1
|
Lee SH, Ahn HJ, Kim GM, Yang M, Kim JA, Lee SM, Heo BY, Choi JW, Lee JY, Jeong H, Kim J. Effect of Sevoflurane Anesthesia on Diastolic Function: A Prospective Observational Study. Anesth Analg 2024:00000539-990000000-00768. [PMID: 38412113 DOI: 10.1213/ane.0000000000006924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
BACKGROUND The effect of sevoflurane on left ventricular diastolic function is not well understood. We hypothesized that parameters of diastolic function may improve under sevoflurane anesthesia in patients with preexisting diastolic dysfunction compared to patients with normal diastolic function. METHODS This observational study included 60 patients undergoing breast surgery or laparoscopic cholecystectomy. Patients were assigned to diastolic dysfunction (n = 34) or normal (n = 26) groups of septal e' < 8 or ≥ 8.0 cm/s on the first thoracic echocardiography (TTE) performed before anesthesia. During anesthesia, sevoflurane was maintained at 1 to 2 minimum alveolar concentration (MAC) to maintain the bispectral index at 40 to 50. At the end of surgery, the second TTE was performed under 0.8 to 1 MAC of sevoflurane with the patient breathing spontaneously without ventilator support. Primary end point was the percentage change (Δ) of e' on 2 TTEs (Δe'). Secondary end points were ΔE/e', Δleft atrial volume index (ΔLAVI), and Δtricuspid regurgitation maximum velocity (ΔTR Vmax). These percentage changes (Δ) were compared between diastolic dysfunction and normal groups. RESULTS e' (Δe': 30 [6, 64] vs 0 [-18, 11]%; P < .001), mitral inflow E wave velocity (E), mitral inflow E/A ratio (E/A), and mitral E velocity deceleration time (DT) improved significantly in diastolic dysfunction group compared to normal group. LAVI decreased in diastolic dysfunction group but did not reach statistical significance between the 2 groups (ΔLAVI:-15 [-31, -3] vs -4 [-20, 10]%, P = .091). ΔE/e' was not different between the 2 groups (11 [-16, 26] vs 12 [-9, 22]%, P = .853) (all: median [interquartile range, IQR]). TR was minimal in both groups. CONCLUSIONS In this study, echocardiographic parameters of diastolic function, including septal e', E, E/A, and DT, improved with sevoflurane anesthesia in patients with preexisting diastolic dysfunction, but remained unchanged in patients with normal diastolic function.
Collapse
Affiliation(s)
- Sang Hyun Lee
- From the Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
2
|
Kumar R, Kumar P, Srivastava PK, Kumar P. Echocardiographic and Angiographic Assessment of Right Ventricular Function and Right Coronary Artery Stenosis in Acute Inferior Wall Myocardial Infarction. Cureus 2023; 15:e46403. [PMID: 37927618 PMCID: PMC10620981 DOI: 10.7759/cureus.46403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND Cardiovascular diseases (CVDs) are a global concern. CVD remains a primary cause of death despite reduced coronary heart disease death rates. Acute coronary syndrome (ACS) involves myocardial infarction (MI) and unstable angina, sharing mechanisms such as plaque instability. Our study assesses the right ventricular (RV) function's predictive value in acute inferior wall MI (IWMI) to identify high-risk patients with an elevated likelihood of experiencing severe cardiac complications, hemodynamic instability, or a higher mortality risk following an acute IWMI. METHODOLOGY The research was conducted in the Department of Cardiology at the Rajendra Institute of Medical Sciences (RIMS), Ranchi, from July 2021 to June 2022, following the necessary ethical approval. A cohort of 140 patients with IWMI, carefully chosen according to rigorous criteria, clearly understood the study's objectives before providing informed consent. The evaluations were conducted in the following order: clinical assessments, followed by blood testing, then echocardiography, and finally, coronary angiography. Furthermore, the study examined risk factors and utilized statistical methods to elucidate the associations between qualities and results. RESULTS The study included 140 participants, with 61% being male and 39% female. Among the participants, 14% were aged 30-45, 50% were aged 46-60, and 30% were over 60. Age shows significant proportions in different categories. Diabetes, dyslipidemia, hypertension, and smoking/tobacco