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Prajapathi S, Kapoor A, Agarwal SK, Tewari P, Pande S, Chandra B, Sahu A, Khanna R, Kumar S, Garg N, Tewari S. Does high dose statin pretreatment affect global strains in patients undergoing valve replacement. Indian J Thorac Cardiovasc Surg 2024; 40:300-310. [PMID: 38681712 PMCID: PMC11045680 DOI: 10.1007/s12055-023-01652-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 11/08/2023] [Accepted: 11/09/2023] [Indexed: 05/01/2024] Open
Abstract
Purpose To study the effect of rosuvastatin 40 mg (initiated 7 days prior to surgery) in patients undergoing valve replacement (VR) for rheumatic mitral valve disease on left ventricular (LV) strain and biomarker release kinetics. Methods In this randomized study, cardiac biomarkers viz. troponin I (TnI), Creatine kinase MB (CK-MB), N-terminal pro B-type natriuretic peptide (NTPBNP) were measured before surgery; and 8, 24 and 48 h postoperatively. Global LV (circumferential, global circumferential strain (GCS); longitudinal, GLS; radial, global radial strain (GRS)) strains were measured preoperatively; and 48 h and 30 days postoperatively. Results Following VR, Global Longitudinal Strain (GLS), Global Circumferential Strain (GCS) and Global Radial Strain (GRS) declined at 48 h in both statin loaded (SL) and non loaded (NL) groups. The %decline in strain was significantly lower in SL group (% change in GLS 35.8% vs 38.8%, GCS 34% vs 44.1%, GRS 45.7% vs 52.6%; p < 0.001).All strain values improved at 30 days with higher improvement in SL group (GLS -15.92 ± 2.00% vs -12.6 ± 1.66%, GCS -15.12 ± 2.93% vs -13.04 ± 2.44%; GRS 22.12 ± 6.85% vs 19.32 ± 6.48%). While TnI, CKMB, NTPBNP increased following surgery, values at 8, 24 and 48 h were lower in the SL vs. NL group. Mean change (baseline to peak biomarker value) was also significantly lower in SL group.The SL group had shorter hospital and Intensive Care Unit (ICU) stay. On Receiver Operating Characteristic Curve (ROC) analysis, baseline GCS ≤ 14% best predicted postoperative 30 day Left Ventricular Ejection Fraction (LVEF) ≤ 50%. Conclusion Pre-operative high dose rosuvastatin was "cardioprotective" with favorable effect on LV global strain and release kinetics of biomarkers. These cut-offs (described for the first time for rheumatic VR) can be used as prognostic predictors.
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Affiliation(s)
- Sudesh Prajapathi
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Aditya Kapoor
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | | | - Prabhat Tewari
- Cardiac Anesthesia, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Shantanu Pande
- Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Bipin Chandra
- Cardiovascular and Thoracic Surgery, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Ankit Sahu
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Roopali Khanna
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Sudeep Kumar
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Naveen Garg
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
| | - Satyendra Tewari
- Department of Cardiology, Sanjay Gandhi PGIMS, Lucknow, 226014 India
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Hirasawa K, Izumo M, Akashi YJ. Stress echocardiography in valvular heart disease. Front Cardiovasc Med 2023; 10:1233924. [PMID: 38162127 PMCID: PMC10755922 DOI: 10.3389/fcvm.2023.1233924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2023] [Accepted: 11/24/2023] [Indexed: 01/03/2024] Open
Abstract
Valvular heart disease (VHD) has been a significant health problem, particularly in developed countries, in relation to the aging population. Recent developments in the management of VHD require a more accurate assessment of disease severity to determine the need for transcatheter interventions or open heart surgery. Stress echocardiography is a crucial imaging modality for identifying the underlying pathology of VHD. Optimal administration of exercise or intravenous drugs may reveal hemodynamic abnormalities under stress without posing an invasive risk. Therefore, the implementation of stress echocardiography is recommended for determining interventional indications and risk stratification in mitral regurgitation and aortic stenosis. In addition, recent evidence has accumulated regarding the usefulness of stress echocardiography in various conditions including mitral stenosis, aortic regurgitation, and post-interventional VHD. Here, we summarize the current evidence and future perspectives on stress echocardiography in VHD.
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Affiliation(s)
- Kensuke Hirasawa
- Department of Cardiovascular Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yoshihiro J. Akashi
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine, Kawasaki, Japan
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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
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Kislitsina ON, Thomas JD, Crawford E, Michel E, Kruse J, Liu M, Andrei AC, Cox JL, McCarthy PM. Predictors of Left Ventricular Dysfunction After Surgery for Degenerative Mitral Regurgitation. Ann Thorac Surg 2019; 109:669-677. [PMID: 31830438 DOI: 10.1016/j.athoracsur.2019.10.044] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 10/10/2019] [Accepted: 10/14/2019] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study was performed to determine whether strain can supplement the ability of left ventricular (LV) ejection fraction (LVEF) to predict postoperative ventricular dysfunction in patients undergoing mitral valve surgery for degenerative mitral regurgitation (DMR). METHODS From 2004 to 2017, 520 patients with an LVEF of 60% or more underwent mitral valve surgery (98% repair) for DMR. All patients had preoperative, predischarge, and follow-up (mean, 5.0 ± 3.6 years) echocardiograms. Speckle tracking was performed in 119 of 520 patients (22.9%) to determine LV strain, right ventricular free-wall strain, and left atrial longitudinal strain. Multivariate logistic and Cox regression models were used in this subgroup to evaluate associations with early postoperative LV dysfunction and medium-term overall survival, respectively. RESULTS Median preoperative LVEF of the entire cohort was 65%. Based on predischarge echocardiogram, 449 patients (86.3%) maintained postoperative LVEF of 50% or greater. Seventy-one patients (13.7%) had a predischarge LVEF of less than 50%, 49 (9.4%) had a predischarge LVEF of 40% to 49%, and 22 (4.2% overall) had a predischarge LVEF of less than 40%. Abnormal preoperative LV, right ventricular, and left atrial strain measurements were significantly associated with the development of postoperative LV dysfunction, but preoperative hemodynamic and non-strain echo parameters did not vary enough in absolute values to be clinically useful as predictors of postoperative LV dysfunction. CONCLUSIONS Preoperative strain measurements in DMR patients were significantly associated with superior capabilities of detecting underlying LV dysfunction despite preserved preoperative LVEF. Strain analysis may serve as another marker for optimal timing of surgical intervention in DMR patients.
