58.3 %) having cardiac remodeling, which is more than control groups (p < 0.001). Anabolic androgenic steroid-users presented lower diastolic function (E and E/A) compared to non-users (p = 0.003 and <0.001, respectively). Ejection fraction was decreased among anabolic androgenic steroid-users versus the sedentary group only (p = 0.020), while anabolic androgenic steroid-users presented reduced global longitudinal strain of 15.43 % compared to both control groups (p < 0.001). Moreover, anabolic androgenic steroid-users experienced more tricuspid valve regurgitation (p = 0.001). CONCLUSIONS Anabolic androgenic steroid consumption is associated with global cardiac remodeling with increased dimensions of the left ventricle, and atrium. Anabolic androgenic steroid-users present left ventricular hypertrophy with reduced subclinical systolic function. Moreover, anabolic androgenic steroid consumption is correlated with valve regurgitation and dilation of the sino-tubular junction.
Collapse
Affiliation(s)
- Sabah Hammoud
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Sciences, Section 1, Lebanese University, Rafic Hariri Educational Campus, Hadat, Lebanon; Department of Pharmacy, Radboud University Medical Center, the Netherlands
| | - Bart J F van den Bemt
- Department of Pharmacy, Radboud University Medical Center, the Netherlands; Department of Pharmacy, Sint Maartenskliniek, the Netherlands; Department of Pharmacy, University Medical Center Maastricht, the Netherlands
| | - Ayman Jaber
- Department of Cardiology, Mount Lebanon Hospital - University Medical Center, Lebanon
| | - Mazen Kurdi
- Laboratory of Experimental and Clinical Pharmacology, Faculty of Sciences, Section 1, Lebanese University, Rafic Hariri Educational Campus, Hadat, Lebanon.
| |
Collapse
|
3
|
Spiliotaki E, Saranteas T, Moschovaki N, Panagouli K, Pistioli E, Kitsinelis V, Briasoulis P, Papadimos T. Inferior vena cava ultrasonography in the assessment of intravascular volume status and fluid responsiveness in the emergency department and intensive care unit: A critical analysis review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2022; 50:733-744. [PMID: 35302241 DOI: 10.1002/jcu.23194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/23/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
Rapid evaluation of intravascular volume status is vital; either excessive or limited fluid administration may result in adverse patient outcomes. In this narrative review, critical analysis of pertinent diagnostic accuracy studies is developed to delineate the role of inferior vena cava ultrasound measurements in the assessment of both intravascular volume status and fluid responsiveness in the emergency department and intensive care unit. In addition, limitations, and technical considerations of inferior vena cava ultrasound measurements as well as directions for future research are thoroughly discussed.
Collapse
Affiliation(s)
- Eleni Spiliotaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Theodosios Saranteas
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nefeli Moschovaki
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Konstantina Panagouli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Efstathia Pistioli
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Vasilios Kitsinelis
- Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Panagiotis Briasoulis
- Department of Anesthesiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Thomas Papadimos
- Department of Anesthesia, Division of critical care, Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
4
|
Fujioka T, Nakamura K, Minamoto T, Tsuzuki N, Yamaguchi J, Hidaka Y. Ultrasonographic evaluation of the caudal vena cava in dogs with right-sided heart disease. J Vet Cardiol 2021; 34:80-92. [PMID: 33626419 DOI: 10.1016/j.jvc.2021.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 01/17/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION/OBJECTIVES In humans with impaired right-sided cardiac function, the caudal vena cava (CVC) diameter serves as a marker of venous congestion. This study aimed to investigate whether ultrasonographic CVC variables could identify the presence of right-sided congestive heart failure (R-CHF) in dogs with right-sided heart disease (RHD). ANIMALS Fifty client-owned control dogs and 67 dogs with RHD were enrolled. The dogs with RHD were subdivided into the non-R-CHF (n = 43) and R-CHF (n = 24) groups. MATERIALS AND METHODS We measured and compared the ultrasonographic CVC variables and echocardiographic variables among the groups. Receiver operating characteristic (ROC) curve analysis was performed to calculate the sensitivity and specificity of the variables at optimal cutoff values. RESULTS We obtained the highest accuracies of the ratio of the shortest diameter (SD) of the minimal CVC area to the aorta diameter (Ao) during inspiration [SD(min)/Ao] and of the ratio of SD(min) to the longest diameter of the minimal CVC area during inspiration [LD(min),SD/LD(min)], with high sensitivities, specificities, and an area under the ROC curve greater than 0.925. CONCLUSIONS In addition to the echocardiographic assessment of right-sided cardiac function, the CVC variables in this study, especially SD(min)/Ao and SD/LD(min), would be useful diagnostic indices for identifying R-CHF in dogs with RHD.