addiction did not differ among stenosis groups. Proximal right coronary artery (RCA) stenosis patients had elevated jugular venous pressure (JVP). The echocardiograms were performed within 48 hours of post-percutaneous coronary intervention, and significant differences between groups were observed. Participants with proximal stenosis had lower tricuspid annular plane systolic excursion (TAPSE) and right ventricular fractional area change (RVFAC), which showed compromised RV systolic function. Proximal stenosis patients had reduced systolic motion velocity (Sm), indicating impaired myocardial contraction. Echocardiographic parameters such as early diastolic velocity (Em), atrial contraction velocity (Am), Em/Am ratio (a marker of diastolic function), isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) between groups were different, indicating distinct cardiac functions. Proximal stenosis increased the myocardial performance index (MPI), indicating cardiac impairment. The left ventricular ejection fraction (LVEF) was comparable in the two stenosis groups, indicating similar left ventricular performance. CONCLUSION Echocardiography showed significant RV function differences in acute inferior wall ST-segment elevation myocardial infarction (STEMI) patients with proximal and distal RCA lesions. RV dysfunction is linked to right ventricle myocardial infarction (RVMI), and echocardiographic markers can provide valuable insights. Results emphasize that acute inferior wall STEMI is diagnosed by electrocardiogram (ECG) criteria, particularly ST-segment elevation. However, these markers emphasize the importance of RV assessment in RCA involvement assessment. These findings suggest that RV function can help diagnose acute inferior wall STEMI RCA involvement. In acute inferior STEMIs, RV function echocardiography is essential for RCA lesion location.
Collapse
Affiliation(s)
- Rajneesh Kumar
- Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Prakash Kumar
- Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Prabin K Srivastava
- Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| | - Prashant Kumar
- Department of Cardiology, Rajendra Institute of Medical Sciences, Ranchi, IND
| |
Collapse
|
3
|
Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
| | | | | |
Collapse
|
4
|
Park J, Song YJ, Kim S, Kim DK, Kim KH, Seol SH, Kim DI, Ha SJ. The long-term prognostic value of E/e' in patients with ST segment elevation myocardial infarction. Indian Heart J 2022; 74:369-374. [PMID: 35977590 PMCID: PMC9647651 DOI: 10.1016/j.ihj.2022.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/27/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives This study aimed to evaluate the long-term prognostic value of E/e’ ratio in patients with ST-segment elevation myocardial infarction (STEMI). Methods We retrospectively assessed 314 patients who underwent primary coronary interventions between January 2010 and December 2015. The included patients were classified into two groups according to the E/e’ ratios: E/e’<15 (n = 245) and E/e’≥15 (n = 69). We investigated the incidence of major adverse cardiac events (MACEs) from the event to the final follow-up period of at least three years. Results A total of 55 cases of MACEs occurred during the follow-up. The E/e’≥15 group showed a significantly higher rate of MACEs than the E/e’<15 group (34.8% vs. 12.7%, p < 0.001). Among the MACE, the percentage of cardiac deaths (17.4% vs. 0.4%, p < 0.001) was higher in the E/e’≥15 group than in the E/e’<15 group. In the multivariable model, E/e’≥15 was demonstrated as the strongest prognostic factor for MACEs (hazard ratio [HR], 2.597; 95% confidence interval [CI], 1.294–5.211; p = 0.007) and cardiac death (HR, 27.537; 95% CI, 3.287–230.689; p = 0.002), while left ventricular ejection fraction (LVEF) was not. Neither the discrepancy of systolic nor diastolic function between initial and follow-up echocardiography affected the overall prevalence of MACEs. A disparity was observed between the two groups, with a significant increase in the rate of MACEs in the E/e’≥15 group (log-rank test, p < 0.001). Conclusion The baseline E/e’≥15 in patients with STEMI after successful reperfusion is the strongest predictor of poor long-term clinical outcomes among those analyzed.