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Affiliation(s)
- Olga N Kislitsina
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.
| | - James D Thomas
- Division of Cardiology, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Erin Crawford
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Eriberto Michel
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Jane Kruse
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Menghan Liu
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Adin-Cristian Andrei
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - James L Cox
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Patrick M McCarthy
- Division of Cardiac Surgery, Bluhm Cardiovascular Institute, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
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Kim HM, Cho GY, Hwang IC, Choi HM, Park JB, Yoon YE, Kim HK. Myocardial Strain in Prediction of Outcomes After Surgery for Severe Mitral Regurgitation. JACC Cardiovasc Imaging 2018; 11:1235-1244. [DOI: 10.1016/j.jcmg.2018.03.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Revised: 02/20/2018] [Accepted: 03/20/2018] [Indexed: 12/29/2022]
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Mentias A, Alashi A, Naji P, Gillinov AM, Rodriguez LL, Mihaljevic T, Suri RM, Grimm RA, Svensson LG, Griffin BP, Desai MY. Exercise capacity in asymptomatic patients with significant primary mitral regurgitation: independent effect of global longitudinal left ventricular strain. Cardiovasc Diagn Ther 2018; 8:460-468. [PMID: 30214861 DOI: 10.21037/cdt.2018.05.03] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background Despite preserved left ventricular ejection fraction (LVEF), patients with significant primary mitral regurgitation (MR) often have reduced exercise capacity. In asymptomatic patients with ≥3+ primary MR undergoing rest-stress echocardiography (RSE), we sought to evaluate the incremental impact of left ventricular global longitudinal strain (LV-GLS) on exercise capacity. Methods A total of 660 asymptomatic patients with ≥3+ primary MR, non-dilated LV and LVEF ≥60% (mean age, 57±14 years, 66% men, body mass index or BMI 25±4 kg/m2) who underwent RSE at our center between 2001 and 2013 were included. Standard RSE data were obtained. Average resting LV-GLS was measured using Velocity Vector Imaging. Results Mean mitral effective regurgitant orifice, resting right ventricular systolic pressure (RVSP) and LV-GLS were 0.45±0.2 cm2, 31±12 mmHg and -21.7%±2%, respectively; 28% had flail mitral leaflet. Mean metabolic equivalents (METs) and post-stress RVSP were 9.9±3, and 46±15 mmHg; 28% achieved <100% age-gender predicted METs. No patient had ischemia or significant arrhythmias. On logistic regression, resting LV-GLS [odds ratio (OR), 1.40, 95% confidence interval (CI): 1.21-1.55, BMI (OR, 1.11, 95% CI: 1.06-1.17)] and resting RVSP 1.22 (1.02-1.49) were independent predictors of exercise capacity. Area under the curve for association between 100% age-gender predicted METs and various factors were as follows: (I) BMI (0.60, 95% CI: 0.55-0.65, P<0.001); (II) resting RVSP (0.57, 95% CI: 0.52-0.62, P=0.006) and LV-GLS (0.66, 95% CI: 0.61-0.70, P<0.001). Conclusions In asymptomatic patients with ≥3+ primary MR, non-dilated LV and preserved LVEF, LV-GLS is independently associated with exercise capacity, beyond known predictors.
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Affiliation(s)
- Amgad Mentias
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alaa Alashi
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Peyman Naji
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - A Marc Gillinov
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - L Leonardo Rodriguez
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Tomislav Mihaljevic
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Rakesh M Suri
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Richard A Grimm
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Lars G Svensson
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Brian P Griffin
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Milind Y Desai
- Heart Valve Center, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
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7
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Suzuki K, Hirano Y, Yamada H, Murata M, Daimon M, Takeuchi M, Seo Y, Izumi C, Akaishi M. Practical guidance for the implementation of stress echocardiography. J Echocardiogr 2018; 16:105-129. [PMID: 29876799 PMCID: PMC6132937 DOI: 10.1007/s12574-018-0382-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 05/07/2018] [Accepted: 05/16/2018] [Indexed: 01/01/2023]
Abstract
Exercise stress testing has been widely undertaken for the diagnosis of heart diseases. The accurate assessment of clinical conditions can be conducted by comparing the findings obtained from the results of stress echocardiography with the changes in the blood/heart rate and electrocardiograms. Numerous overseas studies have reported the utility of stress echocardiography in diagnosing myocardial ischemia; in Japan, the use of this modality for this purpose was included in the national health insurance reimbursable list in 2012. Nevertheless, stress echocardiography is far from being a widespread practice in Japan. This might be due to insufficient equipment (e.g., ergometers, space for test implementation) at each medical institution, shortage of technicians and sonographers who are well experienced and who are responsible for obtaining images during stress testing. The other possible reasons include the limited evidence available in Japan and the lack of a standardized testing protocol. Further dissemination of the practice of exercise stress echocardiography in this country is deemed necessary to establish satisfactory evidence for the use of stress echocardiography in the Japanese population. To this end, efforts are underway to develop a standardized protocol and report format to be adopted throughout Japan. We here present a guideline created by the Guideline Development Committee of the Japanese Society of Echocardiography that describes safe and effective stress echocardiography protocols and report formats. The readers are encouraged to perform exercise stress echocardiography using the proposed template for consensus document and report attached to this guideline.
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Affiliation(s)
- Kengo Suzuki
- Division of Cardiology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yutaka Hirano
- Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Hirotsugu Yamada
- Department of Cardiology, Tokushima University Hospital, Tokushima, Japan
| | - Mitsushige Murata
- Department of Laboratory Medicine, School of Medicine, Keio University, Tokyo, Japan
| | - Masao Daimon
- Department of Clinical Laboratory, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of the University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshihiro Seo
- Cardiovascular Division, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Chisato Izumi
- National Cerebral and Cardiovascular Center, Suita, Japan
| | - Makoto Akaishi
- Tokai University Tokyo Hospital, 1-2-5 Yoyogi Shibuya-ku, Tokyo, Japan.
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8
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Kim JD, Son I, Kwon WK, Sung TY, Sidik H, Kim K, Kang H, Bang J, Yeo GE, Lee DK, Kim TY. Isoflurane's Effect on Intraoperative Systolic Left Ventricular Performance in Cardiac Valve Surgery Patients. J Korean Med Sci 2018; 33:e28. [PMID: 29318795 PMCID: PMC5760813 DOI: 10.3346/jkms.2018.33.e28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/28/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Isoflurane, a common anesthetic for cardiac surgery, reduced myocardial contractility in many experimental studies, few studies have determined isoflurane's direct impact on the left ventricular (LV) contractile function during cardiac surgery. We determined whether isoflurane dose-dependently reduces the peak systolic velocity of the lateral mitral annulus in tissue Doppler imaging (S') in patients undergoing cardiac surgery. METHODS During isoflurane-supplemented remifentanil-based anesthesia for patients undergoing cardiac surgery with preoperative LV ejection fraction greater than 50% (n = 20), we analyzed the changes of S' at each isoflurane dose increment (1.0, 1.5, and 2.0 minimum alveolar concentration [MAC]: T1, T2, and T3, respectively) with a fixed remifentanil dosage (1.0 μg/min/kg) by using transesophageal echocardiography. RESULTS Mean S' values (95% confidence interval [CI]) at T1, T2, and T3 were 10.5 (8.8-12.2), 9.5 (8.3-10.8), and 8.4 (7.3-9.5) cm/s, respectively (P < 0.001 in multivariate analysis of variance test). Their mean differences at T1 vs. T2, T2 vs. T3, and T1 vs. T3 were -1.0 (-1.6, -0.3), -1.1 (-1.7, -0.6), and -2.1 (-3.1, -1.1) cm/s, respectively. Phenylephrine infusion rates were significantly increased (0.26, 0.22, and 0.47 μg/kg/min at T1, T2, and T3, respectively, P < 0.001). CONCLUSION Isoflurane increments (1.0-2.0 MAC) dose-dependently reduced LV systolic long-axis performance during cardiac surgeries with a preserved preoperative systolic function.
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Affiliation(s)
- Ju Deok Kim
- Department of Anesthesiology and Pain Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ilsoon Son
- Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea
| | - Won Kyoung Kwon
- Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea
- Department of Anesthesiology, Konkuk University School of Medicine, Seoul, Korea
| | - Tae Yun Sung
- Department of Anesthesiology, Konyang University Hospital, Konyang University College of Medicine, Daejeon, Korea
| | - Hanafi Sidik
- Cardiothoracic Anaesthesiology and Perfusion Unit, Sarawak General Hospital, Jalan Tun Ahmad Zaidi Adruce, Sarawak, Malaysia
| | - Karam Kim
- Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea
| | - Hyun Kang
- Department of Anesthesiology, Chung-Ang University School of Medicine, Seoul, Korea
| | - Jiyon Bang
- Department of Anesthesiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gwi Eun Yeo
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Dong Kyu Lee
- Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Seoul, Korea
| | - Tae Yop Kim
- Department of Anesthesiology, Konkuk University Medical Center, Seoul, Korea
- Department of Anesthesiology, Konkuk University School of Medicine, Seoul, Korea.
