1
|
Robinson S, Ring L, Oxborough D, Harkness A, Bennett S, Rana B, Sutaria N, Lo Giudice F, Shun-Shin M, Paton M, Duncan R, Willis J, Colebourn C, Bassindale G, Gatenby K, Belham M, Cole G, Augustine D, Smiseth OA. The assessment of left ventricular diastolic function: guidance and recommendations from the British Society of Echocardiography. Echo Res Pract 2024; 11:16. [PMID: 38825710 PMCID: PMC11145885 DOI: 10.1186/s44156-024-00051-2] [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: 09/18/2023] [Accepted: 05/13/2024] [Indexed: 06/04/2024] Open
Abstract
Impairment of left ventricular (LV) diastolic function is common amongst those with left heart disease and is associated with significant morbidity. Given that, in simple terms, the ventricle can only eject the volume with which it fills and that approximately one half of hospitalisations for heart failure (HF) are in those with normal/'preserved' left ventricular ejection fraction (HFpEF) (Bianco et al. in JACC Cardiovasc Imaging. 13:258-271, 2020. 10.1016/j.jcmg.2018.12.035), where abnormalities of ventricular filling are the cause of symptoms, it is clear that the assessment of left ventricular diastolic function (LVDF) is crucial for understanding global cardiac function and for identifying the wider effects of disease processes. Invasive methods of measuring LV relaxation and filling pressures are considered the gold-standard for investigating diastolic function. However, the high temporal resolution of trans-thoracic echocardiography (TTE) with widely validated and reproducible measures available at the patient's bedside and without the need for invasive procedures involving ionising radiation have established echocardiography as the primary imaging modality. The comprehensive assessment of LVDF is therefore a fundamental element of the standard TTE (Robinson et al. in Echo Res Pract7:G59-G93, 2020. 10.1530/ERP-20-0026). However, the echocardiographic assessment of diastolic function is complex. In the broadest and most basic terms, ventricular diastole comprises an early filling phase when blood is drawn, by suction, into the ventricle as it rapidly recoils and lengthens following the preceding systolic contraction and shortening. This is followed in late diastole by distension of the compliant LV when atrial contraction actively contributes to ventricular filling. When LVDF is normal, ventricular filling is achieved at low pressure both at rest and during exertion. However, this basic description merely summarises the complex physiology that enables the diastolic process and defines it according to the mechanical method by which the ventricles fill, overlooking the myocardial function, properties of chamber compliance and pressure differentials that determine the capacity for LV filling. Unlike ventricular systolic function where single parameters are utilised to define myocardial performance (LV ejection fraction (LVEF) and Global Longitudinal Strain (GLS)), the assessment of diastolic function relies on the interpretation of multiple myocardial and blood-flow velocity parameters, along with left atrial (LA) size and function, in order to diagnose the presence and degree of impairment. The echocardiographic assessment of diastolic function is therefore multifaceted and complex, requiring an algorithmic approach that incorporates parameters of myocardial relaxation/recoil, chamber compliance and function under variable loading conditions and the intra-cavity pressures under which these processes occur. This guideline outlines a structured approach to the assessment of diastolic function and includes recommendations for the assessment of LV relaxation and filling pressures. Non-routine echocardiographic measures are described alongside guidance for application in specific circumstances. Provocative methods for revealing increased filling pressure on exertion are described and novel and emerging modalities considered. For rapid access to the core recommendations of the diastolic guideline, a quick-reference guide (additional file 1) accompanies the main guideline document. This describes in very brief detail the diastolic investigation in each patient group and includes all algorithms and core reference tables.
Collapse
Affiliation(s)
| | - Liam Ring
- West Suffolk Hospital NHS Trust, Bury St Edmunds, UK
| | | | - Allan Harkness
- East Suffolk and North Essex NHS Foundation Trust, Colchester, UK
| | - Sadie Bennett
- University Hospital of the North Midlands, Stoke-On-Trent, UK
| | - Bushra Rana
- Imperial College Healthcare NHS Trust, London, UK
| | | | | | | | | | - Rae Duncan
- Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle, UK
| | | | | | | | | | - Mark Belham
- Addenbrookes Hospital, Cambridge University Hospitals, Cambridge, UK
| | - Graham Cole
- Imperial College Healthcare NHS Trust, London, UK
| | | | - Otto A Smiseth
- Division of Cardiovascular and Pulmonary Diseases, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| |
Collapse
|
2
|
Ma CS, Sun SK, Wang L, Zhou BY, Dong FL. The value of left atrial longitudinal strain in evaluating left atrial appendage spontaneous echo contrast in non-valvular atrial fibrillation. Front Cardiovasc Med 2023; 10:1090139. [PMID: 37485259 PMCID: PMC10359994 DOI: 10.3389/fcvm.2023.1090139] [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: 11/09/2022] [Accepted: 06/07/2023] [Indexed: 07/25/2023] Open
Abstract
Background Spontaneous echo contrast (SEC) observed in transesophageal echocardiography (TEE) is a reliable predictor of the risk of future ischemic stroke in patients with non-valvular atrial fibrillation (NVAF). Left atrial strain globally reflects atrial function, remodeling and distensibility. The left atrial appendage (LAA) is a myogenic remnant of the left atrium, which can actively relax and contract. The left atrial appendage (LAA) is an important part of releasing the pressure of the left atrium. The key role of the left atrium is to regulate the left ventricular filling pressure, act as a reservoir for pulmonary venous return during ventricular contraction, and act as a conduit, transferring blood to the Left ventricle during early ventricular diastole. The purpose of this study was to explore the relationship between left atrial function and left atrial appendage spontaneous echo contrast (LAASEC). Methods A retrospective study of 338 patients with non-valvular AF was conducted. Two-dimensional speckle-tracking echocardiography provided the following metrics of LA strain: LA strain during the reservoir phase (LASr), LA strain during the conduit phase (LAScd). LA or LAA has the dense SEC of more than grade 3, which is defined as mud like change or pre thrombosis. Results Patients with level 3 SEC (n = 81) has lower LASr than those with lower grades of SEC (n = 257) (7.20 ± 3.70 vs. 17.48 ± 8.67, P < 0.001). Multivariate logistic regression model showed that the type of atrial fibrillation (persistent∼), increased heart rate, decreased LASr were independently associated with the dense LAASEC (OR (CI 95%), 5.558 (1.618-19.09), 1.016 (1.006-1.026) 0.002, 1.224 (1.085-1.381), both P < 0.01). Venn Diagram showed that lower CHADVASC2 score groups had dense SEC cases. Receiver operating characteristic (ROC) curve was used for analyzing results and selecting cut off values. The cut off point for LASr < 8.85% and CHADVASC2 score was >2 scores with sensitivity and specificity were 79% and 85%. Conclusion Lower LASr is independently associated with the dense LAASEC in NVAF and has incremental values superior to clinical scores. The decrease of LASr may be a potential non-invasive parameter for evaluating the higher risk of LAA thrombosis.
Collapse
|
3
|
Bertacchini F, Agabiti Rosei C, Buso G, Cappellini S, Stassaldi D, Aggiusti C, Salvetti M, Paini A, De Ciuceis C, Muiesan ML. Subclinical HMOD in Hypertension: Left Ventricular Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:585-593. [PMID: 36352335 PMCID: PMC9708770 DOI: 10.1007/s40292-022-00548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023] Open
Abstract
Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary syndromes, peripheral artery disease, stroke, and chronic renal disease. Arterial hypertension leads to the development of subclinical hypertension mediated organ damage (HMOD) which has prognostic relevance and may influence the choice of treatment options. Alterations of cardiac structure and function represent the more widely assessed form of HMOD. This manuscript will focus on the diagnostic opportunities, prognostic significance and treatment of diastolic dysfunction alterations.
Collapse
Affiliation(s)
- Fabio Bertacchini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Sara Cappellini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Deborah Stassaldi
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carlo Aggiusti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy.
| |
Collapse
|
4
|
Assessment of age, gender, and anxiety on ECG waveform morphology in a large population of domestic dogs. Sci Rep 2022; 12:7339. [PMID: 35513697 PMCID: PMC9072377 DOI: 10.1038/s41598-022-11378-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 04/18/2022] [Indexed: 11/24/2022] Open
Abstract
Cardiovascular diseases are major causes of death in the western world and this incidence increases in the elderly population. With aging, there are physiologic changes to the cardiac structure secondary to adipose tissue deposition, calcification of valve leaflets and changes in the structure of the heart including atrial remodeling. Such changes can make the myocardium more susceptible to stress leading to a higher prevalence of cardiovascular diseases in the aging population. Studies in healthy humans have shown that these structural and molecular changes in the heart are manifested as changes on an electrocardiogram (ECG). Using animal models, similar ECG changes have been found in guinea pigs, rabbits, and mice. No veterinary study has specifically evaluated if comparable aging changes occur in canine species. In this cross-sectional retrospective study, 12,026 ECGs from apparently healthy dogs were obtained and evaluated. Age was observed to have both linear and non-linear associations with multiple ECG variables, including P wave amplitude and duration, R amplitude and QRS duration. This study confirmed that, like humans, there may be ECG changes secondary to normal physiological cardiac aging. Further studies are warranted to confirm and elaborate on these findings as canines may be a useful model for cardiac aging in humans.
Collapse
|
5
|
Granot Y, Ben-Assa E, Sapir O, Laufer-Perl M, Topilsky Y, Rozenbaum Z. Age-specific mortality risk of mild diastolic dysfunction among hospitalized patients with preserved ejection fraction. Int J Cardiol 2021; 332:216-222. [PMID: 33775792 DOI: 10.1016/j.ijcard.2021.03.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 02/05/2021] [Accepted: 03/22/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND The conveyed risk of mild diastolic dysfunction (MDD) according to age had not been thoroughly studied. We aimed to investigate the mortality-risk of MDD by age-groups among inpatients with preserved ejection fraction (EF), and determine ranges of diastolic function parameters by prognosis. METHODS In a single-center retrospective study we identified inpatients who underwent echocardiography between 2012 and 2018 and had preserved EF without significant valvulopathies. Propensity scores were used to adjust for baseline characteristics and main diagnoses at discharge. Comparisons for all-cause mortality between MDD and normal diastolic function were conducted by age groups. Using classification and regression trees (CART) modeling we determined age-specific cut-offs according to outcome. RESULTS The cohort consisted of 15,777 inpatients. Mortality rate during a 33.9-months median follow-up was 21.6%. MDD was associated with increased mortality risk among all ages up to 90 years, thereafter no difference was detected. Adjusted hazard ratios inversely related to age - 1.99(95%CI 1.25-3.16, p = 0.004), 1.82(95%CI1.46-2.26, p < 0.001), 1.88(95%CI1.64-2.15, p < 0.001), 1.78(95%CI1.59-2.01, p < 0.001), and 1.32(95%CI0.95-1.83, p = 0.093), for 18-44, 45-59, 60-74, 75-89, and ≥90 years, respectively (Pinteraction = 0.009). New cut-offs of E/e' for ages 75-89(16), e' lateral for ages ≥90(6 cm/s), e' septal for ages 60-74(5 cm/s), and E/A ratio for ages 18-44(1.5), predicted outcome more accurately than guidelines-based recommendations. The remaining cut-offs were not better predictors compared to guidelines-based recommendations. CONCLUSIONS MDD is a consequential finding at all ages up to 90 years among inpatients with preserved EF, although its significance decreases with age. Diastolic function of several age-groups may be better delineated by cut-offs that presage adverse prognoses. Helsinki committee approval number: 0170-17-TLV.