Collapse
Affiliation(s)
- Jino Park
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Yeo-Jeong Song
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
| | - Seunghwan Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Dong-Kie Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Ki-Hun Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sang-Hoon Seol
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Sang-Jin Ha
- Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Republic of Korea
| |
Collapse
|
5
|
Barros-Gomes S, Roger VL, Pislaru SV, Kimura T, Pislaru C, Enriquez-Sarano M. Cardiac remodeling in acute myocardial infarction: Prospective insights from multimodality ultrasound imaging. Echocardiography 2021; 38:2032-2042. [PMID: 34845767 PMCID: PMC9059245 DOI: 10.1111/echo.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 10/13/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The severity of MI declined markedly in the last decade, and contemporary patterns of cardiac remodeling after MI are not defined. METHODS We prospectively enrolled community patients with first MI and performed comprehensive two- and three-dimensional echocardiography. Remodeling was defined as left ventricular (LV) end-systolic volume index (ESVI) above American Society of Echocardiography normal values. Remodeling patterns were characterized as an increase in LVESVI or LV end-diastolic volume index (LVEDVI), or both. RESULTS Between 2014 and 2016, 213 patients (63±13 years; 34% women) were enrolled within 3 days after MI (77% non-ST-elevation MI). Acute remodeling was present in 51% of patients. Higher troponin and wall motion score index were associated with greater remodeling (p < 0.001). Atrial annular area, leaflet tenting and papillary muscle areas increased with greater remodeling (p < 0.001). The greater the cardiac remodeling, the lower the LV ejection fraction and global longitudinal strain (p < 0.001). This decrease in LV function was accompanied by stroke volume augmentation and maintenance of cardiac index at the expense of increased LVEDVI. Different remodeling patterns were identified. Cases showing increased LVEDVI and normal LVESVI had smallest infarct size and better hemodynamics compared to cases with augmented LVESVI and normal LVEDVI. CONCLUSION Acute remodeling occurs in more than half of first MI cases and exhibits different patterns defined by cavity size and hemodynamic profile. Acute remodeling is a global phenomenon, which also involves the left atrium and the mitral apparatus.
Collapse
Affiliation(s)
| | - Véronique L. Roger
- Department of Cardiovascular Diseases Medicine, Mayo Clinic College of Medicine, Rochester, MN
- Epidemiology and Community Health Branch National Heart, Lung and Blood Institute, National Institutes of Health
| | - Sorin V. Pislaru
- Department of Cardiovascular Diseases Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | | | - Cristina Pislaru
- Department of Cardiovascular Diseases Medicine, Mayo Clinic College of Medicine, Rochester, MN
| | - Maurice Enriquez-Sarano
- Department of Cardiovascular Diseases Medicine, Mayo Clinic College of Medicine, Rochester, MN
| |
Collapse
|
6
|
Lan NSR, Yeap BB, Fegan PG, Green G, Rankin JM, Dwivedi G. Empagliflozin and left ventricular diastolic function following an acute coronary syndrome in patients with type 2 diabetes. Int J Cardiovasc Imaging 2020; 37:517-527. [PMID: 32959096 DOI: 10.1007/s10554-020-02034-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 09/18/2020] [Indexed: 12/25/2022]
Abstract
Sodium-glucose cotransporter 2 inhibitors can improve heart failure outcomes, however, the effects on left ventricular (LV) function remain unclear. This prospective observational study aimed to investigate whether initiating empagliflozin therapy was associated with improved LV diastolic function following an acute coronary syndrome (ACS) in patients with type 2 diabetes (T2D). Patients with ACS and T2D were identified during hospitalisation in a cardiology unit. Empagliflozin was initiated at discharge in eligible patients (i.e. HbA1c > 7%) without contraindications or precautions. Transthoracic echocardiography was performed during admission and after 3-6 months. Changes in echocardiographic parameters were compared between patients initiated on empagliflozin versus not initiated on empagliflozin (control). There were 22 patients in each group (n = 44). Baseline characteristics, medications and echocardiographic parameters were similar except HbA1c (empagliflozin: 9.8 ± 1.6% versus control: 6.6 ± 0.7%, p < 0.001). Baseline LV global longitudinal strain (GLS) (empagliflozin: - 12.4 ± 2.8 versus control: - 13.0 ± 3.6%) and ejection fraction (51.1 ± 11.3 versus 54.9 ± 10.8%) were similar. The difference in change from baseline to follow-up was significant for LV mass index (empagliflozin: - 14.1 ± 21.6 versus control: 3.6 ± 18.7 g/m2, p = 0.006), left atrial volume index (- 2.1 ± 8.1 versus 3.4 ± 9.5 ml/m2, p = 0.045), mitral valve E-wave velocity (- 0.14 ± 0.23 versus 0.03 ± 0.16 m/s, p = 0.007) and average E/e' (- 2.1 ± 2.6 versus 0.9 ± 3.4, p = 0.002). There were no significant between-group differences in change for LV GLS, ejection fraction and volume. In patients with ACS and T2D, addition of empagliflozin to ACS therapy at discharge was associated with a reduction in LV mass and favourable changes in diastolic function parameters. Further studies are warranted to investigate these findings.
Collapse
Affiliation(s)
- Nick S R Lan
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Perth, WA, 6150, Australia. .,Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia.
| | - Bu B Yeap
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia.,Medical School, The University of Western Australia, Perth, Australia
| | - P Gerry Fegan
- Department of Endocrinology and Diabetes, Fiona Stanley Hospital, Perth, Australia.,Medical School, Curtin University, Perth, Australia
| | - Gillian Green
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Perth, WA, 6150, Australia
| | - James M Rankin
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Perth, WA, 6150, Australia
| | - Girish Dwivedi
- Department of Cardiology, Fiona Stanley Hospital, 11 Robin Warren Drive, Perth, WA, 6150, Australia.,Medical School, The University of Western Australia, Perth, Australia.,Harry Perkins Institute of Medical Research, Perth, Australia
| |
Collapse
|
7
|
Determinants of Diastolic Dysfunction Following Myocardial Infarction: Evidence for Causation Beyond Infarct Size. Heart Lung Circ 2020; 29:1815-1822. [PMID: 32601021 DOI: 10.1016/j.hlc.2020.04.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 02/18/2020] [Accepted: 04/16/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The determinants of severe diastolic dysfunction (DD) following myocardial infarction (MI) are not well defined. This study sought to define the determinants of severe DD (restrictive mitral inflow pattern on Doppler echocardiography [RFP]) in patients with a first-ever MI, with particular emphasis on the impact of infarct size. METHODS Retrospective single-centre study including consecutive patients admitted to a tertiary referral centre with a first-ever non-ST-elevation-MI (NSTEMI) or ST-elevation-MI (STEMI) (n=477). Peak troponin-I (Peak-TnI) was used as the principal measure of infarct size, whilst left ventricular ejection fraction (LVEF) and wall motion score index (WMSI) were regarded as surrogate measures. Echocardiography was performed within 24 hours of admission for all patients. RFP was defined as E/A ratio >2.0 or E/A ratio >1.5 and E-wave deceleration time <140 ms. RESULTS A total of 69 patients (14.5%) had RFP. Peak-TnI levels were higher in the RFP group (32.6±32.7 versus 16.9±25.2 μg/L, p<0.001). In sequential multivariable models incorporating significant clinical, angiographic and left ventricular (LV) size-related variables, Peak-TnI (OR 1.98, p=0.001), WMSI (OR 2.34, p=0.048) and LVEF (OR 0.97, p=0.044) were independent predictors of RFP. Presence of diabetes was also an independent predictor in all the models constructed. When patients were stratified according to an LVEF of 50%, 39% of RFP patients had a preserved LVEF (RFP/preserved EF group), and these patients had lower Peak-TnI levels compared to the RFP/reduced EF group (14.4±18.7 vs 44.5±35.5 μg/L). CONCLUSIONS Whilst infarct size is a major determinant of severe diastolic dysfunction after MI, a significant subset of patients develop severe diastolic dysfunction despite a small infarct size and preserved LVEF, highlighting that other factors such as pre-existing diastolic dysfunction due to risk factors such as diabetes have an important role in causation.