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9
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Leng S, Zhang S, Jiang M, Zhao X, Wu R, Allen J, He B, Tan RS, Zhong L. Imaging 4D morphology and dynamics of mitral annulus in humans using cardiac cine MR feature tracking. Sci Rep 2018; 8:81. [PMID: 29311562 PMCID: PMC5758818 DOI: 10.1038/s41598-017-18354-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/11/2017] [Indexed: 12/19/2022] Open
Abstract
Feature tracking in cine cardiac magnetic resonance (CMR) is a quantitative technique to assess heart structure and function. We investigated 4-dimensional (4D) dynamics and morphology of the mitral annulus (MA) using a novel tracking system based on radially rotational long-axis cine CMR series. A total of 30 normal controls and patients with mitral regurgitation were enrolled. The spatiotemporal changes of the MA were characterized by an in-house developed program. Dynamic and morphological parameters extracted from all 18 radial slices were used as references and were compared with those from subsequently generated sub-datasets with different degrees of sparsity. An excellent agreement was found among all datasets including routine 2-, 3- and 4-chamber views for MA dynamics such as peak systolic velocity (Sm) and mitral annular plane systolic excursion (MAPSE). MA morphology for size and shape was addressed adequately by as few as 6 radial slices, but poorly by only three routine views. Patients with regurgitation showed significantly reduced mitral dynamics and mild annular deformation, which was consistent between three routine views and 18 reference slices. In conclusion, feature tracking cine CMR provided a comprehensive and distinctive profile for 4D MA dynamics and morphology, which may help in studying different cardiac diseases.
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Affiliation(s)
- Shuang Leng
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Shuo Zhang
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Philips Healthcare, 622 Lorong 1, Toa Payoh, 319763, Singapore, Singapore
| | - Meng Jiang
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Xiaodan Zhao
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore
| | - Rui Wu
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - John Allen
- Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Ben He
- Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, 200001, People's Republic of China
| | - Ru San Tan
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore.,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore
| | - Liang Zhong
- National Heart Research Institute Singapore, National Heart Centre, Singapore, 5 Hospital Drive, 169609, Singapore. .,Duke-NUS Medical School, 8 College Road, Singapore, 169857, Singapore.
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10
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Dulgheru R, Marchetta S, Sugimoto T, Go YY, Girbea A, Oury C, Lancellotti P. Exercise Testing in Mitral Regurgitation. Prog Cardiovasc Dis 2017; 60:342-350. [PMID: 29128571 DOI: 10.1016/j.pcad.2017.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 10/29/2017] [Indexed: 12/29/2022]
Abstract
Mitral regurgitation (MR) is the second most common valvular heart disease referred for corrective surgery. Diagnostic and management dilemmas are not uncommon when dealing with MR patients. Exercise testing plays an important role in sorting out some of these clinical challenges. In primary asymptomatic MR, exercise testing allows symptom assessment, confident link of symptoms to valve disease severity, safe deferral of surgery for the next 1-year in patients with preserved exercise capacity, insights into the mechanism of exercise-induced dyspnea and helps in individual risk stratification. Moreover, exercise testing in the form of exercise stress echocardiography is also useful in the evaluation of patients with secondary ischemic MR for risk stratification as well as for the detection of patients with moderate ischemic MR in whom mitral valve repair at the time of surgical revascularization may add benefit.
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Affiliation(s)
- Raluca Dulgheru
- University of Liège Hospital, Department of Cardiology, Heart Valve Clinic, Liège, Belgium
| | - Stella Marchetta
- University of Liège Hospital, Department of Cardiology, Heart Valve Clinic, Liège, Belgium
| | - Tadafumi Sugimoto
- University of Liège Hospital, Department of Cardiology, Heart Valve Clinic, Liège, Belgium
| | - Yun Yun Go
- National Heart Research Institute Singapore, National Heart Centre Singapore, Singapore
| | - Alexandra Girbea
- University of Liège Hospital, Department of Cardiology, Heart Valve Clinic, Liège, Belgium
| | - Cécile Oury
- GIGA Cardiovascular Sciences, University Hospital Sart Tilman, Liège, Belgium
| | - Patrizio Lancellotti
- University of Liège Hospital, Department of Cardiology, Heart Valve Clinic, Liège, Belgium; GIGA Cardiovascular Sciences, University Hospital Sart Tilman, Liège, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy.
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11
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Sperry BW, Ibrahim A, Negishi K, Negishi T, Patel P, Popović ZB, Culver D, Brunken R, Marwick TH, Tamarappoo B. Incremental Prognostic Value of Global Longitudinal Strain and 18F-Fludeoxyglucose Positron Emission Tomography in Patients With Systemic Sarcoidosis. Am J Cardiol 2017; 119:1663-1669. [PMID: 28343598 DOI: 10.1016/j.amjcard.2017.02.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 01/05/2023]
Abstract
In independent studies, abnormal global longitudinal strain (GLS) and myocardial inflammation or scar detected by 18F-fludeoxyglucose positron emission tomography (FDG-PET) are associated with poor prognosis among patients with high likelihood for cardiac sarcoidosis. However, commonly used imaging modalities have not been evaluated in the same population. Our goals were to examine the relation between GLS and FDG-PET, and to evaluate the incremental prognostic value of these imaging techniques for predicting major adverse cardiac events (MACE) in patients suspected to have cardiac sarcoidosis. We identified patients with systemic sarcoidosis who underwent an echocardiogram and FDG-PET within 60 days. Regional strain (average of base, mid, and apical segmental strains from each of 6 wall regions) was calculated and compared with regional FDG-PET findings. The associations among GLS, FDG-PET findings, and MACE (defined as death, ventricular tachycardia, heart failure hospitalization, or transplantation) were evaluated using a Cox model. Of 84 patients, 51 had abnormal FDG-PET. GLS was impaired in patients with abnormal versus normal FDG-PET (-14.2 ± 4.7% vs -17.9 ± 3.5%, p <0.01). After adjusting for clinical risk factors, both GLS and the number of segments with abnormal perfusion and metabolism on FDG-PET were associated with adverse cardiac events (p <0.01 for both). In conclusion, GLS and regional LS are impaired in patients with abnormal perfusion and metabolism detected using FDG-PET. Additionally, both GLS and abnormal FDG-PET have incremental prognostic value for predicting MACE in patients with systemic sarcoidosis.