Collapse
Affiliation(s)
- Yoav Granot
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Eyal Ben-Assa
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Orly Sapir
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Medical Center and Sackler Faculty of Medicine, Tel Aviv University, Israel; Department of Cardiology, Montefiore Medical Center, Bronx, NY, USA.
| |
Collapse
|
6
|
Boudagh S, Alizadehasl A, Bakhshandeh H, Sadeghipour P, Mohebbi B, Baay M, Alemzadeh-Ansari M, Hosseini Z, Norouzi Z, Maleki M, Noohi F, Khalili Y, Naderi N, Pouraliakbar H, Ghadrdoost B, Arabian M, Khaleghparast S. Normal values of echocardiographic parameters and incidence of valvular heart findings in 2229 iranian peaple: Results from the “HAMRAH survey”. Res Cardiovasc Med 2021. [DOI: 10.4103/rcm.rcm_18_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
7
|
Trachsel LD, Boidin M, Henri C, Fortier A, Lalongé J, Juneau M, Nigam A, Gayda M. Women and men with coronary heart disease respond similarly to different aerobic exercise training modalities: a pooled analysis of prospective randomized trials. Appl Physiol Nutr Metab 2020; 46:417-425. [PMID: 33096006 DOI: 10.1139/apnm-2020-0650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We aimed to compare cardiopulmonary exercise test (CPET) parameters, cardiac adaptations, and proportion of responders after different aerobic training programs amongst women and men with coronary heart disease (CHD). Patients with CHD were evaluated with a CPET and echocardiography before and after 3 months of aerobic exercise training. Peak oxygen uptake exercise training response was assessed according to the median peak oxygen uptake change for post- versus pretraining in the whole cohort (stratification non/low responders (NLR) vs. high-responders) and normalized for lean body mass (LBM). Eighty-three CHD patients were included (19 women, 64 men; 27 patients with interval, 19 with continuous, and 37 with combination exercises). Peak oxygen uptake, peak workload normalized for LBM, pulmonary variables (i.e., ventilation and oxygen uptake efficiency slope), and O2 pulse were significantly lower in women versus men. These parameters improved similarly with training in both sexes (p < 0.05). There were no differences in the proportion of NLR among women and men with CHD (7/19 (37%) vs. 35/64 (55%), p = 0.1719). Left ventricular ejection fraction and mean peak early diastolic mitral annulus velocity improved similarly with training in both sexes (p < 0.05). Women and men with CHD have a similar exercise training response regarding key CPET and echocardiographic parameters. The proportion of responders is similar. ClinicalTrials.gov: NCT03414996, NCT02048696, NCT03443193. Novelty: Cardiopulmonary adaptations to exercise training are similar among CHD men and women. Proportion of peak oxygen uptake for non/low/high responders is similar in CHD men and women. Left ventricular systolic and diastolic function improved similarly after exercise training in CHD men and women.
Collapse
Affiliation(s)
- Lukas-Daniel Trachsel
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1N6, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada.,University Clinic for Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, CH-3010 Switzerland
| | - Maxime Boidin
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1N6, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada.,School of Kinesiology and Exercise Science, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada
| | - Christine Henri
- Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Annik Fortier
- Montreal Health Innovations Coordinating Center, Montreal Heart Institute, Montreal, QC H1T 1C8, Canada
| | - Julie Lalongé
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1N6, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Martin Juneau
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1N6, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Anil Nigam
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1N6, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| | - Mathieu Gayda
- Cardiovascular Prevention and Rehabilitation (ÉPIC) Center, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1N6, Canada.,Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC H3T 1J4, Canada.,Research Centre, Montreal Heart Institute, Université de Montréal, Montreal, QC H1T 1C8, Canada
| |
Collapse
|
8
|
Thomas L, Muraru D, Popescu BA, Sitges M, Rosca M, Pedrizzetti G, Henein MY, Donal E, Badano LP. Evaluation of Left Atrial Size and Function: Relevance for Clinical Practice. J Am Soc Echocardiogr 2020; 33:934-952. [DOI: 10.1016/j.echo.2020.03.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 03/31/2020] [Accepted: 03/31/2020] [Indexed: 01/05/2023]
|
9
|
Chetrit M, Cremer PC, Klein AL. Imaging of Diastolic Dysfunction in Community-Based Epidemiological Studies and Randomized Controlled Trials of HFpEF. JACC Cardiovasc Imaging 2020; 13:310-326. [DOI: 10.1016/j.jcmg.2019.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 10/09/2019] [Accepted: 10/16/2019] [Indexed: 11/30/2022]
|
10
|
Prasad SB, Holland DJ, Atherton JJ, Whalley G. New Diastology Guidelines: Evolution, Validation and Impact on Clinical Practice. Heart Lung Circ 2019; 28:1411-1420. [PMID: 31064714 DOI: 10.1016/j.hlc.2019.03.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 03/22/2019] [Indexed: 01/12/2023]
Abstract
The 2016 American Society of Echocardiography/European Association of Echocardiography (ASE/EACVI) guidelines on the assessment of diastolic function sought to simplify the assessment of diastolic function by recommending a streamlined, stepped approach with a focus on four key variables. Haemodynamic validation using simultaneous cardiac catheterisation and echocardiographic assessment of diastolic function have shown robust prediction of left ventricular filling pressure (LVFP) using the streamlined 2016 algorithms, with favourable comparisons to the 2009 guidelines. Similarly, prognostic validation data demonstrates that the 2016 algorithms are easier to implement in clinical practice, have superior inter-observer reliability across a broad range of observer experience, and are better at predicting clinical outcomes. Furthermore, published data show improved classification of clinical heart failure patients. However, increased specificity of the updated 2016 guidelines results in a lower prevalence of diastolic dysfunction compared to the 2009 recommendations. Further refinement of guidelines for the identification and diagnosis of diastolic dysfunction is possible through incorporation of new diastolic parameters.
Collapse
Affiliation(s)
- Sandhir B Prasad
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia.
| | - David J Holland
- Department of Cardiology, Sunshine Coast University Hospital, Brisbane, Qld, Australia; School of Human Movement and Nutrition Sciences, The University of Queensland, Brisbane, Qld, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia; School of Medicine, The University of Queensland, Brisbane, Qld, Australia
| | - Gillian Whalley
- Department of Medicine, University of Otago, Dunedin, New Zealand
| |
Collapse
|
11
|
Gardin JM. Pulsed Doppler Echocardiography: An Historical Perspective. J Am Soc Echocardiogr 2018; 31:1330-1343. [PMID: 30522606 DOI: 10.1016/j.echo.2018.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Indexed: 10/27/2022]
Abstract
Over the past six decades, echocardiography has evolved into an important technique for not only imaging cardiac structures, but also, by employing the Doppler equation, for assessing cardiac blood flow and tissue velocities. This review focuses on pulsed Doppler echocardiography: its principles, early development, and clinical applications. Important clinical applications include: (1) measurement of flow velocities, stroke volumes, and regurgitant and shunt volumes; (2) assessment of time intervals, e.g., pulmonary artery acceleration time as a measure of pulmonary artery pressure and resistance or the timing of mitral regurgitation in hypertrophic cardiomyopathy; (3) detection of turbulent flow in regurgitation, stenoses, and shunts, enhanced by the implementation of color Doppler; and (4) evaluation of left ventricular diastolic function in conjunction with pulsed tissue Doppler and deformation (strain) measurements.
Collapse
Affiliation(s)
- Julius M Gardin
- Division of Cardiology, Department of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey.
| |
Collapse
|
12
|
Diastolic Assessment: Application of the New ASE Guidelines. CURRENT CARDIOVASCULAR IMAGING REPORTS 2018. [DOI: 10.1007/s12410-018-9474-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
13
|
Pascual F, Schisler JC, Grevengoed TJ, Willis MS, Coleman RA. Modeling the Transition From Decompensated to Pathological Hypertrophy. J Am Heart Assoc 2018; 7:JAHA.117.008293. [PMID: 29622588 PMCID: PMC6015423 DOI: 10.1161/jaha.117.008293] [Citation(s) in RCA: 5] [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] [Indexed: 12/21/2022]
Abstract
BACKGROUND Long-chain acyl-CoA synthetases (ACSL) catalyze the conversion of long-chain fatty acids to fatty acyl-CoAs. Cardiac-specific ACSL1 temporal knockout at 2 months results in a shift from FA oxidation toward glycolysis that promotes mTORC1-mediated ventricular hypertrophy. We used unbiased metabolomics and gene expression analyses to examine the early effects of genetic inactivation of fatty acid oxidation on cardiac metabolism, hypertrophy development, and function. METHODS AND RESULTS Global cardiac transcriptional analysis revealed differential expression of genes involved in cardiac metabolism, fibrosis, and hypertrophy development in Acsl1H-/- hearts 2 weeks after Acsl1 ablation. Comparison of the 2- and 10-week transcriptional responses uncovered 137 genes whose expression was uniquely changed upon knockdown of cardiac ACSL1, including the distinct upregulation of fibrosis genes, a phenomenon not observed after complete ACSL1 knockout. Metabolomic analysis identified metabolites altered in hearts displaying partially reduced ACSL activity, and rapamycin treatment normalized the cardiac metabolomic fingerprint. CONCLUSIONS Short-term cardiac-specific ACSL1 inactivation resulted in metabolic and transcriptional derangements distinct from those observed upon complete ACSL1 knockout, suggesting heart-specific mTOR (mechanistic target of rapamycin) signaling that occurs during the early stages of substrate switching. The hypertrophy observed with partial Acsl1 ablation occurs in the context of normal cardiac function and is reminiscent of a physiological process, making this a useful model to study the transition from physiological to pathological hypertrophy.