Collapse
|
8
|
Sara JD, Toya T, Taher R, Lerman A, Gersh B, Anavekar NS. Asymptomatic Left Ventricle Systolic Dysfunction. Eur Cardiol 2020; 15:e13. [PMID: 32373186 PMCID: PMC7199190 DOI: 10.15420/ecr.2019.14] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 01/06/2020] [Indexed: 12/22/2022] Open
Abstract
Heart failure is a common debilitating illness, associated with significant morbidity and mortality, rehospitalisation and societal costs. Current guidelines and position statements emphasise the management of patients with overt symptomatic disease, but the increasing prevalence of congestive heart failure underscores the need to identify and manage patients with early left ventricular dysfunction prior to symptom onset. Asymptomatic left ventricular systolic dysfunction (ALVSD), classified as stage B heart failure, is defined as depressed left ventricular systolic function in the absence of clinical heart failure. Early initiation of therapies in patients with presumed ALVSD has been shown to lead to better outcomes. In this article, the authors clarify issues surrounding the definition and natural history of ALVSD, outline clinical tools that may be of value in identifying patients with ALVSD and highlight potential opportunities for future investigations to better address aspects of our understanding of this complex syndrome.
Collapse
Affiliation(s)
- Jaskanwal D Sara
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science Rochester, MN, US
| | - Takumi Toya
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science Rochester, MN, US.,Division of Cardiology, National Defense Medical College Tokorozawa, Japan
| | - Riad Taher
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science Rochester, MN, US
| | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science Rochester, MN, US
| | - Bernard Gersh
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science Rochester, MN, US
| | - Nandan S Anavekar
- Department of Cardiovascular Medicine, Mayo Clinic College of Medicine and Science Rochester, MN, US
| |
Collapse
|
9
|
Metformin Alleviates Left Ventricular Diastolic Dysfunction in a Rat Myocardial Ischemia Reperfusion Injury Model. Int J Mol Sci 2020; 21:ijms21041489. [PMID: 32098266 PMCID: PMC7073047 DOI: 10.3390/ijms21041489] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 02/16/2020] [Accepted: 02/19/2020] [Indexed: 12/25/2022] Open
Abstract
An increased incidence of myocardial infarction (MI) has recently emerged as the cause of cardiovascular morbidity and mortality worldwide. In this study, cardiac function was investigated in a rat myocardial ischemia/reperfusion (I/R) model using echocardiography. Metformin administration significantly increased ejection fraction and fractional shortening values on Days 3 and 7 when MI occurred, indicating that metformin improved left ventricular systolic function. In the Sham + MET and MI + MET groups, the E' value was significantly different up to Day 3 but not at Day 7. This may mean that left ventricular diastolic function was effectively restored to some extent by Day 7 when metformin was administered. These results suggest that diastolic dysfunction, assessed by echocardiography, does not recover in the early phase of ischemic reperfusion injury in the rat myocardial I/R model. However, administering metformin resulted in recovery in the early phase of ischemic reperfusion injury in this model. Further gene expression profiling of left ventricle tissues revealed that the metformin-treated group had notably attenuated immune and inflammatory profiles. To sum up, a rat myocardial I/R injury model and ultrasound-based assessment of left ventricular systolic and diastolic function can be used in translational research and for the development of new heart failure-related drugs, in addition to evaluating the potential of metformin to improve left ventricular (LV) diastolic function.