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Affiliation(s)
- Brett W Sperry
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Ahmed Ibrahim
- Department of Cardiothoracic Surgery, Cleveland Clinic, Cleveland, Ohio
| | - Kazuaki Negishi
- Menzies Research Institute Tasmania, Hobart, Tasmania, Australia
| | - Tomoko Negishi
- Menzies Research Institute Tasmania, Hobart, Tasmania, Australia
| | - Parag Patel
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Zoran B Popović
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Daniel Culver
- Department of Pulmonary and Critical Care, Cleveland Clinic, Cleveland, Ohio
| | - Richard Brunken
- Department of Nuclear Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Thomas H Marwick
- Menzies Research Institute Tasmania, Hobart, Tasmania, Australia; Baker-IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia
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12
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30:101-138. [DOI: 10.1016/j.echo.2016.10.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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13
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Candan O, Hatipoglu Akpinar S, Dogan C, Demirkıran A, Dindar B, Bayram Z, Yılmaz F, Kaymaz C, Ozdemir N. Twist deformation for predicting postoperative left ventricular function in patients with mitral regurgitation: A speckle tracking echocardiography study. Echocardiography 2017; 34:422-428. [DOI: 10.1111/echo.13462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Affiliation(s)
- Ozkan Candan
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | | | - Cem Dogan
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Aykut Demirkıran
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Barış Dindar
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Zubeyde Bayram
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Fatih Yılmaz
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Cihangir Kaymaz
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
| | - Nihal Ozdemir
- Kartal Kosuyolu Heart & Research Hospital; Cardiology Clinic; Istanbul Turkey
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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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Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2016. [DOI: 10.5812/rijm.41456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Esmaeilzadeh M, Alimi H, Hosseini S, Samiei N, Parsaee M. Global and Regional Longitudinal Strains Predict Left Ventricular Dysfunction after Mitral Valve Repair: A Two Dimensional Speckle Tracking Study. RAZAVI INTERNATIONAL JOURNAL OF MEDICINE 2016. [DOI: 10.17795/rijm41456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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17
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1191-1229. [DOI: 10.1093/ehjci/jew190] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
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Sinha SK, Garg S, Thakur R, Krishna V, Singh K, Sachan M, Goel A, Razi M, Pandey U, Varma CM. Prognostic Importance of Exercise Brain Natriuretic Peptide in Asymptomatic Chronic Organic Severe Mitral Regurgitation: An Observational Study. J Clin Med Res 2016; 8:797-804. [PMID: 27738481 PMCID: PMC5047018 DOI: 10.14740/jocmr2680w] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2016] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND The optimal timing of surgery in patients with chronic organic severe mitral regurgitation (MR) continues to be debated, especially for those who are asymptomatic. The aim of the study was to determine independent and additive prognostic value of exercise brain natriuretic peptide (eBNP) in patients with severe asymptomatic MR and normal left ventricular ejection fraction (LVEF). METHODS Two hundred twenty-three consecutive patients with severe MR defined by effective regurgitant orifice (ERO) area ≥ 40 mm2 and/or residual volume ≥ 60 mL, LVEF > 60%, and normal LV end-systolic diameter < 40 mm underwent symptom limited exercise treadmill test (TMT). Echocardiography was done immediately after exercise. Data were obtained within 3 minutes of peak exercise. BNP levels were assessed before echo (after 30 minutes of supine rest) and at exercise (i.e., within the 3 minutes of the end of effort). Patients were followed up every 3 months up to 15 months for major adverse cardiac events (MACEs) (cardiovascular death, need for mitral valve surgery and hospitalization for acute pulmonary edema or heart failure). RESULTS Mean age was 31.2 ± 9 years (range: 18 - 40) with majority being male (n = 153; 68%). Etiologies were rheumatic (n = 201; 90%), mitral valve prolapse (n = 17; 7.6%) and hypertrophic cardiomyopathy (n = 5; 2.4%). BNP level significantly increased from rest (65.24 ± 43.92 pg/mL; median: 43.5 pg/mL) to exercise (100.24 ± 98.24 pg/mL; median: 66.5 pg/mL; P < 0.001). Patients were divided into three tertiles according to eBNP levels (T1 = 15 - 44; T2 = 45 - 104; T3 = 105 - 400). There was trend for significantly lower exercise time in T3. During TMT, 66 (29.5%) stopped exercise due to dyspnea. They had similar resting BNP level compared with others but had significantly higher eBNP level (136 ± 109.7 pg/mL vs. 84.88 ± 90.2 pg/mL; P < 0.001). During follow-up (15 months), MACE occurred in 83 patients (37.2%): mitral valve replacement (MVR) in 59 patients (symptomatic: 43; LV dilatation or dysfunction: 9; both symptoms and dilatation/dysfunction: 7), 17 hospitalizations for congestive heart failure, five patients developing acute pulmonary edema and atrial fibrillation in remaining two patients. This was 7.6%, 35% and 69% in T1, T2 and T3, respectively and had significantly higher eBNP level than without any event (165 ± 119 pg/mL vs. 57 ± 48 pg/mL; P < 0.001). Using receiver operating characteristic curve analysis, the best cut-off value of eBNP level to predict cardiac events was 90 pg/mL (sensitivity: 75%; specificity: 88.6%; positive predictive value: 79%; negative predictive value: 83.9%). CONCLUSION In asymptomatic patients, eBNP level provides incremental prognostic value beyond echocardiographic data and those with elevated eBNP should be considered at high risk for reduced event-free survival and might be considered for early MVR.
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Affiliation(s)
- Santosh Kumar Sinha
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Shalini Garg
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Ramesh Thakur
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Vinay Krishna
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Karandeep Singh
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mohit Sachan
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Amit Goel
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Mahamdula Razi
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Umeshwar Pandey
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
| | - Chandra Mohan Varma
- Department of Cardiology, LPS Institute of Cardiology, G. S. V. M. Medical College, Kanpur, Uttar Pradesh 208002, India
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Abstract
Transthoracic echocardiography is the most widely used imaging test in cardiology. Although completely noninvasive, transthoracic echocardiography has a well-established role in the diagnosis of numerous cardiovascular diseases, and also provides critical qualitative and quantitative information on their prognosis and pathophysiological processes. The aim of this Review is to outline the broad principles of transthoracic echocardiography, including the traditional techniques of two-dimensional, colour, and spectral Doppler echocardiography, and newly developed advances including tissue Doppler, myocardial deformation imaging, torsion, stress echocardiography, contrast and three-dimensional echocardiography. The advantages and disadvantages, clinical application, prognostic value, and salient research findings of each modality are described. Advances in complex imaging techniques are expected to continue unabated, and this Review highlights technical improvements that will influence the diagnosis and improve our understanding of cardiovascular function and disease.
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Affiliation(s)
- Anita C Boyd
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
| | - Nelson B Schiller
- University of California, 505 Parnassus Avenue, San Francisco, CA 94143, USA
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Liverpool Hospital, Corner Elizabeth/Goulburn Street, NSW 2170, Australia
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Kadappu KK, Thomas L. Tissue Doppler Imaging in Echocardiography: Value and Limitations. Heart Lung Circ 2015; 24:224-33. [DOI: 10.1016/j.hlc.2014.10.003] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Accepted: 10/15/2014] [Indexed: 10/24/2022]
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21
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LV Mechanics in Mitral and Aortic Valve Diseases. JACC Cardiovasc Imaging 2014; 7:1151-66. [DOI: 10.1016/j.jcmg.2014.07.015] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 07/22/2014] [Accepted: 07/24/2014] [Indexed: 11/22/2022]
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22
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Kim JH, Park HM. Usefulness of conventional and tissue Doppler echocardiography to predict congestive heart failure in dogs with myxomatous mitral valve disease. J Vet Intern Med 2014; 29:132-40. [PMID: 25270196 PMCID: PMC4858102 DOI: 10.1111/jvim.12466] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 07/23/2014] [Accepted: 08/26/2014] [Indexed: 11/29/2022] Open
Abstract
Background Systolic and diastolic functions have been evaluated to predict outcome in congestive heart failure (CHF). Recently, tissue Doppler imaging (TDI) has become useful for the estimation of myocardial function in cardiac diseases of humans and animals. Objective This study was designed to assess whether myocardial function as assessed by TDI is associated with the occurrence of CHF in dogs with myxomatous mitral valve disease (MMVD) and whether additional information is gained over conventional Doppler variables. Animals Forty‐one privately owned dogs (15 healthy dogs and 26 dogs with MMVD) were included. Dogs with MMVD were divided into non‐CHF (n = 10) and CHF groups (n = 16). Methods Conventional echocardiographic examinations were performed. In addition, TDI‐derived variables, including radial and longitudinal velocities, strain, and strain rate were assessed. Results Several (12 of 47, 26%) conventional and tissue Doppler echocardiography variables were significant predictors of CHF in a univariate analysis (P < .05). However, TDI‐derived E/Em sept was the only load‐independent significant predictor of CHF (P < .05) after multivariate logistic regression analysis. The E/Em sept cut‐off value of >18.7 had a sensitivity of 56% and specificity of 90% in predicting CHF in dogs with MMVD. Conclusions and Clinical Importance The combination of TDI of the mitral annulus and mitral inflow velocity provided better estimates of diastolic dysfunction in dogs with MMVD and CHF. Additional study is warranted to assess TDI‐derived E/Em sept, an index of diastolic function that could contribute to the management of dogs with MMVD and CHF.