Collapse
Affiliation(s)
- Florencia Pascual
- Department of Nutrition, University of North Carolina at Chapel Hill, NC
| | - Jonathan C Schisler
- Department of Pharmacology, University of North Carolina at Chapel Hill, NC.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC.,McAllister Heart Institute University of North Carolina at Chapel Hill, NC
| | | | - Monte S Willis
- Department of Pharmacology, University of North Carolina at Chapel Hill, NC.,Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC.,McAllister Heart Institute University of North Carolina at Chapel Hill, NC
| | - Rosalind A Coleman
- Department of Nutrition, University of North Carolina at Chapel Hill, NC
| |
Collapse
|
14
|
Clarke GD, Molina‐Wilkins M, Solis‐Herrera C, Mendez V, Monroy A, Cersosimo E, Chilton RJ, Abdul‐Ghani M, DeFronzo RA. Impaired left ventricular diastolic function in T2DM patients is closely related to glycemic control. Endocrinol Diabetes Metab 2018; 1:e00014. [PMID: 30815550 PMCID: PMC6354805 DOI: 10.1002/edm2.14] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/24/2018] [Accepted: 02/18/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Left ventricular (LV) diastolic dysfunction commonly is observed in individuals with type 2 diabetes mellitus (T2DM). We employed transthoracic echocardiography (TTE) and cardiac magnetic resonance imaging (CMRI) to investigate the hypothesis that LV diastolic dysfunction in T2DM is associated with poor glycemic control. METHODS Forty subjects, 21 with normal glucose tolerance (NGT) and 19 with T2DM, were studied with CMRI and TTE to assess LV function. Early-to-late transmitral flow ratio (E/A) and deceleration time (DecT) were assessed with both modalities. Normalized (to body surface area) end-diastolic volume (EDV/BSA) and normalized peak LV filling rate (pLVFR/BSA) were assessed with CMRI. Early transmitral flow velocity to septal velocity (E/e') and isovolumetric relaxation time (IVRT) were measured using TTE. Dimensional parameters were normalized to body surface area (BSA). RESULTS CMRI measurements demonstrated impaired E/A (1.13 ± 0.34 vs 1.62 ± 0.42, P < .001), increased DecT (174 ± 46 ms vs 146 ± 15, P = .005), as well as lower EDV/BSA (63 ± 10 vs 72 ± 9 mL/m2, P < .01) and pLVFR/BSA (189 ± 46 vs 221 ± 48 mL s-1 m-2, P < .05) in T2DM subjects. TTE measurements revealed lower E/A (1.1 ± 0.4 vs 1.4 ± 0.2, P < .001) and E/e' (6.8 ± 1.5 vs 8.7 ± 2.0, P < .0001) with higher DecT (203 ± 22 ms vs 179 ± 18, P < .001) and IVRT (106 ± 14 ms vs 92 ± 10, P < .001) in T2DM. Multiple parameters of LV function: E/ACMRI (r = -.50, P = .001), E/ATTE (r = -.46, P < .005), pLVFR/BSA (r = -.35, P < .05), E/e' (r = -.46, P < .005), EDV/BSACMRI (r = -.51, P < .0001), EDV/BSATTE (r = -.42, P < .01) were negatively correlated with HbA1c. All but E/e' also were inversely correlated with fasting plasma glucose (FPG). CONCLUSIONS Impaired LV diastolic function (DF) was found in T2DM subjects with both CMRI and TTE, and multiple LVDF parameters correlated negatively with HbA1c and FPG. These results indicate that impaired LVDF is inversely linked to glycemic control in T2DM patients.
Collapse
Affiliation(s)
- Geoffrey D. Clarke
- Department of RadiologyTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Marjorie Molina‐Wilkins
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Carolina Solis‐Herrera
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Verna Mendez
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Adriana Monroy
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Eugenio Cersosimo
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Robert J. Chilton
- Cardiology DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Muhammad Abdul‐Ghani
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| | - Ralph A. DeFronzo
- Diabetes DivisionDepartment of MedicineTexas Diabetes InstituteUniversity of Texas Health Science Center at San AntonioSan AntonioTXUSA
| |
Collapse
|
15
|
Iyngkaran P, Anavekar NS, Neil C, Thomas L, Hare DL. Shortness of breath in clinical practice: A case for left atrial function and exercise stress testing for a comprehensive diastolic heart failure workup. World J Methodol 2017; 7:117-128. [PMID: 29354484 PMCID: PMC5746665 DOI: 10.5662/wjm.v7.i4.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Revised: 06/29/2017] [Accepted: 11/22/2017] [Indexed: 02/06/2023] Open
Abstract
The symptom cluster of shortness of breath (SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
Collapse
Affiliation(s)
- Pupalan Iyngkaran
- Department of Medicine, Northern Territory Medical School, Flinders University, Charles Darwin University Campus, Casuarina, NT 0815, Australia
| | - Nagesh S Anavekar
- Department of Cardiology, Northern Hospital, Northern Health, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Christopher Neil
- Cardiology Unit Western Health, Department of Medicine, Western Precinct, University of Melbourne, Melbourne, VIC 3076, Australia
| | - Liza Thomas
- South Western Sydney Clinical School, University of New South Wales, Sydney, NSW 214, Australia
- Westmead Hospital, Westmead Clincal School, University of Sydney, NSW 2145, Australia
| | - David L Hare
- Cardiovascular Research, University of Melbourne, Melbourne, VIC 3076, Australia
- Heart Failure Services, Austin Health, Melbourne, VIC 3084, Australia
| |
Collapse
|
16
|
Alcidi GM, Esposito R, Evola V, Santoro C, Lembo M, Sorrentino R, Lo Iudice F, Borgia F, Novo G, Trimarco B, Lancellotti P, Galderisi M. Normal reference values of multilayer longitudinal strain according to age decades in a healthy population: A single-centre experience. Eur Heart J Cardiovasc Imaging 2017. [DOI: 10.1093/ehjci/jex306] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
|
17
|
Avriel A, Klement AH, Johnson SR, de Perrot M, Granton J. Impact of Left Ventricular Diastolic Dysfunction on Lung Transplantation Outcome in Patients With Pulmonary Arterial Hypertension. Am J Transplant 2017; 17:2705-2711. [PMID: 28508451 DOI: 10.1111/ajt.14352] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 03/31/2017] [Accepted: 05/02/2017] [Indexed: 01/25/2023]
Abstract
Diastolic dysfunction may influence perioperative outcome, early graft function, and long-term survival. We compared the outcomes of double lung transplantation (DLTx) for patients with pulmonary arterial hypertension (PAH) with preoperative left ventricular (LV) diastolic dysfunction with the outcomes of patients without diastolic dysfunction. Of 116 consecutive patients with PAH (who underwent transplantation between January 1995 and December 2013), 44 met our inclusion and exclusion criteria. Fourteen (31.8%) patients with diastolic dysfunction pretransplantation had a higher body mass index (29 [IQR 21.5-32.6] vs 22.4 [IQR 19.9-25.3] kg/m2 ) and mean pulmonary arterial pressure (54.6 ± 10 mmHg vs 47 ± 11.3 mmHg) and right atrial pressure (16.5 ± 5.2 mmHg vs 10.6 ± 5.2 mmHg). The patients received extracorporeal life support more frequently (33% vs 7% [p = 0.02]), had worse APACHE II scores (21.7 ± 7.4 vs 15.3 ± 5.3 [p = 0.02]), and a trend toward worse ventilator-free days (2.5 [IQR 6.5-32.5] vs 17 [IQR 3-23] [p = 0.08]). There was no effect on development of primary graft dysfunction or intensive care unit/hospital survival. One-year survival was worse (hazard ratio [HR] 4.45, 95% confidence interval [CI] 1.3-22, p = 0.02). Diastolic dysfunction was the only variable that correlated with overall survival (HR 5.4, 95% CI 1.3-22, p = 0.02). Diastolic dysfunction leads to early postoperative morbidity and worse survival in patients with PAH after DLTx.
Collapse
Affiliation(s)
- A Avriel
- Pulmonology Institute, Department of Medicine, Soroka Medical Center, Faculty of Health Sciences Ben-Gurion University, Beer-Sheva, Israel
| | - A H Klement
- Meir Medical Center, Faculty of Health Sciences, Tel- Aviv University, Tel-Aviv, Israel
| | - S R Johnson
- Division of Rheumatology, Department of Medicine, University Health Network, Toronto, Ontario, Canada
| | - M de Perrot
- Multiorgan Transplant Program, University Health Network, and the Division of Thoracic Surgery, University Health Network, Toronto, Ontario, Canada
| | - J Granton
- Multiorgan Transplant Program, University Health Network, and the Division of Respirology, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
18
|
Liao JN, Chao TF, Kuo JY, Sung KT, Tsai JP, Lo CI, Lai YH, Su CH, Hung CL, Yeh HI, Chen SA. Age, Sex, and Blood Pressure-Related Influences on Reference Values of Left Atrial Deformation and Mechanics From a Large-Scale Asian Population. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.006077. [DOI: 10.1161/circimaging.116.006077] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 08/02/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Jo-Nan Liao
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Tze-Fan Chao
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Jen-Yuan Kuo
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Kuo-Tzu Sung
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Jui-Peng Tsai
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Chi-In Lo
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Yau-Huei Lai
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Cheng-Huang Su
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Chung-Lieh Hung
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Hung-I Yeh
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| | - Shih-Ann Chen
- From the Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taiwan (J.-N.L., T.-F.C, S.-A.C.); Institute of Clinical Medicine (J.-N.L., T.-F.C, S.-A.C.) and Cardiovascular Research Center (J.-N.L., T.-F.C, S.-A.C.), National Yang-Ming University, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C.-H.S., C.-L.H., H.-I.Y.); Medical Research (J.-Y.K., K.-T.S., J.-P.T., C.-I.L., Y.-H.L., C
| |
Collapse
|
19
|
Gupta VA, Nanda NC, Sorrell VL. Role of Echocardiography in the Diagnostic Assessment and Etiology of Heart Failure in Older Adults. Heart Fail Clin 2017; 13:445-466. [DOI: 10.1016/j.hfc.2017.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
Dencker M, Stagmo M. Reported normal values and weighted means for commonly used echocardiography pulsed Doppler and tissue Doppler measurements. Clin Physiol Funct Imaging 2017; 38:341-350. [DOI: 10.1111/cpf.12427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 02/22/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Magnus Dencker
- Department of Medical Imaging and Physiology; Skåne University Hospital; Lund University; Malmö Sweden
| | - Martin Stagmo
- Department of Cardiology; Skåne University Hospital; Lund University; Lund Sweden
| |
Collapse
|
21
|
Reduced trans-mitral A-wave velocity predicts the presence of wild-type transthyretin amyloidosis in elderly patients with left ventricular hypertrophy. Heart Vessels 2016; 32:708-713. [PMID: 27882404 DOI: 10.1007/s00380-016-0925-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 11/18/2016] [Indexed: 10/20/2022]
Abstract
Wild-type transthyretin amyloidosis (ATTRwt) is often overlooked in elderly patients with left ventricular hypertrophy (LVH). Impaired atrial function, in addition to ventricular diastolic dysfunction, is one of the hallmarks of cardiac amyloidosis. Here, we assessed the hypothesis that atrial function evaluated by A-velocity in pulse Doppler echocardiography is useful to differentiate ATTRwt in elderly patients with LVH. We analyzed 133 consecutive patients who underwent tissue biopsy to rule out infiltrative cardiomyopathy in our institute. We excluded patients younger than 50 years, without LVH (LV thickness was less than 12 mm), with other types of cardiac amyloidosis and patients with chronic atrial fibrillation, and analyzed remaining 51 patients (ATTRwt: 16, non-ATTRwt: 35). ATTRwt patients were significantly older and had advanced heart failure compared with non-ATTRwt group. In echocardiography, E/A, E/e', and relative wall thickness was significantly higher in ATTRwt group than non-ATTRwt group. A-velocity was significantly decreased in ATTRWT group compared with non-ATTRwt group (40.8 ± 20.8 vs. 78.7 ± 28.2 cm/s, p = 0.0001). Multivariate logistic analysis using eight forced inclusion models identified trans-mitral Doppler A-wave velocity was more significant factor of cardiac amyloidosis in ATTRwt. In receiver operating characteristic (ROC) analysis, the area under the curve (AUC) for A-wave velocity in discrimination between ATTRwt and non-ATTRwt were 0.86 (CI 0.76-0.96, p < 0.001). The cut-off value was 62.5 cm/s, and it yielded the best combination of sensitivity (69.7%) and specificity (87.5%) for prediction of amyloidosis. We concluded that reduced A-velocity predicts the presence of ATTRwt in elderly patients with LVH in sinus rhythm.