Collapse
|
10
|
Prasad R, Singh K, Sethi KK, Singh S. Role of flow propagation velocity across mitral valve in the assessment of diastolic dysfunction and prognostication in acute myocardial infarction. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/jiae.jiae_33_19] [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
|
11
|
Litwin SE, Zile MR. Should We Test for Diastolic Dysfunction? How and How Often? JACC Cardiovasc Imaging 2020; 13:297-309. [DOI: 10.1016/j.jcmg.2019.02.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 02/14/2019] [Accepted: 02/20/2019] [Indexed: 01/24/2023]
|
12
|
Left atrial volume index: Can it provide additional prognostic information in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention? Rev Port Cardiol 2018; 37:799-807. [PMID: 30318188 DOI: 10.1016/j.repc.2018.01.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 11/25/2017] [Accepted: 01/15/2018] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION We sought to assess the prognostic impact of left atrial (LA) size on long-term outcomes of ST-segment elevation myocardial infarction (STEMI). METHODS We studied 200 consecutive patients admitted to a single center between January 2010 and December 2014 with non-fatal STEMI treated with primary percutaneous coronary intervention (pPCI) who underwent a comprehensive echocardiographic examination at discharge. LA volume was estimated by the area-length method. The left atrium was classified as normal, mildly, moderately or severely enlarged by LA volume index (LAVI). The endpoints were defined as all-cause mortality, a cardiac composite endpoint (all-cause mortality, reinfarction, unplanned revascularization and hospitalization for heart failure) and a cardiovascular composite endpoint (cardiac endpoint plus atrial fibrillation and ischemic stroke) during follow-up. RESULTS In this STEMI population, 58% had normal LA size, 22.5% had mild LA enlargement, 10% had moderate LA enlargement and 9.5% had severe LA enlargement. During a median follow-up of 28 (IQR 21-38) months, 14 (7.0%) patients died, 53 (26.5%) had the cardiac and 58 (29%) the cardiovascular composite endpoints. There was a stepwise increase in the incidence of all-cause mortality (p=0.020) and both cardiac (p<0.001) and cardiovascular (p<0.001) endpoints with each increment of LAVI class. In multivariate analysis, severe LA enlargement by LAVI was an independent predictor of all-cause mortality (HR: 11.153; 95% CI: 1.924-64.642, p=0.007) and the cardiac (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) and cardiovascular (HR: 4.351; 95% CI: 1.919-9.862, p<0.001) endpoints during follow-up. CONCLUSIONS This contemporary study confirms the prognostic effect of LA size at discharge, applying the most recent reference values in STEMI patients treated with pPCI.
Collapse
|
13
|
Prasad SB, Lin AK, Guppy-Coles KB, Stanton T, Krishnasamy R, Whalley GA, Thomas L, Atherton JJ. Diastolic Dysfunction Assessed Using Contemporary Guidelines and Prognosis Following Myocardial Infarction. J Am Soc Echocardiogr 2018; 31:1127-1136. [DOI: 10.1016/j.echo.2018.05.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/17/2022]
|
14
|
Left atrial volume index: Can it provide additional prognostic information in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2018.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
|
15
|
Prada G, Vieillard-Baron A, Martin AK, Hernandez A, Mookadam F, Ramakrishna H, Diaz-Gomez JL. Echocardiographic Applications of M-Mode Ultrasonography in Anesthesiology and Critical Care. J Cardiothorac Vasc Anesth 2018; 33:1559-1583. [PMID: 30077562 DOI: 10.1053/j.jvca.2018.06.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Indexed: 02/03/2023]
Abstract
Proficiency in echocardiography and lung ultrasound has become essential for anesthesiologists and critical care physicians. Nonetheless, comprehensive echocardiography measurements often are time-consuming and technically challenging, and conventional 2-dimensional images do not permit evaluation of specific conditions (eg, systolic anterior motion of the mitral valve, pneumothorax), which have important clinical implications in the perioperative setting. M-mode (motion-based) ultrasonographic imaging, however, provides the most reliable temporal resolution in ultrasonography. Hence, M-mode can provide clinically relevant information in echocardiography and lung ultrasound-driven approaches for diagnosis, monitoring, and interventional procedures performed by anesthesiologists and intensivists. Although M-mode is feasible, this imaging modality progressively has been abandoned in echocardiography and is often underutilized in lung ultrasound. This article aims to comprehensively illustrate contemporary applications of M-mode ultrasonography in the anesthesia and critical care medicine practice. Information presented for each clinical application will include image acquisition and interpretation, evidence-based clinical implications in the critically ill and surgical patient, and limitations. The present article focuses on echocardiography and reviews left ventricular function (mitral annular plane systolic excursion, E-point septal separation, fractional shortening, and transmitral propagation velocity); right ventricular function (tricuspid annular plane systolic excursion, subcostal echocardiographic assessment of tricuspid annulus kick, outflow tract fractional shortening, ventricular septal motion, wall thickness, and outflow tract obstruction); volume status and responsiveness (inferior vena cava and superior vena cava diameter and respiratory variability [collapsibility and distensibility indexes]); cardiac tamponade; systolic anterior motion of the mitral valve; and aortic dissection.