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Affiliation(s)
- J-H Kim
- Department of Veterinary Internal Medicine, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
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Solovyova O, Katsnelson LB, Konovalov PV, Kursanov AG, Vikulova NA, Kohl P, Markhasin VS. The cardiac muscle duplex as a method to study myocardial heterogeneity. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2014; 115:115-28. [PMID: 25106702 PMCID: PMC4210666 DOI: 10.1016/j.pbiomolbio.2014.07.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 07/25/2014] [Indexed: 12/14/2022]
Abstract
This paper reviews the development and application of paired muscle preparations, called duplex, for the investigation of mechanisms and consequences of intra-myocardial electro-mechanical heterogeneity. We illustrate the utility of the underlying combined experimental and computational approach for conceptual development and integration of basic science insight with clinically relevant settings, using previously published and new data. Directions for further study are identified.
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Affiliation(s)
- O Solovyova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia.
| | - L B Katsnelson
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - P V Konovalov
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - A G Kursanov
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia
| | - N A Vikulova
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia
| | - P Kohl
- National Heart and Lung Institute, Imperial College of London, Heart Science Centre, Harefield Hospital, Hill End Road, Harefield UB9 6JH, UK; Department of Computer Sciences, University of Oxford, UK
| | - V S Markhasin
- Institute of Immunology and Physiology, Ural Branch of the Russian Academy of Sciences, 106 Pervomayskaya Str, Ekaterinburg 620049, Russia; Ural Federal University, 19 Mira Str, Ekaterinburg 620002, Russia
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Echocardiographic assessment of left ventricular function in mitral regurgitation. Cardiovasc Endocrinol 2014. [DOI: 10.1097/xce.0000000000000028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Song Y, Lee S, Kwak YL, Shim CY, Chang BC, Shim JK. Tissue Doppler Imaging Predicts Left Ventricular Reverse Remodeling After Surgery for Mitral Regurgitation. Ann Thorac Surg 2013; 96:2109-15. [DOI: 10.1016/j.athoracsur.2013.06.087] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/16/2013] [Accepted: 06/20/2013] [Indexed: 10/26/2022]
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Rowland T, Unnithan V. Myocardial Inotropic Response to Progressive Exercise in Healthy Subjects. Curr Sports Med Rep 2013; 12:93-100. [DOI: 10.1249/jsr.0b013e3182874cf8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Dolor-Torres MC, Ling LH. Surgical timing of degenerative mitral regurgitation: what to consider. J Cardiovasc Ultrasound 2012; 20:165-71. [PMID: 23346284 PMCID: PMC3542508 DOI: 10.4250/jcu.2012.20.4.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/09/2012] [Accepted: 11/21/2012] [Indexed: 01/19/2023] Open
Abstract
Severe primary mitral regurgitation (MR) is a progressive condition which engenders significant mortality and morbidity if left untreated. The optimal timing of surgery in patients with MR of degenerative origin continues to be debated, especially for those who are asymptomatic. Apart from symptoms, current authoritative guidelines recommend intervention when there is incipient left ventricular dysfunction, pulmonary hypertension or new onset atrial fibrillation. This review focuses on the asymptomatic subject with severe MR, and examines contemporary clinical decision-making and management strategies, including the 2012 European guidelines on valvular heart disease. We discuss the rationale for risk stratifying the asymptomatic individual, and highlight current and novel diagnostic tools that may have a useful role, with an emphasis on echocardiographic imaging.
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Olaf S, Debora B, Ricarda B, Gunnar B, Jochen K, Schimke I, Halle M, Jaffe A. Exercise tolerance in asymptomatic patients with moderate-severe valvular heart disease and preserved ejection fraction. Arch Med Sci 2012; 8:1018-26. [PMID: 23319976 PMCID: PMC3542492 DOI: 10.5114/aoms.2012.32409] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2012] [Revised: 11/10/2012] [Accepted: 11/20/2012] [Indexed: 01/19/2023] Open
Abstract
INTRODUCTION For asymptomatic patients with moderate-severe valvular heart disease, in whom symptoms may be obscured, objective exercise tolerance measures are warranted for decisions concerning physical activities and surgical treatment. MATERIAL AND METHODS We compared 61 patients (39 with aortic stenosis, 22 with aortic or mitral regurgitation) to 23 controls without valvular heart disease but with indications for stress testing. All participants underwent cardiopulmonary function testing and dobutamine stress echocardiography. Blood was drawn before as well as after bicycle stress to assess high-sensitivity cardiac troponin T (hscTnT). Patients who underwent surgery were re-evaluated 1.5 ±0.9 years after the operation. RESULTS Conventional bicycle test following guideline criteria revealed a pathologic result in 26% of the patients, whereas spiroergometry showed an objectively reduced exercise tolerance in 59%, reaching a prognostically relevant feature in 39%. Stress echocardiography detected a reduced systolic reserve in 33% and elevated filling pressures in 62%. These abnormalities were significantly less present in the control group (4, 17, 9, 9, 4% respectively, p < 0.05 each). Baseline hscTnT detected patients with the prognostically important feature of reduced exercise tolerance (area under the curve 0.689 (95% CI: 0.546-0.831), p = 0.015). Objective preoperative exercise tolerance predicted sustained cardiocirculatory and myocardial dysfunction postoperatively. CONCLUSIONS Cardiopulmonary function testing and dobutamine stress echocardiography identify exercise intolerance in patients with asymptomatic valvular heart disease beyond stress-test criteria recommended in recent guidelines. High-sensitivity cardiac troponin I may be of additional value. Results of these tests presage post-operative function.