Collapse
|
22
|
Schober KE, Chetboul V. Echocardiographic evaluation of left ventricular diastolic function in cats: Hemodynamic determinants and pattern recognition. J Vet Cardiol 2016; 17 Suppl 1:S102-33. [PMID: 26776572 DOI: 10.1016/j.jvc.2015.02.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/26/2015] [Accepted: 02/04/2015] [Indexed: 10/22/2022]
Abstract
Left ventricular (LV) diastolic dysfunction is highly prevalent in cats and is a functional hallmark of feline cardiomyopathy. The majority of cats with hypertrophic, restrictive, and dilated cardiomyopathy have echocardiographic evidence of abnormal LV filling, even during the occult (preclinical) phase. Moderate and severe diastolic dysfunction is an indicator of advanced myocardial disease, is associated with clinical signs including exercise intolerance and congestive heart failure, affects outcome, and influences therapeutic decisions. Therefore, identification and quantification of LV diastolic dysfunction are clinically important. Surrogate measures of diastolic function determined by transthoracic two-dimensional, M-mode, and Doppler echocardiographic (DE) methods have been used widely for such purpose. Major functional characteristics of LV diastole, including global function, relaxation and untwist, chamber compliance, filling volume, and the resultant filling pressures can be semi-quantified by echocardiographic methods, and variables retrieved from transmitral flow, pulmonary vein flow, and tissue Doppler recordings are most frequently used. Although there is still a critical lack of well-designed studies in the field, knowledge has steadily accumulated over the past 20 years, reference ranges of diastolic echocardiographic variables have been determined, epidemiological studies have been conducted, and new treatments of diastolic dysfunction in cats have been evaluated. This report will give the reader a summary of the current status in the field of feline diastology with focus on the noninvasive diagnostic methods and interpretation of echocardiographic surrogate measures of LV diastolic function. Lastly, a grading system using a composite of left atrial size and various DE variables potentially useful in the functional classification of LV diastole in cats is introduced.
Collapse
Affiliation(s)
- Karsten E Schober
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH 43210, USA.
| | - Valérie Chetboul
- Université Paris-Est, Ecole Nationale Vétérinaire d'Alfort, Unité de Cardiologie d'Alfort (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), 7 avenue du general de Gaulle, 94704 Maisons-Alfort cedex, France
| |
Collapse
|
23
|
Zakynthinos E, Pierutsakos C, Konstantinidis K, Zakynthinos S, Papadogiannis D. Losartan Reduces Left Ventricular Hypertrophy Proportionally to Blood Pressure Reduction in Hypertensives, but Does Not Affect Diastolic Cardiac Function. Angiology 2016; 55:669-78. [PMID: 15547653 DOI: 10.1177/00033197040550i608] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In contrast to the well-recognized salutary effects of angiotensin-converting enzyme inhibition, the value of angiotensin II type I (ATl)-receptor blockade on left ventricular hypertrophy (LVH) is controversial. In addition, the data on the influence of this therapy on cardiac diastolic function are scarce. Thirty-nine patients with moderate primary hypertension, LVH, and normal systolic function received losartan, 50 to 100 mg daily. Transthoracic echocardiography was performed at baseline and after 6 months of treatment. Thirty-one patients completed and were included in the study (16 males, 61.1 ±1.0 years). The patients were divided into responders if mean blood pressure (BP) decreased >5 mm Hg at the end of the study (20 patients) and non-responders (mean BP decrease ≤5 mm Hg, 11 patients). The BP and the LVH were significantly reduced (systolic BP by 10.0%, diastolic BP 6.5%, mean BP 8.2%, left ventricular mass index [LVMI] 6.2%, interventricular septum 5.8%, posterior wall 3.0%) (p≤0.02), attributed to the reduction of BP and LVH in responders; the LVH in non-responders did not alter with treatment. A significant correlation was noted between changes in BP and LVMI ( r =0.60, p<0.001). The systolic cardiac function remained normal. The Doppler parameters usually used to assess the diastolic function of the LV (early diastolic filling velocity [E wave], late diastolic filling velocity [A wave], ratio of E/A waves, isovolumic relaxation time), which were abnormal at baseline, did not change with treatment. The size of the left atrium increased (p<0.05) at the end of the study. In conclusion, a 6-month course with losartan decreased BP and LVH. However, the LVH regression was rather associated with the reduction of the hemodynamic stimulus per se, than any trophic effect of the drug in the myocardium. The diastolic cardiac function remained abnormal with treatment.
Collapse
Affiliation(s)
- E Zakynthinos
- Department of Critical Care and Pulmonary Services, University of Athens Medical School, Evangelismos Hospital, Athens, Greece.
| | | | | | | | | |
Collapse
|
24
|
Kapłon-Cieślicka A, Tymińska A, Peller M, Balsam P, Ozierański K, Galas M, Marchel M, Crespo-Leiro MG, Maggioni AP, Drożdż J, Filipiak KJ, Opolski G. Diagnosis, Clinical Course, and 1-Year Outcome in Patients Hospitalized for Heart Failure With Preserved Ejection Fraction (from the Polish Cohort of the European Society of Cardiology Heart Failure Long-Term Registry). Am J Cardiol 2016; 118:535-42. [PMID: 27374606 DOI: 10.1016/j.amjcard.2016.05.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 05/23/2016] [Accepted: 05/23/2016] [Indexed: 10/21/2022]
Abstract
Compared with heart failure (HF) with reduced ejection fraction (HF-REF), the diagnosis of HF with preserved EF (HF-PEF) is more challenging. The aim of the study was to assess the prevalence of HF-PEF among patients hospitalized for HF, to evaluate the pertinence of HF-PEF diagnosis and to compare HF-PEF and HF-REF patients with respect to outcomes. The analysis included 661 Polish patients hospitalized for HF, selected from the European Society of Cardiology (ESC)-HF Long-Term Registry. Patients with an EF of ≥50% were included in the HF-PEF group and patients with an EF of <50% - in the HF-REF group. The primary end point was all-cause death at 1 year. The secondary end point was a composite of all-cause death and rehospitalization for HF at 1 year. HF-PEF was present in 187 patients (28%). Of those 187 patients, mitral inflow pattern was echocardiographically assessed in 116 patients (62%) and classified as restrictive/pseudonormal in 37 patients (20%). Compared with HF-REF subjects, patients with HF-PEF were older, more often female, and had a higher prevalence of hypertension, atrial fibrillation and sleep apnea. Despite lower B-type natriuretic peptide concentrations and lower prevalence of moderate-to-severe mitral regurgitation in patients with HF-PEF, congestive symptoms at admission were as severe as in patients with HF-REF. There were no significant differences in in-hospital mortality between the HF groups. One-year mortality was high in both groups (17% in HF-PEF vs 21% in HF-REF, p = 0.22). There was a trend toward a lower frequency of the secondary end point in the HF-PEF group (32% vs 40%, p = 0.07). In conclusion, in clinical practice, even easily obtainable echocardiographic indexes of diastolic dysfunction are relatively rarely acquired. One-year survival rate of patients with HF-PEF is not significantly better than that of patients with HF-REF.
Collapse
|
25
|
Peverill RE, Chou B, Donelan L, Mottram PM, Gelman JS. Possible Mechanisms Underlying Aging-Related Changes in Early Diastolic Filling and Long Axis Motion-Left Ventricular Length and Blood Pressure. PLoS One 2016; 11:e0158302. [PMID: 27351745 PMCID: PMC4924872 DOI: 10.1371/journal.pone.0158302] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 06/13/2016] [Indexed: 01/19/2023] Open
Abstract
Background The transmitral E wave and the peak velocity of early diastolic mitral annular motion (e`) both decrease with age, but the mechanisms underlying these age-related changes are incompletely understood. This study investigated the possible contributions of blood pressure (BP) and left ventricular end-diastolic length (LVEDL) to age-related reductions in E and e`. Methods The study group were 82 healthy adult subjects <55 years of age who were not obese or hypertensive. Transmitral flow and mitral annular motion were recorded using pulsed-wave Doppler. LVEDL was measured from the mitral annular plane to the apical endocardium. Results Age was positively correlated with diastolic BP and septal wall thickness (SWT), inversely correlated with LVEDL (β = -0.25) after adjustment for sex and body surface area, but was not related to left ventricular end-diastolic diameter (LVEDD). Age was also inversely correlated with E (r = -0.36), septal e`(r = -0.53) and lateral e`(r = -0.53). On multivariable analysis, E was inversely correlated with diastolic BP and LVEDD, septal e`was inversely correlated with diastolic BP and positively correlated with SWT and LVEDL, after adjusting for body mass index, whilst lateral e`was inversely correlated with diastolic BP and positively correlated with LVEDL. Conclusion The above findings are consistent with higher BP being a contributor to age-related reductions in both E and e`and shortening of LVEDL with age being a contributor to the age-related reduction in e`. An implication of these findings is that slowing of myocyte relaxation is unlikely to be the sole, and may not be the main, mechanism underlying age-related decreases in E and e`.