Collapse
Affiliation(s)
- Gabriel Prada
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL
| | - Antoine Vieillard-Baron
- Intensive Care Unit, Assistance Publique-Hôpitaux de Paris, University Hospital Ambroise Paré, Boulogne-Billancourt, France; Faculty of Medicine Paris Ile-de-France Ouest, University of Versailles Saint-Quentin en Yvelines, Saint-Quentin En Yvelines, France; INSERM U-1018, CESP, Team 5, University of Versailles Saint-Quentin en Yvelines, Villejuif, France
| | - Archer K Martin
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL
| | - Antonio Hernandez
- Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, TN
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ
| | - Harish Ramakrishna
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic Hospital, Phoenix, AZ.
| | - Jose L Diaz-Gomez
- Department of Critical Care Medicine, Mayo Clinic, Jacksonville, FL; Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Jacksonville, FL; Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL
| |
Collapse
|
16
|
Two-year Follow-up of Patients With Unstable Angina/Non-ST Segment Elevation Myocardial Infarction Undergoing Early Invasive Strategy: Predictors of Normal or Near-Normal Coronary Angiography and Mortality. Crit Pathw Cardiol 2018; 17:47-52. [PMID: 29432377 DOI: 10.1097/hpc.0000000000000108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Predictors of normal or near-normal coronary angiography (NONCAG) in patients with unstable angina/non-ST-elevation myocardial infarction (UA/NSTEMI) and their importance regarding the prognosis are not understood. Accordingly, we determined these predictors as well as mortality risk factors at 2-year follow-up of UA/NSTEMI patients managed by the early invasive strategy. METHODS We prospectively studied consecutive patients with UA/NSTEMI managed with the early invasive strategy at Tehran Heart Center, in 1-year period. Echocardiography was performed before coronary angiography (CAG) for all the patients. Baseline characteristics, laboratory parameters, echocardiographic findings, invasive treatment modalities, and survival status after 2 years of follow-up were collected. We identified the predictors of NONCAG in the first phase of the study and then the risk factors of mortality in the second phase. RESULTS In the study period, 298 patients including 211 (71%) males, with the age of 59.31 ± 10.72 years were enrolled. The following factors were predictors of NONCAG: the female sex (P < 0.001); negative family history of CAD (P = 0.028); Thrombolysis in Myocardial Infarction (TIMI) risk score (P < 0.001); and early transmitral flow velocity/mean mitral annular velocity (E/E'mean) (P = 0.003). The following items were significant protective factors against mortality: percutaneous coronary intervention (PCI) (P = 0.012), age (P = 0.001), and E/E'mean (P = 0.020). CONCLUSION Patients' baseline characteristics as well as echocardiographic data could help in predicting those with NONCAG and PCI can be considered as the treatment of strategy with the most protection against mortality.