Collapse
Affiliation(s)
- T Fujioka
- Asap Animal Clinic, 3597-1 Ganda, Nogata, Fukuoka 822-0001, Japan; Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki 889-2192, Japan
| | - K Nakamura
- Organization for Promotion of Tenure Track, University of Miyazaki, 1-1 Gakuen, Kibanadai-nishi, Miyazaki 889-2192, Japan
| | - T Minamoto
- Evergreen Vet Research & Publication, 2-10-2 Hanaike, Ichinomiya, Aichi 491-0914, Japan
| | - N Tsuzuki
- Department of Clinical Veterinary Science, Obihiro University of Agriculture and Veterinary Medicine, Inada, Obihiro, Hokkaido 080-8555, Japan
| | - J Yamaguchi
- Asap Animal Clinic, 3597-1 Ganda, Nogata, Fukuoka 822-0001, Japan
| | - Y Hidaka
- Laboratory of Veterinary Surgery, Department of Veterinary Medicine, Faculty of Agriculture, University of Miyazaki, 1-1 Gakuen Kibanadai-nishi, Miyazaki 889-2192, Japan.
| |
Collapse
|
5
|
The Impact of Exercise and Athletic Training on Vascular Structure and Function. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2020. [DOI: 10.1007/s11936-020-00861-7] [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: 10/23/2022]
|
6
|
Beaubien-Souligny W, Rola P, Haycock K, Bouchard J, Lamarche Y, Spiegel R, Denault AY. Quantifying systemic congestion with Point-Of-Care ultrasound: development of the venous excess ultrasound grading system. Ultrasound J 2020; 12:16. [PMID: 32270297 PMCID: PMC7142196 DOI: 10.1186/s13089-020-00163-w] [Citation(s) in RCA: 252] [Impact Index Per Article: 63.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 02/17/2020] [Indexed: 12/12/2022] Open
Abstract
Background Organ congestion is a mediator of adverse outcomes in critically ill patients. Point-Of-Care ultrasound (POCUS) is widely available and could enable clinicians to detect signs of venous congestion at the bedside. The aim of this study was to develop several grading system prototypes using POCUS and to determine their respective ability to predict acute kidney injury (AKI) after cardiac surgery. This is a post-hoc analysis of a single-center prospective study in 145 patients undergoing cardiac surgery for which repeated daily measurements of hepatic, portal, intra-renal vein Doppler and inferior vena cava (IVC) ultrasound were performed during the first 72 h after surgery. Five prototypes of venous excess ultrasound (VExUS) grading system combining multiple ultrasound markers were developed. Results The association between each score and AKI was assessed using time-dependant Cox models as well as conventional performance measures of diagnostic testing. A total of 706 ultrasound assessments were analyzed. We found that defining severe venous congestion as the presence of severe flow abnormalities in multiple Doppler patterns with a dilated IVC (≥ 2 cm) showed the strongest association with the development of subsequent AKI compared with other combinations (HR: 3.69 CI 1.65–8.24 p = 0.001). The association remained significant after adjustment for baseline risk of AKI and vasopressor/inotropic support (HR: 2.82 CI 1.21–6.55 p = 0.02). Furthermore, this severe VExUS grade offered a useful positive likelihood ratio (+LR: 6.37 CI 2.19–18.50) when detected at ICU admission, which outperformed central venous pressure measurements. Conclusions The combination of multiple POCUS markers may identify clinically significant venous congestion.
Collapse
Affiliation(s)
- William Beaubien-Souligny
- Department of Anesthesiology and Intensive Care, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada. .,Division of Nephrology, Centre Hospitalier de l'Université de Montreal, 1000, Rue St-Denis, Montreal, QC, H2X 0C1, Canada.
| | - Philippe Rola
- Division of Intensive Care, Santa Cabrini Hospital, Montreal, QC, Canada
| | - Korbin Haycock
- Department of Emergency Medicine, Loma Linda University School of Medicine, Loma Linda, CA, 92354, USA
| | - Josée Bouchard
- Division of Nephrology, Hôpital Sacré-Cœur de Montréal, Montreal, QC, Canada
| | - Yoan Lamarche
- Department of Surgery and Critical Care, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Rory Spiegel
- Departments of Critical Care and Emergency Medicine, Washington Hospital Center, Georgetown University, Washington, DC, USA
| | - André Y Denault
- Department of Anesthesiology and Intensive Care, Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada.,Division of Intensive Care, Centre Hospitalier de L'Université de Montreal, Montreal, QC, Canada
| |
Collapse
|
7
|
Cops J, De Moor B, Haesen S, Lijnen L, Wens I, Lemoine L, Reynders C, Penders J, Lambrichts I, Mullens W, Hansen D. Endurance Exercise Intervention Is Beneficial to Kidney Function in a Rat Model of Isolated Abdominal Venous Congestion: a Pilot Study. J Cardiovasc Transl Res 2019; 13:769-782. [PMID: 31848881 DOI: 10.1007/s12265-019-09947-5] [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] [Received: 10/02/2019] [Accepted: 12/09/2019] [Indexed: 11/24/2022]
Abstract
In this study, the effects of moderate intense endurance exercise on heart and kidney function and morphology were studied in a thoracic inferior vena cava constricted (IVCc) rat model of abdominal venous congestion. After IVC surgical constriction, eight sedentary male Sprague-Dawley IVCc rats (IVCc-SED) were compared to eight IVCc rats subjected to moderate intense endurance exercise (IVCc-MOD). Heart and kidney function was examined and renal functional reserve (RFR) was investigated by administering a high protein diet (HPD). After 12 weeks of exercise training, abdominal venous pressure, indices of body fat content, plasma cystatin C levels, and post-HPD urinary KIM-1 levels were all significantly lower in IVCc-MOD versus IVCc-SED rats (P < 0.05). RFR did not differ between both groups. The implementation of moderate intense endurance exercise in the IVCc model reduces abdominal venous pressure and is beneficial to kidney function.