Collapse
Affiliation(s)
- Roger E. Peverill
- Monash Cardiovascular Research Centre, Monash Heart and Department of Medicine (School of Clinical Sciences at Monash Medical Centre), Monash University and Monash Health, Clayton, Victoria, Australia
- * E-mail:
| | - Bon Chou
- Monash Cardiovascular Research Centre, Monash Heart and Department of Medicine (School of Clinical Sciences at Monash Medical Centre), Monash University and Monash Health, Clayton, Victoria, Australia
| | - Lesley Donelan
- Monash Cardiovascular Research Centre, Monash Heart and Department of Medicine (School of Clinical Sciences at Monash Medical Centre), Monash University and Monash Health, Clayton, Victoria, Australia
| | - Philip M. Mottram
- Monash Cardiovascular Research Centre, Monash Heart and Department of Medicine (School of Clinical Sciences at Monash Medical Centre), Monash University and Monash Health, Clayton, Victoria, Australia
| | - John S. Gelman
- Monash Cardiovascular Research Centre, Monash Heart and Department of Medicine (School of Clinical Sciences at Monash Medical Centre), Monash University and Monash Health, Clayton, Victoria, Australia
| |
Collapse
|
26
|
Choi JO, Shin MS, Kim MJ, Jung HO, Park JR, Sohn IS, Kim H, Park SM, Yoo NJ, Choi JH, Kim HK, Cho GY, Lee MR, Park JS, Shim CY, Kim DH, Shin DH, Shin GJ, Shin SH, Kim KH, Park JH, Lee SY, Kim WS, Park SW. Normal Echocardiographic Measurements in a Korean Population Study: Part II. Doppler and Tissue Doppler Imaging. J Cardiovasc Ultrasound 2016; 24:144-52. [PMID: 27358707 PMCID: PMC4925392 DOI: 10.4250/jcu.2016.24.2.144] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 05/10/2016] [Accepted: 05/10/2016] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Hemodynamic and functional evaluation with Doppler and tissue Doppler study as a part of comprehensive echocardiography is essential but normal reference values have never been reported from Korean normal population especially according to age and sex. METHODS Using Normal echOcaRdiographic Measurements in a KoreAn popuLation study subjects, we obtained normal reference values for Doppler and tissue Doppler echocardiography including tricuspid annular velocities according to current guidelines and compared values according to gender and age groups. RESULTS Mitral early diastolic (E) and late diastolic (A) velocity as well as E/A ratio were significantly higher in women compared to those in men. Conversely, mitral peak systolic and late diastolic annular velocity in both septal and lateral mitral annulus were significantly lower in women compared to those in men. However, there were no significant differences in both septal and lateral mitral early diastolic annular (e') velocity between men and women. In both men and women, mitral E velocity and its deceleration time as well as both E/A and E/e' ratio considerably increased with age. There were no significant differences in tricuspid inflow velocities and tricuspid lateral annular velocities between men and women except e' velocity, which was significantly higher in women compared to that in men. However, changes in both tricuspid inflow and lateral annular velocities according to age were similar to those in mitral velocities. CONCLUSION Since there were significant differences in Doppler and tissue Doppler echocardiographic variables between men and women and changes according to age were even more considerable in both gender groups, normal Doppler echocardiographic values should be differentially applied based on age and sex.
Collapse
Affiliation(s)
- Jin-Oh Choi
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gil Hospital, Gachon University of Medicine and Science, Incheon, Korea
| | - Mi-Jeong Kim
- Division of Cardiology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hae Ok Jung
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jeong Rang Park
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Il Suk Sohn
- Department of Cardiology, Kyung Hee University School of Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Hyungseop Kim
- Division of Cardiology, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Nam Jin Yoo
- Department of Internal Medicine, Wonkwang University Hospital, Institute of Wonkwang Medical Science, Iksan, Korea
| | - Jung Hyun Choi
- Division of Cardiology, Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Hyung-Kwan Kim
- Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University College of Medicine, Seoul, Korea
| | - Goo-Yeong Cho
- Division of Cardiology, Department of Internal Medicine, Seoul National University and Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Mi-Rae Lee
- Division of Cardiology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Jin-Sun Park
- Department of Cardiology, Ajou University School of Medicine, Suwon, Korea
| | - Chi Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Dae-Hee Kim
- Department of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae-Hee Shin
- Division of Cardiology, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - Gil Ja Shin
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Korea
| | - Sung Hee Shin
- Division of Cardiology, Department of Internal Medicine, Inha University College of Medicine, Incheon, Korea
| | - Kye Hun Kim
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
| | - Jae-Hyeong Park
- Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea
| | - Sang Yeub Lee
- Division of Cardiology, Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Korea
| | - Woo-Shik Kim
- Department of Internal Medicine, Cardiovascular Center, Kyung Hee University Medical Center, Seoul, Korea
| | - Seung Woo Park
- Division of Cardiology, Department of Medicine, Heart Vascular Stroke Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
27
|
Smith C, Asrar Ul Haq M, Jerums G, Hanson E, Hayes A, Allen JD, Sbaraglia M, Selig S, Wong C, Hare DL, Levinger I. Assessing the Value of BMI and Aerobic Capacity as Surrogate Markers for the Severity of Left Ventricular Diastolic Dysfunction in Patients with Type 2 Diabetes Who Are Obese. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2016; 10:61-5. [PMID: 27199576 PMCID: PMC4869605 DOI: 10.4137/cmc.s38116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Revised: 02/02/2016] [Accepted: 02/05/2016] [Indexed: 11/05/2022]
Abstract
Left ventricular diastolic dysfunction (LVDD) is one of the earliest signs for abnormal cardiac function in patients with type 2 diabetes (T2DM). It is important to explore the risk factors that will assist in identifying the severity of the LVDD in this population. We examined the influences of fitness and fatness on the level of left ventricular (LV) impairment in patients with T2DM. Twenty-five patients (age: 64.0 ± 2.5 years, body mass index [BMI] = 36.0 ± 1.5 kg/m(2), mean ± standard error of measurement) with T2DM and preserved systolic function, but impaired diastolic function, mitral valve (MV) E/e', participated in the study. LV function was assessed using a stress echocardiograph, aerobic power was assessed with a sign- and symptom-limited graded exercise test, and the fatness level was assessed using Dual-energy X-ray absorptiometry and BMI. Patients in the higher 50% of BMI had higher lateral and septal MV E/e' (∼34% and ∼25%, respectively, both P < 0.001), compared to those in the lower 50% of BMI, with no difference in LV ejection fraction (LVEF) (P > 0.05). In addition, a higher BMI correlated with a higher lateral (r = 0.62, P < 0.001) and septal (r = 0.56, P < 0.01) E/e'. There was no such relationship for VO2peak. BMI and VO2peak were not correlated with LV systolic function (ejection fraction). In individuals with T2DM and diastolic dysfunction, a higher BMI was associated with worsening diastolic function independent of their aerobic capacity. The data provide a simple and practical approach for clinicians to assist in the early identification and diagnostics of functional changes in the heart diastolic function in this population.
Collapse
Affiliation(s)
- Cassandra Smith
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Muhammad Asrar Ul Haq
- University of Melbourne and the Department of Cardiology, Austin Health, Melbourne Australia
| | - George Jerums
- University of Melbourne and the Department of Endocrinology, Austin Health, Melbourne, Australia
| | - Erik Hanson
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, NC, USA
| | - Alan Hayes
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.; Centre for Chronic Disease, College of Health and Biomedicine, Victoria University, Melbourne, VIC, Australia
| | - Jason D Allen
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Melissa Sbaraglia
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia
| | - Steve Selig
- School of Exercise and Nutrition Sciences, Deakin University, Melbourne, VIC, Australia
| | - Chiew Wong
- University of Melbourne and Western Health, Melbourne, Australia
| | - David L Hare
- University of Melbourne and the Department of Cardiology, Austin Health, Melbourne Australia
| | - Itamar Levinger
- Clinical Exercise Science Research Program, Institute of Sport, Exercise and Active Living (ISEAL), Victoria University, Melbourne, VIC, Australia.; University of Melbourne and the Department of Cardiology, Austin Health, Melbourne Australia
| |
Collapse
|
28
|
Assessment and impact of diastolic function by echocardiography in elderly patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2016; 13:252-60. [PMID: 27103921 PMCID: PMC4826896 DOI: 10.11909/j.issn.1671-5411.2016.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Doppler echocardiography is the gold standard for assessment of diastolic dysfunction, which is increasingly recognised as a cause of heart failure, especially in the elderly. Using a combination of Doppler echocardiography techniques, it is possible to identify grades of diastolic dysfunction, estimate left ventricular filling pressures and establish the chronicity of diastolic dysfunction. These physiologically-derived measures have been widely validated against invasive measurements of left heart pressures and have been shown to be prognostically valuable in a wide range of clinical settings. This review explores the mechanisms, and approaches to the assessment of diastolic dysfunction in the elderly. The challenge for clinicians is to identify pathophysiological changes from those associated with normal ageing. When used in combination, and taking age into account, Doppler echocardiographic parameters are helpful in the assessment of dyspnoea in older patients and provide prognostic insights.
Collapse
|
29
|
Marwick TH, Gillebert TC, Aurigemma G, Chirinos J, Derumeaux G, Galderisi M, Gottdiener J, Haluska B, Ofili E, Segers P, Senior R, Tapp RJ, Zamorano JL. Recommendations on the Use of Echocardiography in Adult Hypertension: A Report from the European Association of Cardiovascular Imaging (EACVI) and the American Society of Echocardiography (ASE). J Am Soc Echocardiogr 2016; 28:727-54. [PMID: 26140936 DOI: 10.1016/j.echo.2015.05.002] [Citation(s) in RCA: 235] [Impact Index Per Article: 29.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Hypertension remains a major contributor to the global burden of disease. The measurement of blood pressure continues to have pitfalls related to both physiological aspects and acute variation. As the left ventricle (LV) remains one of the main target organs of hypertension, and echocardiographic measures of structure and function carry prognostic information in this setting, the development of a consensus position on the use of echocardiography in this setting is important. Recent developments in the assessment of LV hypertrophy and LV systolic and diastolic function have prompted the preparation of this document. The focus of this work is on the cardiovascular responses to hypertension rather than the diagnosis of secondary hypertension. Sections address the pathophysiology of the cardiac and vascular responses to hypertension, measurement of LV mass, geometry, and function, as well as effects of treatment.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Roxy Senior
- Biomedical Research Unit, Imperial College, London, UK; Royal Brompton Hospital, London, UK
| | | | - Jose L Zamorano
- University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, Madrid 28034, Spain
| |
Collapse
|
30
|
Kubota Y, Asai K, Murai K, Tsukada YT, Hayashi H, Saito Y, Azuma A, Gemma A, Shimizu W. COPD advances in left ventricular diastolic dysfunction. Int J Chron Obstruct Pulmon Dis 2016; 11:649-55. [PMID: 27099482 PMCID: PMC4820215 DOI: 10.2147/copd.s101082] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background COPD is concomitantly present in ~30% of patients with heart failure. Here, we investigated the pulmonary function test parameters for left ventricular (LV) diastolic dysfunction and the relationship between pulmonary function and LV diastolic function in patients with COPD. Patients and methods Overall, 822 patients who underwent a pulmonary function test and echocardiography simultaneously between January 2011 and December 2012 were evaluated. Finally, 115 patients with COPD and 115 age- and sex-matched control patients with an LV ejection fraction of ≥50% were enrolled. Results The mean age of the patients was 74.4±10.4 years, and 72.3% were men. No significant differences were found between the two groups regarding comorbidities, such as hypertension, diabetes mellitus, and anemia. The index of LV diastolic function (E/e′) and the proportion of patients with high E/e′ (defined as E/e′ ≥15) were significantly higher in patients with COPD than in control patients (10.5% vs 9.1%, P=0.009; 11.3% vs 4.3%, P=0.046). E/e′ was significantly correlated with the residual volume/total lung capacity ratio. Univariate and multivariate analyses revealed severe COPD (Global Initiative for Chronic Obstructive Lung Disease III or IV) to be a significant predictive factor for high E/e′ (odds ratio [OR] 5.81, 95% confidence interval [CI] 2.13–15.89, P=0.001 and OR 6.00, 95% CI 2.08–17.35, P=0.001, respectively). Conclusion Our data suggest that LV diastolic dysfunction as a complication of COPD may be associated with mechanical exclusion of the heart by pulmonary overinflation.