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Affiliation(s)
- Schulz Olaf
- Interventional Cardiology Spandau, Berlin, Germany
| | - Brala Debora
- Interventional Cardiology Spandau, Berlin, Germany
| | | | | | | | - Ingolf Schimke
- Department of Cardiology, Charité Universitätsmedizin Berlin, Germany
| | - Martin Halle
- Department of Prevention and Sports Medicine, Technische Universität Munich, Germany
| | - Allan Jaffe
- Mayo Clinic and Medical School, Rochester, MN, USA
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Ternacle J, Berry M, Alonso E, Kloeckner M, Couetil JP, Randé JLD, Gueret P, Monin JL, Lim P. Incremental value of global longitudinal strain for predicting early outcome after cardiac surgery. Eur Heart J Cardiovasc Imaging 2012; 14:77-84. [PMID: 22893712 DOI: 10.1093/ehjci/jes156] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Global longitudinal strain (GLS) seems accurate for detecting subclinical myocardial dysfunction, and may therefore be used to improve risk stratification for cardiac surgery. METHODS AND RESULTS Longitudinal strain (by two-dimensional speckle tracking) was computed in 425 patients [mean age 67 ± 13 years, 69% male, left ventricular ejection fraction (LVEF) 51 ± 13%] referred for cardiac surgery [isolated coronary artery bypass graft (CABG) (n = 155), aortic valve surgery (n = 174), mitral surgery (n = 96)]. GLS (global-ε) was assessed for predicting early postoperative death. Despite a fair correlation between LVEF and global strain (r = -0.73, P < 0.0001), 40% of patients with preserved LVEF (defined as LVEF ≥50%) had abnormal global-ε (defined as global-ε >-16%): -12.8 ± 1.7%, range -15% to -8%. In patients with preserved LVEF, NT-proBNP level (983 vs. 541 pg/mL, P = 0.03), heart failure symptoms (NYHA class, 2.2 ± 0.9 vs. 1.9 ± 0.9, P = 0.02), and the need for prolonged (>48 h) inotropic support after surgery (33.3 vs. 21.2%, P = 0.03) were greater when global-ε was impaired. Importantly, despite similar EuroSCORE (9.7 ± 12 vs. 7.7 ± 9%, P = 0.2 for EuroSCORE I and 4.2 ± 6.2 vs. 3.4 ± 4.9%, P = 0.4 for EuroSCORE II), the rate of postoperative death was 2.4-fold (11.8 vs. 4.9%, P = 0.04) in patients with preserved LVEF when global-ε was impaired. Multivariate analysis showed that global-ε is an independent predictor for early postoperative mortality [odds ratio = 1.10 (1.01-1.21)] after adjustment to EuroSCORE. CONCLUSION GLS has an incremental value over LVEF for risk stratification in patients referred for cardiac surgery.
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Affiliation(s)
- Julien Ternacle
- APHP, Cardiovascular Department and INSERM U955 Team 3, Henri Mondor University Hospital, 51 Av de Lattre de Tassigny, 94100 Creteil, France
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Witkowski TG, Thomas JD, Debonnaire PJMR, Delgado V, Hoke U, Ewe SH, Versteegh MIM, Holman ER, Schalij MJ, Bax JJ, Klautz RJM, Marsan NA. Global longitudinal strain predicts left ventricular dysfunction after mitral valve repair. Eur Heart J Cardiovasc Imaging 2012; 14:69-76. [DOI: 10.1093/ehjci/jes155] [Citation(s) in RCA: 142] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Koestenberger M, Nagel B, Ravekes W, Avian A, Heinzl B, Fritsch P, Fandl A, Rehak T, Gamillscheg A. Left ventricular long-axis function: reference values of the mitral annular plane systolic excursion in 558 healthy children and calculation of z-score values. Am Heart J 2012; 164:125-31. [PMID: 22795292 DOI: 10.1016/j.ahj.2012.05.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 05/10/2012] [Indexed: 01/01/2023]
Abstract
BACKGROUND Longitudinal myocardial function has gained more interest in the last years. The mitral annular plane systolic excursion (MAPSE) is an echocardiographic measurement to assess left ventricular (LV) long-axis function in adults. The aim of this study was to evaluate MAPSE values in a healthy pediatric population and to propose reference values. METHODS A prospective study was conducted in a group of 558 healthy children and adolescents (age day 1 to 18 years) (body surface area [BSA] 0.18-2.21 m(2)). We determined the effects of age and BSA on MAPSE values and a possible correlation of MAPSE values with LV ejection fraction values. RESULTS The MAPSE ranged from a mean of 0.57 cm (z-score ±2: 0.38-0.76 cm) in neonates to 1.63 cm (z-score ±2: 1.31-1.95 cm) in 18-year-old adolescents. The MAPSE values showed a positive correlation with age (r = 0.87, P < .001) and BSA (r = 0.89, P < .001) with a nonlinear course. There was no significant difference in MAPSE values between females or males. A positive correlation was found between MAPSE values and LV ejection fraction values (r = 0.28, P < .001). CONCLUSIONS Z-scores of MAPSE values were calculated, and percentile charts were established to serve as reference data in patients with congenital heart disease or heart failure in the future.
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Affiliation(s)
- Martin Koestenberger
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.
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Gunjan M, Kurien S, Tyagi S. Early prediction of left ventricular systolic dysfunction in patients of asymptomatic chronic severe rheumatic mitral regurgitation using tissue Doppler and strain rate imaging. Indian Heart J 2012; 64:245-8. [PMID: 22664804 DOI: 10.1016/s0019-4832(12)60080-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS Identification of subclinical left ventricular (LV) dysfunction in patients with rheumatic mitral regurgitation (MR) facilitates optimal surgical results and better postoperative LV function. This study is designed to assess the role of tissue Doppler and strain rate (SR) imaging in early detection of LV systolic dysfunction in patients with asymptomatic chronic severe MR. METHODS AND RESULTS Patients were studied under four groups. Group I: Normal subject (n = 25). Group II: Patients with chronic severe MR with ejection fraction (EF) > 60% and end-systolic dimension (ESD) ≤ 40 mm (n=23). Group III: Patients with chronic severe MR with EF ≥ 60% and ESD 41-50 mm (n = 27). Group IV: Patients with chronic severe MR with EF < 60% with any ESDs (n = 25). With decrease in EF and increase in ESD there was decrease in systolic velocity and increased in precontraction time and contraction time was noted. The tissue Doppler systolic indices between groups were statistically significant P < 0.05 and showed significant correlation value r = 0.45 between groups. Strain (S) and SR significantly decreased with decrease in EF and increase in ESD P < 0.05, r = 0.45 between different groups. CONCLUSION Our study showed significant correlation between tissue Doppler systolic indices and SR imaging with EF and ESD.