Collapse
Affiliation(s)
- Jirka Cops
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium. .,Faculty of Medicine and Life Sciences, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.
| | - Bart De Moor
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.,Department of Nephrology, Jessa Ziekenhuis, 3500, Hasselt, Belgium
| | - Sibren Haesen
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.,Faculty of Medicine and Life Sciences, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium
| | - Lien Lijnen
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium
| | - Inez Wens
- Laboratory of Experimental Hematology, Vaccine & Infectious Disease Institute, Faculty of Medicine and Health Sciences, University of Antwerp, 2000, Antwerp, Belgium
| | - Lieselotte Lemoine
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.,Department of Surgical Oncology, Ziekenhuis Oost-Limburg, 3600, Genk, Belgium
| | - Carmen Reynders
- Clinical Laboratory, Ziekenhuis Oost-Limburg, 3600, Genk, Belgium
| | - Joris Penders
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.,Clinical Laboratory, Ziekenhuis Oost-Limburg, 3600, Genk, Belgium
| | - Ivo Lambrichts
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium
| | - Wilfried Mullens
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.,Department of Cardiology, Ziekenhuis Oost-Limburg, 3600, Genk, Belgium
| | - Dominique Hansen
- BIOMED, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.,REVAL, UHasselt - Universiteit Hasselt, Agoralaan, 3590, Diepenbeek, Belgium.,Heart Centre, Jessa Ziekenhuis, 3500, Hasselt, Belgium
| |
Collapse
|
8
|
Bjarnegård N, Länne T, Cinthio M, Ekstrand J, Hedman K, Nylander E, Henriksson J. Vascular characteristics in young women-Effect of extensive endurance training or a sedentary lifestyle. Acta Physiol (Oxf) 2018; 223:e13041. [PMID: 29359513 DOI: 10.1111/apha.13041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/13/2022]
Abstract
AIM To explore whether high-level endurance training in early age has an influence on the arterial wall properties in young women. METHODS Forty-seven athletes (ATH) and 52 controls (CTR), all 17-25 years of age, were further divided into runners (RUN), whole-body endurance athletes (WBA), sedentary controls (SC) and normally active controls (AC). Two-dimensional ultrasound scanning of the carotid arteries was conducted to determine local common carotid artery (CCA) geometry and wall distensibility. Pulse waves were recorded with a tonometer to determine regional pulse wave velocity (PWV) and pulse pressure waveform. RESULTS Carotid-radial PWV was lower in WBA than in RUN (P < .05), indicating higher arterial distensibility along the arm. Mean arterial pressure was lower in ATH than in CTR and in RUN than in WBA (P < .05). Synthesized aortic augmentation index (AI@75) was lower among ATH than among CTR (-12.8 ± 1.6 vs -2.6 ± 1.2%, P < .001) and in WBA than in RUN (-16.4 ± 2.5 vs -10.7 ± 2.0%, P < .05), suggesting a diminished return of reflection waves to the aorta during systole. Carotid-femoral PWV and intima-media thickness (IMT), lumen diameter and radial distensibility of the CCA were similar in ATH and CTR. CONCLUSION Elastic artery distensibility and carotid artery IMT are not different in young women with extensive endurance training over several years and in those with sedentary lifestyle. On the other hand, our data suggest that long-term endurance training is associated with potentially favourable peripheral artery adaptation, especially in sports where upper body work is added. This adaptation, if persisting later in life, could contribute to lower cardiovascular risk.
Collapse
Affiliation(s)
- N. Bjarnegård
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Department of Clinical Physiology; Region Jönköping County; Jönköping Sweden
| | - T. Länne
- Division of Cardiovascular Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
- Department of Thoracic and Vascular Surgery; Region Östergötland; Linköping Sweden
| | - M. Cinthio
- Department of Biomedical Engineering; Faculty of Engineering; Lund University; Lund Sweden
| | - J. Ekstrand
- Division of Community Medicine; Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - K. Hedman
- Department of Clinical Physiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - E. Nylander
- Department of Clinical Physiology and Department of Medical and Health Sciences; Linköping University; Linköping Sweden
| | - J. Henriksson
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm Sweden
| |
Collapse
|