Collapse
Affiliation(s)
- Yoshiaki Kubota
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kuniya Asai
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Koji Murai
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yayoi Tetsuou Tsukada
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Hiroki Hayashi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Arata Azuma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Wataru Shimizu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
31
|
Shan J, Zhang L, Holmes AA, Taub CC. The Impact of Race on the Prognosis of Preclinical Diastolic Dysfunction: A Large Multiracial Urban Population Study. Am J Med 2016; 129:222.e1-10. [PMID: 26475254 DOI: 10.1016/j.amjmed.2015.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/05/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND This study was performed to assess the impact of race on the incidence of heart failure and survival in patients with preclinical diastolic dysfunction. METHODS All adults during a 5-year period with grade 1 diastolic dysfunction on echocardiogram, left ventricular ejection fraction ≥ 50%, and no diagnosis of heart failure were included in this study. Clinical endpoints were new diagnosis of heart failure (International Classification of Diseases-Ninth Revision code 428.0) and all-cause mortality. A total of 7878 patients: 20.8% non-Hispanic White, 35.8% non-Hispanic Black, and 31.0% Hispanic individuals (mean age was 68 ± 12 years, 37% men) were included in the study. Non-Hispanic Whites were older, more frequently male, and had a higher mean socioeconomic status and more antecedent myocardial infarction. RESULTS Non-Hispanic Blacks and Hispanics had more hypertension, diabetes, renal disease, and cerebrovascular disease. After a median follow-up time of 6 years, 1356 patients developed heart failure and 2078 patients died. The 10-year cumulative probabilities of heart failure and all-cause mortality were 23.9% and 32.6%, respectively. Time to incident heart failure was similar among the 3 racial groups. However, non-Hispanic Blacks (hazard ratio 0.80, P = .002) and Hispanics (hazard ratio 0.67, P < .001) experienced lower mortality compared with non-Hispanic Whites, which was confirmed on a propensity-scored sensitivity analysis. CONCLUSIONS Time to heart failure was similar among the 3 racial groups, however, non-Hispanic Whites experienced worse survival compared with non-Hispanic Blacks and Hispanics, despite their higher burden of risk factors. The reasons for worse survival in the non-Hispanic white population need to be further explored.
Collapse
Affiliation(s)
- Jian Shan
- Department of Medicine, Montefiore Medical Center, Bronx, NY
| | - Lili Zhang
- Department of Medicine, Jacobi Medical Center, Bronx, NY
| | | | - Cynthia C Taub
- Division of Cardiology, Montefiore Medical Center, Bronx, NY.
| |
Collapse
|
32
|
Yao GH, Zhang M, Yin LX, Zhang C, Xu MJ, Deng Y, Liu Y, Deng YB, Ren WD, Li ZA, Tang H, Zhang QB, Mu YM, Fang LG, Zhang Y. Doppler Echocardiographic Measurements in Normal Chinese Adults (EMINCA): a prospective, nationwide, and multicentre study. Eur Heart J Cardiovasc Imaging 2015; 17:512-22. [DOI: 10.1093/ehjci/jev330] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 11/19/2015] [Indexed: 11/13/2022] Open
|
33
|
Filì D, Falletta C, Luca A, Hernandez Baravoglia C, Clemenza F, Miraglia R, Scardulla C, Tuzzolino F, Vizzini G, Gridelli B, Bosch J. Circulatory response to volume expansion and transjugular intrahepatic portosystemic shunt in refractory ascites: Relationship with diastolic dysfunction. Dig Liver Dis 2015; 47:1052-8. [PMID: 26427586 DOI: 10.1016/j.dld.2015.08.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 08/25/2015] [Accepted: 08/27/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Cirrhotic cardiomyopathy may lead to heart failure in stressful circumstances, such as after transjugular intrahepatic portosystemic shunt (TIPS) placement. AIM To examine whether acute volume expansion predicts haemodynamic changes after TIPS and elicits signs of impending heart failure. METHODS We prospectively evaluated refractory ascites patients (group A) and compensated cirrhotics (group B), who underwent echocardiography, NT-proBNP measurement, and heart catheterization before and after volume load; group A repeated measurements after TIPS. RESULTS 15 patients in group A (80% male; 54±12.4 years) and 8 in group B (100% male; 56±6.2 years) were enrolled. Echocardiography disclosed diastolic dysfunction in 30% and 12.5%, respectively. In group A, volume load and TIPS induced a significant increase in right atrial, mean pulmonary, capillary wedge pressure and cardiac index, and a decrease in systemic vascular resistance (respectively, 4.7±2.8 vs. 9.9±3.6 mmHg; 13.3±3.5 vs. 21.9±5.9 mmHg; 8.3±3.4 vs. 15.4±4.7 mmHg; 3.7±0.7 vs. 4.6±11 t/min/m2; 961±278 vs. 767±285 dynscm(-5); and 10.1±3.3 vs. 14.2±3.4 mmHg; 17.5±4 vs. 25.2±4.2 mmHg; 12.3±4 vs. 19.3±3.4 mmHg; 3.4±0.8 vs. 4.5±0.91l t/min/m2; 779±62 vs. 596±199 dynscm(-5), p<0.001 for all pairs). At 24h, cardiopulmonary pressures returned towards baseline. CONCLUSIONS Acute volume expansion predicted haemodynamic changes immediately after TIPS. All patients had adequate haemodynamic adaptation to TIPS; none developed signs of heart failure.
Collapse
Affiliation(s)
- Daniela Filì
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy.
| | - Calogero Falletta
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Angelo Luca
- Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Cesar Hernandez Baravoglia
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Francesco Clemenza
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Roberto Miraglia
- Radiology Service, Department of Diagnostic and Therapeutic Services, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Cesare Scardulla
- Cardiology Unit, Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Fabio Tuzzolino
- Department of Economic, Business and Statistical Sciences, University of Palermo, Palermo, Italy
| | - Giovanni Vizzini
- Hepatology Unit, Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Bruno Gridelli
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, IRCCS - ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
| | - Jaime Bosch
- Liver Unit, Hospital Clínic, University of Barcelona, and Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Barcelona, Spain
| |
Collapse
|
34
|
Burchill LJ, Redington AN, Silversides CK, Ross HJ, Jimenez-Juan L, Mital S, Oechslin EN, Dragulescu A, Slorach C, Mertens L, Wald RM. Renin–angiotensin–aldosterone system genotype and serum BNP in a contemporary cohort of adults late after Fontan palliation. Int J Cardiol 2015; 197:209-15. [DOI: 10.1016/j.ijcard.2015.06.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2015] [Revised: 06/09/2015] [Accepted: 06/12/2015] [Indexed: 10/23/2022]
|
35
|
Abstract
BACKGROUND Anthracyclines are effective medications for childhood cancer. Their limitation is the risk of cardiomyopathy. Although diastolic dysfunction has been described in patients who received anthracyclines, cardiac monitoring has focused on systolic function, which is abnormal in up to 41% of the patients. We conducted a study to assess diastolic function utilising transmitral inflow Doppler velocities and tissue Doppler imaging in anthracycline-treated children 5 years post-therapy. METHODS This was a retrospective study on 63 anthracycline-treated patients. Echocardiographic parameters included peak early and late transmitral inflow Doppler velocities (E, A), E/A ratio, E deceleration time, and tissue Doppler imaging early and late diastolic mitral annulus velocities (E', A'), E/E' ratio, and E'/A' ratio. RESULTS All indices of diastolic function that we measured were normal in the anthracycline-treated patients. CONCLUSION We conclude that diastolic function assessed by transmitral inflow Doppler velocities and tissue Doppler imaging is normal in anthracycline-treated children 5 years after completion of treatment. Further longitudinal study is needed to determine whether diastolic function becomes abnormal with time in this patient population.
Collapse
|
36
|
Authors’ Reply. J Am Soc Echocardiogr 2015; 28:377. [DOI: 10.1016/j.echo.2014.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Indexed: 11/20/2022]
|
37
|
Left ventricular adaptation to high altitude: speckle tracking echocardiography in lowlanders, healthy highlanders and highlanders with chronic mountain sickness. Int J Cardiovasc Imaging 2015; 31:743-52. [DOI: 10.1007/s10554-015-0614-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2014] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
|
38
|
Santoro A, Alvino F, Antonelli G, Cassano FE, De Vito R, Cameli M, Mondillo S. Age related diastolic function in amateur athletes. Int J Cardiovasc Imaging 2015; 31:567-73. [DOI: 10.1007/s10554-015-0592-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/13/2015] [Indexed: 10/24/2022]
|
39
|
Mossahebi S, Zhu S, Kovács SJ. Fractionating E-Wave Deceleration Time Into Its Stiffness and Relaxation Components Distinguishes Pseudonormal From Normal Filling. Circ Cardiovasc Imaging 2015; 8:CIRCIMAGING.114.002177. [DOI: 10.1161/circimaging.114.002177] [Citation(s) in RCA: 9] [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—
Pseudonormal Doppler E-wave filling patterns indicate diastolic dysfunction but are indistinguishable from the normal filling pattern. For accurate classification, maneuvers to alter load or to additionally measure peak
E
′ are required. E-wave deceleration time (DT) has been fractionated into its stiffness (DT
s
) and relaxation (DT
r
) components (DT=DT
s
+DT
r
) by analyzing E-waves via the parametrized diastolic filling formalism. The method has been validated with DT
s
and DT
r
correlating with simultaneous catheterization-derived stiffness (dP/dV) and relaxation (
τ
) with
r
=0.82 and
r
=0.94, respectively. We hypothesize that DT fractionation can (1) distinguish between unblinded (
E
′ known) normal versus pseudonormal age-matched groups with normal left ventricular ejection fraction, and (2) distinguish between blinded (
E
′ unknown) normal versus pseudonormal groups, based solely on E-wave analysis.