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Affiliation(s)
- Manish Gunjan
- Department of Cardiology, GB Pant Hospital, New Delhi, India
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Mohan JC, Mohan V. Subclinical left ventricular systolic dysfunction in chronic mitral regurgitation and its potential impact on management: quo vadis? Indian Heart J 2012; 64:249-53. [DOI: 10.1016/s0019-4832(12)60081-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
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Florescu M, Benea DCCM, Rimbas RC, Cerin G, Diena M, Lanzzillo G, Enescu OA, Cinteza M, Vinereanu D. Myocardial Systolic Velocities and Deformation Assessed by Speckle Tracking for Early Detection of Left Ventricular Dysfunction in Asymptomatic Patients with Severe Primary Mitral Regurgitation. Echocardiography 2011; 29:326-33. [DOI: 10.1111/j.1540-8175.2011.01563.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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35
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Yurdakul S, Tayyareci Y, Yildirimturk O, Memic K, Aytekin V, Aytekin S. Subclinical Left Ventricular Dysfunction in Asymptomatic Chronic Mitral Regurgitation Patients with Normal Ejection Fraction: A Combined Tissue Doppler and Velocity Vector Imaging-Based Study. Echocardiography 2011; 28:877-85. [DOI: 10.1111/j.1540-8175.2011.01428.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Marciniak A, Sutherland GR, Marciniak M, Kourliouros A, Bijnens B, Jahangiri M. Prediction of postoperative left ventricular systolic function in patients with chronic mitral regurgitation undergoing valve surgery ??? the role of deformation imaging. Eur J Cardiothorac Surg 2011; 40:1131-7. [DOI: 10.1016/j.ejcts.2011.02.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2010] [Revised: 01/30/2011] [Accepted: 02/01/2011] [Indexed: 11/29/2022] Open
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Sharif D, Sharif-Rasslan A, Shahla C, Rosenschein U. Application of Mitral Annular Systolic Displacements and Velocities for the Evaluation of Left Ventricular Systolic Function and Reserve. Cardiol Res 2011; 2:36-41. [PMID: 28348658 PMCID: PMC5358127 DOI: 10.4021/cr7w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2011] [Indexed: 11/22/2022] Open
Abstract
Background Mitral annular systolic displacement from M-mode echocardiography and velocity from tissue Doppler imaging reflect subendocardial longitudinal systolic LV performance and may precede radial abnormalities. The aim of this study is to evaluate the utility of mitral annular systolic displacement (D) and velocity (V) during dobutamine stress echocardiography (DSE) in detecting left ventricular (LV) functional reserve and wall motion abnormality (WMA). Methods and Results Fifty-nine subjects, 15 with resting WMA, underwent DSE and measurement of mitral systolic (D) and (V) before and immediately after DSE. Annular septal (D) was lower in those with WMA than in those without, at rest 10.5 ± 4 cm versus 13.2 ± 2 cm, p = 0.015, and after DSE, 11.7 ± 3.8 cm versus 14 ± 2.25 cm, p = 0.036, but without significant change after stress. Annular systolic (V) at rest with WMA was 9.7 ± 1.8 cm/sec and similar to those without, 11.25 ± 2.7 cm/sec. In both groups the velocity increased after DSE, 14.5 ± 4.5 cm/sec, p = 0.025 with WMA and 17.8 ± 3.2 cm/sec, p = 1.99 x 10-10 in those without WMA. Velocities after DSE were lower in those with WMA, p = 2.25 x 10-6. Conclusions To evaluate LV systolic performance mitral annular systolic longitudinal displacement is valuable at rest, but for assessment of LV functional reserve after stress velocities are better.
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Affiliation(s)
- Dawod Sharif
- Department of Cardiology, Bnai Zion Medical Center, Israel; Technion - Israel Institute of Technology, Haifa, Israel
| | | | - Camilia Shahla
- Department of Cardiology, Bnai Zion Medical Center, Israel
| | - Uri Rosenschein
- Department of Cardiology, Bnai Zion Medical Center, Israel; Technion - Israel Institute of Technology, Haifa, Israel
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Tidholm A, Ljungvall I, Höglund K, Westling A, Häggström J. Tissue Doppler and Strain Imaging in Dogs with Myxomatous Mitral Valve Disease in Different Stages of Congestive Heart Failure. J Vet Intern Med 2009; 23:1197-207. [DOI: 10.1111/j.1939-1676.2009.0403.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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To ACY, Stewart RA. Novel methods to assess heart valve disease. Future Cardiol 2009; 4:583-92. [PMID: 19804352 DOI: 10.2217/14796678.4.6.583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Optimal timing of surgery for heart valve disease relies on the accurate assessment of symptoms, lesion severity, cardiac function and the risks of disease progression. Recent studies suggest potential roles for new echocardiographic techniques, including tissue Doppler and strain imaging at rest or after exercise stress, cardiac magnetic resonance imaging and biomarkers such as B-type natriuretic peptide. These techniques may identify patients at higher risk of symptomatic deterioration or adverse clinical events, and improve the cost-effectiveness and reliability of follow-up.
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Affiliation(s)
- Andrew C Y To
- Green Lane Cardiovascular Service, Auckland City Hospital, Level 3, Building 32, Private Bag 92 189 Auckland 1030, New Zealand
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de Isla LP, de Agustin A, Rodrigo JL, Almeria C, del Carmen Manzano M, Rodríguez E, García A, Macaya C, Zamorano J. Chronic Mitral Regurgitation: A Pilot Study to Assess Preoperative Left Ventricular Contractile Function Using Speckle-Tracking Echocardiography. J Am Soc Echocardiogr 2009; 22:831-8. [DOI: 10.1016/j.echo.2009.04.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2008] [Indexed: 10/20/2022]
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Importance of left ventricular longitudinal function and functional reserve in patients with degenerative mitral regurgitation: assessment by two-dimensional speckle tracking. J Am Soc Echocardiogr 2009; 21:1331-6. [PMID: 19041577 DOI: 10.1016/j.echo.2008.09.023] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The aim of this study was to determine whether two-dimensional speckle tracking of longitudinal myocardial deformation can detect limited contractile reserve during exercise in patients with asymptomatic degenerative mitral regurgitation (MR). METHODS Seventy-one patients with degenerative MR and normal left ventricular (LV) ejection fractions underwent quantitative exercise echocardiography. RESULTS Compared with 23 normal subjects matched for age and sex, LV volumes were greater in patients with MR. At rest, global longitudinal strain (GLS) was lower in patients, indicating subclinical LV dysfunction. During exercise, the extent and the magnitude of changes in GLS were larger in controls than in patients with MR. On multivariate regression analysis, left atrial volume at rest and changes in GLS at peak exercise were independently associated with changes in LV ejection fraction. CONCLUSION In asymptomatic patients with degenerative MR, subnormal LV function can be reliably identified by two-dimensional strain imaging. Limited exercise LV longitudinal contractile recruitment during exercise predicts postoperative LV dysfunction.
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Kim MS, Kim YJ, Kim HK, Han JY, Chun HG, Kim HC, Sohn DW, Oh BH, Park YB. Evaluation of left ventricular short- and long-axis function in severe mitral regurgitation using 2-dimensional strain echocardiography. Am Heart J 2009; 157:345-51. [PMID: 19185644 DOI: 10.1016/j.ahj.2008.10.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2008] [Accepted: 10/08/2008] [Indexed: 01/25/2023]
Abstract
BACKGROUND Few data exist on the changes in left ventricular (LV) short- and long-axis function and their usefulness as markers of LV contractile function in patients with chronic, severe mitral regurgitation (MR). METHODS We studied 59 patients who had severe MR with an ejection fraction > or =50% and 34 healthy controls. Speckle tracking imaging was performed to measure peak systolic radial (SR(R)), circumferential (SR(C)), and longitudinal strain rates (SR(L)). In all patients, the peak rate of LV pressure rise (peak dP/dt) was measured using a micromanometer-tipped catheter. The patients were subdivided into patients with preserved (group 1, peak dP/dt > or =1,300 mm Hg/s [n = 30]) and depressed (group 2 [n = 29]) contractile function. RESULTS SR(L) was significantly depressed in groups 1 and 2 when compared with the control group, but there was no difference between groups 1 and 2. In contrast, SR(R) and SR(C) were depressed only in group 2, whereas there were no differences between the control group and group 1. SR(R) and SR(C) correlated well with peak dP/dt (r = 0.71, P <.001 and r = -0.63, P <.001, respectively), whereas SR(L) did not. These findings suggest that LV long-axis function becomes depressed earlier than short-axis function in the chronic remodeling process. CONCLUSIONS Left ventricular short-axis function is a useful marker of LV contractility in patients with chronic, severe MR. Left ventricular long-axis function becomes depressed earlier in the chronic remodeling process. Therefore, evaluation of short-axis as well as long-axis function might be important for better assessment of LV contractile function in these patients.
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Affiliation(s)
- Min-Seok Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul National University Hospital, Korea
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Skubas N. Intraoperative Doppler Tissue Imaging Is a Valuable Addition to Cardiac Anesthesiologists’ Armamentarium: A Core Review. Anesth Analg 2009; 108:48-66. [DOI: 10.1213/ane.0b013e31818a6c4c] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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McIntyre CW, John SG, Jefferies HJ. Advances in the cardiovascular assessment of patients with chronic kidney disease. NDT Plus 2008; 1:383-391. [PMID: 28657024 PMCID: PMC5477876 DOI: 10.1093/ndtplus/sfn146] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2008] [Accepted: 08/11/2008] [Indexed: 12/11/2022] Open
Abstract
Cardiovascular mortality is grossly elevated in patients with chronic kidney disease (CKD), and is associated with a wide variety of structural and functional abnormalities. These issues have driven additional attempts to further characterise these abnormalities to elucidate the pathophysiology involved, assess individual risk and/or target and monitor therapies specifically directed at the cardiovascular (CV) system. This review aims to assess the techniques that are currently available for the study of the CV system. This includes conventional assessments of the whole CV system from heart to peripheral microcirculation (although not deal with VC assessment), as well as the key functional consequences relating to stress induced cardiovascular reserve, perfusion and vasoregulation. In addition this review will introduce a variety of techniques aiming to expand the envelope of conventional measurements.
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Affiliation(s)
| | - Stephen G. John
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby, UK
| | - Helen J. Jefferies
- Department of Renal Medicine, Derby Hospitals NHS Foundation Trust, Derby, UK
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Carlhäll CJ, Nguyen TC, Itoh A, Ennis DB, Bothe W, Liang D, Ingels NB, Miller DC. Alterations in transmural myocardial strain: an early marker of left ventricular dysfunction in mitral regurgitation? Circulation 2008; 118:S256-62. [PMID: 18824764 DOI: 10.1161/circulationaha.107.753525] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND In asymptomatic patients with severe isolated mitral regurgitation (MR), identifying the onset of early left ventricular (LV) dysfunction can guide the timing of surgical intervention. We hypothesized that changes in LV transmural myocardial strain represent an early marker of LV dysfunction in an ovine chronic MR model. METHODS AND RESULTS Sheep were randomized to control (CTRL, n=8) or experimental (EXP, n=12) groups. In EXP, a 3.5- or 4.8-mm hole was created in the posterior mitral leaflet to generate "pure" MR. Transmural beadsets were inserted into the lateral and anterior LV wall to radiographically measure 3-dimensional transmural strains during systole and diastolic filling, at 1 and 12 weeks postoperatively. MR grade was higher in EXP than CTRL at 1 and 12 weeks (3.0 [2-4] versus 0.5 [0-2]; 3.0 [1-4] versus 0.5 [0-1], respectively, both P<0.001). At 12 weeks, LV mass index was greater in EXP than CTRL (201+/-18 versus 173+/-17 g/m(2); P<0.01). LVEDVI increased in EXP from 1 to 12 weeks (P=0.015). Between the 1 and 12 week values, the change in BNP (-4.5+/-4.4 versus -3.0+/-3.6 pmol/L), PRSW (9+/-13 versus 23+/-18 mm Hg), tau (-3+/-11 versus -4+/-7 ms), and systolic strains was similar between EXP and CTRL. The changes in longitudinal diastolic filling strains between 1 and 12 weeks, however, were greater in EXP versus CTRL in the subendocardium (lateral: -0.08+/-0.05 versus 0.02+/-0.14; anterior: -0.10+/-0.05 versus -0.02+/-0.07, both P<0.01). CONCLUSIONS Twelve weeks of ovine "pure" MR caused LV remodeling with early changes in LV function detected by alterations in transmural myocardial strain, but not by changes in BNP, PRSW, or tau.
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Affiliation(s)
- Carl J Carlhäll
- Department of Cardiothoracic Surgery, Falk Cardiovascular Research Center, Stanford University School of Medicine, Stanford, CA 94305-5247, USA
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Kang SJ, Lim HS, Choi BJ, Choi SY, Yoon MH, Hwang GS, Shin JH, Tahk SJ. The Impact of Exercise-Induced Changes in Intraventricular Dyssynchrony on Functional Improvement in Patients with Nonischemic Cardiomyopathy. J Am Soc Echocardiogr 2008; 21:948-53. [DOI: 10.1016/j.echo.2008.01.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Indexed: 10/22/2022]
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47
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Kang SJ, Lim HS, Hwang J, Choi JH, Seo KW, Choi BJ, Choi SY, Hwang GS, Yoon MH, Shin JH, Tahk SJ. Impact of Changes in Myocardial Velocity Assessed by Tissue Doppler Imaging during Exercise on Dynamic Mitral Regurgitation in Patients with Nonischemic Cardiomyopathy. Echocardiography 2008; 25:394-400. [DOI: 10.1111/j.1540-8175.2007.00621.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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O’Gara P, Sugeng L, Lang R, Sarano M, Hung J, Raman S, Fischer G, Carabello B, Adams D, Vannan M. The Role of Imaging in Chronic Degenerative Mitral Regurgitation. JACC Cardiovasc Imaging 2008; 1:221-37. [DOI: 10.1016/j.jcmg.2008.01.011] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2008] [Accepted: 01/28/2008] [Indexed: 10/22/2022]
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Paraskevaidis IA, Kyrzopoulos S, Tsiapras D, Iliodromitis EK, Parissis J, Farmakis D, Kremastinos DT. The role of left ventricular long axis contraction in patients with asymptomatic non-ischemic mitral valve regurgitation and normal systolic function. Int J Cardiol 2008; 124:64-71. [PMID: 17395299 DOI: 10.1016/j.ijcard.2006.12.089] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2006] [Revised: 12/06/2006] [Accepted: 12/30/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Several indices have been proposed in order to better evaluate chronic mitral regurgitation, however, none of them is unique, thus underlying the diagnostic deficiency. We aimed to investigate the role of long axis contraction in both ventricles in patients with non-ischemic asymptomatic mitral regurgitation (MR). METHODS Eighty-nine patients (40 men, mean age 59.9+/-13.5 years) with non-ischemic asymptomatic MR along with 50 healthy controls were studied. An echocardiographic, including tissue Doppler imaging study, an exercise radionuclide cineangiography and a cardiac catheterization were also performed. RESULTS Fifty of 89 patients (56.2%) had a normal response of left ventricular (LV) ejection fraction on exercise. LV end-diastolic diameter and volume index were significantly higher in patients with an impaired LV response. Moreover, systolic wave maximal velocity and systolic wave slope both at the lateral wall and at the inter-ventricular septum were significantly lower in patients with an impaired LV response. Systolic wave maximal velocity at the lateral wall was the index that best predicted LV response to exercise; while a cutoff value of 9.5 cm/s predicted an impaired LV response with a sensitivity of 96% and a specificity of 100%. MR as defined by the width of vena contracta, was mild/moderate in 78% of patients with a systolic wave maximal velocity at the lateral wall >9.5 cm/s and severe in 69.2% of patients with a velocity <9.5 cm/s. CONCLUSION In patients with asymptomatic non-ischemic MR, the evaluation of LV long axis contraction at rest can unmask a subnormal LV functional status.
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Affiliation(s)
- Ioannis A Paraskevaidis
- Second Department of Cardiology, Athens University Medical School, Attiko University Hospital, Greece.
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50
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Borg AN, Deepak SM, Beynon RP, Williams SG, Ray SG. A comprehensive tissue Doppler assessment of left ventricular function in patients with primary mitral regurgitation. J Am Soc Echocardiogr 2007; 20:1149-59. [PMID: 17604962 DOI: 10.1016/j.echo.2007.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2006] [Indexed: 11/28/2022]
Affiliation(s)
- Alexander N Borg
- Department of Cardiology, Wythenshawe Hospital, Manchester, United Kingdom.
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