Methods and Results—
Data (763 E-waves) from 15 age-matched, pseudonormal (elevated
E
/
E
′) and 15 normal subjects were analyzed. Conventional echocardiographic and parametrized diastolic filling stiffness (
k
) and relaxation (
c
) parameters and DT
s
and DT
r
were compared. Conventional diastolic function parameters did not differentiate between unblinded groups, whereas
k
,
c
(
P
<0.001) and DT
s
, DT
r
(
P
<0.001) did. Independent, blinded (
E
′ not provided) analysis of 42 subjects (30 subjects from unblinded training set and 12 additional subjects from validation set, 581 E-waves) showed that
R
(=DT
r
/DT) had high sensitivity (0.90) and specificity (0.86) in differentiating pseudonormal from normal once
E
′ revealed actual classification.
Conclusions—
arametrized diastolic filling–based E-wave analysis (
k
,
c
or DT
s
and DT
r
) can differentiate normal versus pseudonormal filling patterns without requiring knowledge of
E
′.
Collapse
Affiliation(s)
- Sina Mossahebi
- From the Cardiovascular Biophysics Laboratory, Cardiovascular Division (S.M., S.Z., S.J.K), Department of Physics (S.M., S.Z., S.J.K.), and Department of Medicine, Cardiovascular Division (S.J.K), Washington University School of Medicine, St. Louis, MO
| | - Simeng Zhu
- From the Cardiovascular Biophysics Laboratory, Cardiovascular Division (S.M., S.Z., S.J.K), Department of Physics (S.M., S.Z., S.J.K.), and Department of Medicine, Cardiovascular Division (S.J.K), Washington University School of Medicine, St. Louis, MO
| | - Sándor J. Kovács
- From the Cardiovascular Biophysics Laboratory, Cardiovascular Division (S.M., S.Z., S.J.K), Department of Physics (S.M., S.Z., S.J.K.), and Department of Medicine, Cardiovascular Division (S.J.K), Washington University School of Medicine, St. Louis, MO
| |
Collapse
|
40
|
Age-specific changes in left ventricular diastolic function: a velocity-encoded magnetic resonance imaging study. Eur Radiol 2014; 25:1077-86. [PMID: 25430004 DOI: 10.1007/s00330-014-3488-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 08/20/2014] [Accepted: 11/03/2014] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Our objectives were to assess the ability of phasecontrast MRI (PC-MRI) to detect sub-clinical age-related variations of left ventricular (LV) diastolic parameters and thus to provide age-related reference ranges currently available for echocardiography but not for MRI-PC, and to identify independent associates of such variations. METHODS We studied 100 healthy volunteers (age = 42 ± 15years, 50 females) who had MRI with simultaneous blood pressure measurements. LV mass and volumes were assessed. Semiautomated analysis of PC-MRI data provided: 1) early transmitral (Ef) and atrial (Af) peak filling flow-rates (ml/s) and filling volume (FV), 2) deceleration time (DT), isovolumic relaxation time (IVRT), and 3) early myocardial longitudinal (E') peak velocity. RESULTS MRI-PC diastolic parameters were reproducible as reflected by low coefficients of variations (ranged between 0.31 to 6.26 %). Peak myocardial velocity E' (r = -0.63, p < 0.0001) and flow-rate parameters were strongly and independently associated to age (Ef/Af:r = -0.63, DT:r = 0.46, IVRT:r = 0.44, Ef/FV:r = -0.55, Af/FV:r = 0.56, p < 0.0001). Furthermore, LV relaxation parameters (E', DT, IVRT), were independently associated to LV remodelling (LV mass/end-diastolic volume) and myocardial wall thickness (p < 0.01). CONCLUSIONS PC-MRI age-related reference ranges of diastolic parameters are provided. Such parameters might be useful for a fast, reproducible and reliable characterization of diastolic function in patients referred for clinical MRI exam KEY POINTS • MRI age-related reference values of left ventricular diastolic parameters are provided. • MRI diastolic parameters can characterise sub-clinical age-related variations in healthy individuals. • Diastolic function would complement cardiac MRI exam with currently neglected data. • Diastolic function would enhance MRI diagnostic value in cardiomyopathy and heartfailure.
Collapse
|
41
|
Santos ABS, Kraigher-Krainer E, Gupta DK, Claggett B, Zile MR, Pieske B, Voors AA, Lefkowitz M, Bransford T, Shi V, Packer M, McMurray JJV, Shah AM, Solomon SD. Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail 2014; 16:1096-103. [PMID: 25138249 DOI: 10.1002/ejhf.147] [Citation(s) in RCA: 174] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Revised: 06/12/2014] [Accepted: 07/04/2014] [Indexed: 01/08/2023] Open
Abstract
AIMS Left atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood. METHODS AND RESULTS The PARAMOUNT trial enrolled HFpEF patients (LVEF ≥45%, NT-proBNP >400 pg/mL). We assessed LA reservoir, conduit, and pump function using two-dimensional volume indices and speckle tracking echocardiography in 135 HFpEF patients in sinus rhythm at the time of echocardiography and 40 healthy controls of similar age and gender. Systolic LA strain was related to clinical characteristics and measures of cardiac structure and function. Compared with controls, HFpEF patients had worse LA reservoir, conduit, and pump function. The differences in systolic LA strain (controls 39.2 ± 6.6% vs. HFpEF 24.6 ± 7.3%) between groups remained significant after adjustments and even in the subsets of HFpEF patients with normal LA size or without a history of AF. Among HFpEF patients, lower systolic LA strain was associated with higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function, and higher LV mass and LA volume. However, NT-proBNP and E/E' were similar across the quartiles of LA function. CONCLUSIONS In this HFpEF cohort, we observed impairment in all phases of LA function, and systolic LA strain was decreased independent of LA size or history of AF. LA dysfunction may be a marker of severity and play a pathophysiological role in HFpEF. TRIAL REGISTRATION NCT00887588.
Collapse
Affiliation(s)
- Angela B S Santos
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Postgraduate Program in Cardiovascular Sciences, Cardiology, Federal University of Rio Grande do Sul, Brazil
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Abstract
BACKGROUND AND PURPOSE Left ventricular diastolic dysfunction (LVDD) constitutes the prominent characteristic of cirrhotic cardiomyopathy, but its relevance on the clinical course of cirrhotic patients has not been clearly defined. The aim of the study was to evaluate the relationship of LVDD with the severity and etiology of liver disease and to investigate whether it affects the outcome of cirrhotic patients. METHODS Cardiac function of 45 cirrhotics was studied by a tissue Doppler imaging echocardiography. Diagnosis of LVDD was made according to the latest guidelines of the American Society of Echocardiography. All patients were followed up for a period of 2 years. Death or liver transplantation was the endpoint of the study. RESULTS LVDD was found in 17 (38 %) of 45 patients. Its presence was not found to be associated with the etiology and stage of cirrhosis, but its severity was directly correlated with the Child-Pugh score. At the end of follow-up, 14 patients had died; 9 had LVDD (9/17, 53 %) and 5 had not (5/28, 18 %). Patients who died at the beginning of observation period had a higher Child-Pugh and MELD score, higher BNP, lower albumin and more prolonged QTc. On Kaplan-Meier analysis, patients with LVDD had statistically significantly worse prognosis compared to those without (p = 0.013, log rank: 5.495). Low albumin values (p = 0.003) and presence of LVDD (p = 0.017) were independent predictive factors of mortality. CONCLUSIONS LVDD is a common complication of cirrhosis. As its development seems to be related to a worse prognosis, patients with LVDD must be under a strict follow-up.
Collapse
|
43
|
Krishna BH, Pal P, Pal G, Balachander J, Jayasettiaseelon E, Sreekanth Y, Sridhar M, Gaur G. A Randomized Controlled Trial to Study the Effect of Yoga Therapy on Cardiac Function and N Terminal Pro BNP in Heart Failure. INTEGRATIVE MEDICINE INSIGHTS 2014; 9:1-6. [PMID: 24737932 PMCID: PMC3981569 DOI: 10.4137/imi.s13939] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2014] [Revised: 02/02/2014] [Accepted: 02/06/2014] [Indexed: 12/25/2022]
Abstract
AIMS The purpose of this study was to evaluate whether yoga training in addition to standard medical therapy can improve cardiac function and reduce N terminal pro B-type natriuretic peptide (NT pro BNP) in heart failure (HF). METHODS 130 patients were recruited and randomized into two groups: Control Group (CG) (n = 65), Yoga Group (YG). In YG, 44 patients and in CG, 48 patients completed the study. Cardiac function using left ventricular ejection fraction (LVEF), myocardial performance index (Tei index), and NT pro BNP, a biomarker of HF, was assessed at baseline and after 12 weeks. RESULT Improvement in LVEF, Tei index, and NT pro BNP were statistically significant in both the groups. Furthermore, when the changes in before and after 12 weeks were in percentage, LVEF increased 36.88% in the YG and 16.9% in the CG, Tei index was reduced 27.87% in the YG and 2.79% in the CG, NT pro BNP was reduced 63.75% in the YG and 10.77% in the CG. The between group comparisons from pre to post 12 weeks were significant for YG improvements (LVEF, P < 0.01, Tei index, P < 0.01, NT pro BNP, P < 0.01). CONCLUSION These results indicate that the addition of yoga therapy to standard medical therapy for HF patients has a markedly better effect on cardiac function and reduced myocardial stress measured using NT pro BNP in patients with stable HF.
Collapse
Affiliation(s)
- Bandi Hari Krishna
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Pravati Pal
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gk Pal
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India. ; Advanced Centre for Yoga Therapy Education and Research (ACYTER), JIPMER, Puducherry, India
| | - J Balachander
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - E Jayasettiaseelon
- Advanced Centre for Yoga Therapy Education and Research (ACYTER), JIPMER, Puducherry, India
| | - Y Sreekanth
- Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Mg Sridhar
- Department of Biochemistry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Gs Gaur
- Department of Physiology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| |
Collapse
|
44
|
Left ventricular function in a large cohort of pseudoxanthoma elasticum patients. PLoS One 2014; 9:e90364. [PMID: 24651258 PMCID: PMC3961243 DOI: 10.1371/journal.pone.0090364] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2013] [Accepted: 01/29/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Pseudoxanthoma elasticum (PXE) is a rare autosomal recessive disorder characterized by the mineralization and fragmentation of elastic fibers in the skin, retina, and vascular walls. While there is no doubt that peripheral arterial disease is associated with PXE, several other cardiac complications have been linked with PXE, mainly based on case reports. It remains unclear, whether cardiac systolic or diastolic function impairment is a common complication of PXE. METHODS This study conducted systematic assessment of left ventricular systolic and diastolic function via standard echocardiography and two-dimensional strain imaging, in a large cohort of asymptomatic PXE patients (n = 75) and matched healthy controls (n = 30). RESULTS PXE and controls did not differ in terms of any of the diastolic parameters tested: E-wave (82 ± 17 cm/s vs. 82 ± 13 cm/s, p = 0.890), E deceleration time (191.7 ± 55.6 ms vs. 190.0 ± 35.9 ms, p = 0.879), and E/Em ratio (7.1 ± 2.3 vs. 7.0 ± 1.8, p = 0.829). In addition, no significant differences were observed between PXE and control in terms of left ventricular volumes and ejection fraction, as well as global, basal, mid, and apex longitudinal strains. CONCLUSIONS These findings revealed that preclinical cardiac dysfunction is uncommon in a large population of asymptomatic PXE patients.
Collapse
|
45
|
Paul DS, Grevengoed TJ, Pascual F, Ellis JM, Willis MS, Coleman RA. Deficiency of cardiac Acyl-CoA synthetase-1 induces diastolic dysfunction, but pathologic hypertrophy is reversed by rapamycin. Biochim Biophys Acta Mol Cell Biol Lipids 2014; 1841:880-7. [PMID: 24631848 DOI: 10.1016/j.bbalip.2014.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 02/17/2014] [Accepted: 03/03/2014] [Indexed: 12/14/2022]
Abstract
In mice with temporally-induced cardiac-specific deficiency of acyl-CoA synthetase-1 (Acsl1(H-/-)), the heart is unable to oxidize long-chain fatty acids and relies primarily on glucose for energy. These metabolic changes result in the development of both a spontaneous cardiac hypertrophy and increased phosphorylated S6 kinase (S6K), a substrate of the mechanistic target of rapamycin, mTOR. Doppler echocardiography revealed evidence of significant diastolic dysfunction, indicated by a reduced E/A ratio and increased mean performance index, although the deceleration time and the expression of sarco/endoplasmic reticulum calcium ATPase and phospholamban showed no difference between genotypes. To determine the role of mTOR in the development of cardiac hypertrophy, we treated Acsl1(H-/-) mice with rapamycin. Six to eight week old Acsl1(H-/-) mice and their littermate controls were given i.p. tamoxifen to eliminate cardiac Acsl1, then concomitantly treated for 10weeks with i.p. rapamycin or vehicle alone. Rapamycin completely blocked the enhanced ventricular S6K phosphorylation and cardiac hypertrophy and attenuated the expression of hypertrophy-associated fetal genes, including α-skeletal actin and B-type natriuretic peptide. mTOR activation of the related Acsl3 gene, usually associated with pathologic hypertrophy, was also attenuated in the Acsl1(H-/-) hearts, indicating that alternative pathways of fatty acid activation did not compensate for the loss of Acsl1. Compared to controls, Acsl1(H-/-) hearts exhibited an 8-fold higher uptake of 2-deoxy[1-(14)C]glucose and a 35% lower uptake of the fatty acid analog 2-bromo[1-(14)C]palmitate. These data indicate that Acsl1-deficiency causes diastolic dysfunction and that mTOR activation is linked to the development of cardiac hypertrophy in Acsl1(H-/-) mice.
Collapse
Affiliation(s)
- David S Paul
- McAllister Heart Institute, University of NC at Chapel Hill, 27599, USA.
| | | | - Florencia Pascual
- Department of Nutrition, University of NC at Chapel Hill, 27599, USA.
| | - Jessica M Ellis
- Department of Nutrition, University of NC at Chapel Hill, 27599, USA.
| | - Monte S Willis
- McAllister Heart Institute, University of NC at Chapel Hill, 27599, USA; Department of Pathology and Laboratory Medicine, University of NC at Chapel Hill, 27599, USA.
| | - Rosalind A Coleman
- Department of Nutrition, University of NC at Chapel Hill, 27599, USA; McAllister Heart Institute, University of NC at Chapel Hill, 27599, USA.
| |
Collapse
|
46
|
Balcioğlu AS, Durakoğlugil ME, Okyay K, Tavil Y, Abaci A. Characterization of echocardiographic measures of cardiac structure and function in healthy octogenarians. Echocardiography 2014; 31:1062-70. [PMID: 24506515 DOI: 10.1111/echo.12540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Currently, there is not enough echocardiographic information regarding aging-associated changes in the octogenarian population. We aimed to characterize echocardiographic measures of structure and function among a group of healthy octogenarians. METHODS Approximately 350 octogenarians, residing in nursing homes, were screened in Ankara, Turkey. According to inclusion criteria, 40 octogenarians were enrolled. These subjects underwent conventional and tissue Doppler echocardiography according to the guidelines of the American Society of Echocardiography (ASE). The population was also separated into various groups according to gender, body mass index (BMI, <25 vs. 25-29.9), and blood pressure (<80/120 mmHg vs. 80-89/120-139 mmHg). All measurements were indexed by dividing to body surface area (BSA) for standardization. RESULTS Left ventricular mass (LVM), posterior wall thickness, right ventricular diameter, tricuspid E/A ratio, and septal e'-wave velocity were significantly higher in men, which lost significance after adjusting for BSA. There was no significant difference between groups formed by BMI and blood pressure. Moreover, mild global left and right ventricular dysfunction including a prominent diastolic counterpart, however, with normal ejection fraction was revealed using conventional and tissue Doppler techniques. Finally, we checked our results with the current reference values of the ASE and observed the following differences: ventricular septum, relative wall thickness, LVM, and mass index values were above ASE reference range, posterior wall measurements were close to upper range. On the contrary, left ventricular diameters and volumes were below ASE reference range. CONCLUSIONS We described echocardiographic measures of structure and function in a group of healthy octogenarians.
Collapse
Affiliation(s)
- Akif Serhat Balcioğlu
- Deparment of Cardiology, Medical and Research Center of Alanya, Başkent University, Antalya, Turkey
| | | | | | | | | |
Collapse
|
47
|
Jasaityte R, D'hooge J, Herbots L, Daraban AM, Rademakers F, Claus P. Consistent regional heterogeneity of passive diastolic stretch and systolic deformation in the healthy heart: age-related changes in left ventricle contractility. ULTRASOUND IN MEDICINE & BIOLOGY 2014; 40:37-44. [PMID: 24239364 DOI: 10.1016/j.ultrasmedbio.2013.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/29/2013] [Accepted: 09/01/2013] [Indexed: 06/02/2023]
Abstract
The consistency of the normal spatial distribution of segmental passive stretch (PreS) and systolic strain (SS) within the left ventricle was investigated and a recently proposed echocardiographic estimate of left ventricular (LV) contractility was used to detect contractility changes with age. Hereto, in 54 healthy subjects, segmental PreS and SS were measured on tissue Doppler images of six left ventricle walls. For each subject, a linear regression line was estimated through the segmental PreS and SS values. The slopes and intercepts of this PreS-SS relationship did not differ between age groups, suggesting no changes in LV contractility with age. Moreover, a consistent regional distribution of PreS was observed, with the highest values measured in the septum, resulting in a similar distribution of SS as a direct consequence of the Frank-Starling mechanism.
Collapse
Affiliation(s)
- Ruta Jasaityte
- Division of Cardiovascular Imaging and Dynamics, Department of Cardiovascular Sciences, Catholic University of Leuven, Leuven, Belgium.
| | | | | | | | | | | |
Collapse
|
48
|
Speckle tracking echocardiography in cirrhosis: is it ready for prime time? Hepatol Int 2014. [PMID: 26202402 DOI: 10.1007/s12072-013-9513-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
49
|
Left Atrial and Left Ventricular Diastolic Function in Chronic Chagas Disease. J Am Soc Echocardiogr 2013; 26:1424-33. [DOI: 10.1016/j.echo.2013.08.018] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Indexed: 12/15/2022]
|
50
|
Ghosh E, Kovács SJ. The vortex formation time to diastolic function relation: assessment of pseudonormalized versus normal filling. Physiol Rep 2013; 1:e00170. [PMID: 24400169 PMCID: PMC3871482 DOI: 10.1002/phy2.170] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 10/30/2013] [Accepted: 11/01/2013] [Indexed: 01/18/2023] Open
Abstract
In early diastole, the suction pump feature of the left ventricle opens the mitral valve and aspirates atrial blood. The ventricle fills via a blunt profiled cylindrical jet of blood that forms an asymmetric toroidal vortex ring inside the ventricle whose growth has been quantified by the standard (dimensionless) expression for vortex formation time, VFTstandard = {transmitral velocity time integral}/{mitral orifice diameter}. It can differentiate between hearts having distinguishable early transmitral (Doppler E-wave) filling patterns. An alternative validated expression, VFTkinematic reexpresses VFTstandard by incorporating left heart, near “constant-volume pump” physiology thereby revealing VFTkinematic's explicit dependence on maximum rate of longitudinal chamber expansion (E′). In this work, we show that VFTkinematic can differentiate between hearts having indistinguishable E-wave patterns, such as pseudonormal (PN; 0.75 < E/A < 1.5 and E/E′ > 8) versus normal. Thirteen age-matched normal and 12 PN data sets (738 total cardiac cycles), all having normal LVEF, were selected from our Cardiovascular Biophysics Laboratory database. Doppler E-, lateral annular E′-waves, and M-mode data (mitral leaflet separation, chamber dimension) was used to compute VFTstandard and VFTkinematic. VFTstandard did not differentiate between groups (normal [3.58 ± 1.06] vs. PN [4.18 ± 0.79], P = 0.13). In comparison, VFTkinematic for normal (3.15 ± 1.28) versus PN (4.75 ± 1.35) yielded P = 0.006. Hence, the applicability of VFTkinematic for diastolic function quantitation has been broadened to include analysis of PN filling patterns in age-matched groups.
Collapse
Affiliation(s)
- Erina Ghosh
- Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University in St Louis St. Louis, Missouri
| | - Sándor J Kovács
- Department of Biomedical Engineering, School of Engineering and Applied Science, Washington University in St Louis St. Louis, Missouri ; Cardiovascular Biophysics Laboratory, Cardiovascular Division, Department of Internal Medicine, School of Medicine, Washington University in St Louis St. Louis, Missouri
| |
Collapse
|