Collapse
|
17
|
Amoozgar H, Fath M, Jooya P, Karimi M. Evaluation of Heart Function in Patients With Hemophilia. Clin Appl Thromb Hemost 2017; 23:374-378. [DOI: 10.1177/1076029615614394] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
There are conflicting reports about the protective effect of hemophilia on the occurrence of ischemic heart disease. This study focuses on evaluation of heart function in patients with hemophilia. Cross-sectional, case–control study was done on all patients with hemophilia A or B who came to hemophilia center, and data were compared to controls. The data were collected from their charts, and heart function was evaluated by 2-dimensional, Doppler and pulse tissue Doppler. The serum troponin I level was measured in all patients as a marker of myocardial damage. Fifty patients with hemophilia took part in this study. All of them were male with mean age 29.1 years. Systolic blood pressure (mean = 121.52 ± 11 vs 115.61 ± 9.81, P = .038) and diastolic (mean = 81.94 ± 4.51 vs 75.21 ± 3.95, P = .042) blood pressure were higher in the patients. Five (10%) patients had systolic hypertension and 7 (14%) patients had diastolic hypertension. The M-mode echocardiography results showed that interventricular septum in diastole in patients with hemophilia (mean 1.143 ± 0.29) was significantly thicker than the control group (mean 0.828 ± 0.22, P < .001). Tissue Doppler echocardiography showed that late diastolic velocity of septum (Aa; P = .030), systolic velocity (S) of lateral mitral valve ( P = .006), late diastolic velocity of lateral mitral (Aa) annulus ( P = .038), and late velocity of (Aa) tricuspid ( P = .004) had significant difference compared with the control group ( P < .05). Troponin enzyme level was < 0.1 in all patients. Patients with hemophilia had higher blood pressure and more hypertension. Echocardiographic study of patients with hemophilia showed some increase in septal thickness and changes in diastolic dysfunction
Collapse
Affiliation(s)
- Hamid Amoozgar
- Cardiac and Neonatology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maedeh Fath
- Pediatric Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Parisa Jooya
- Pediatric Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehran Karimi
- Hematology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| |
Collapse
|
18
|
Chen X, Liu F, Xu H, Zha D, Xiu J, Guo J, Zhang A. Left ventricular diastolic dysfunction in patients with ST-elevation myocardial infarction following early and late reperfusion by coronary intervention. Int J Cardiol 2017; 228:886-889. [DOI: 10.1016/j.ijcard.2016.11.146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 11/06/2016] [Indexed: 12/01/2022]
|
19
|
Ryu T, Song SY. Perioperative management of left ventricular diastolic dysfunction and heart failure: an anesthesiologist's perspective. Korean J Anesthesiol 2017; 70:3-12. [PMID: 28184260 PMCID: PMC5296384 DOI: 10.4097/kjae.2017.70.1.3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/19/2016] [Accepted: 12/19/2016] [Indexed: 12/12/2022] Open
Abstract
Anesthesiologists frequently see asymptomatic patients with diastolic dysfunction or heart failure for various surgeries. These patients typically show normal systolic function but abnormal diastolic parameters in their preoperative echocardiographic evaluations. The symptoms that are sometimes seen are similar to those of chronic obstructive pulmonary disease. Patients with diastolic dysfunction, and even with diastolic heart failure, have the potential to develop a hypertensive crisis or pulmonary congestion. Thus, in addition to conventional perioperative risk quantification, it may be important to consider the results of diastolic assessment for predicting the postoperative outcome and making better decisions. If anesthesiologists see female patients older than 70 years of age who have hypertension, diabetes, chronic renal disease, recent weight gain, or exercise intolerance, they should focus on the patient's diastologic echocardiography indicators such as left atrial enlargement or left ventricular hypertrophy. In addition, there is a need for perioperative strategies to mitigate diastolic dysfunction-related morbidity. Specifically, hypertension should be controlled, keeping pulse pressure below diastolic blood pressure, maintaining a sinus rhythm and normovolemia, and avoiding tachycardia and myocardial ischemia. There is no need to classify these diastolic dysfunction, but it is important to manage this condition to avoid worsening outcomes.
Collapse
Affiliation(s)
- Taeha Ryu
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
| | - Seok-Young Song
- Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea
| |
Collapse
|
20
|
Al Ali L, Hartman MT, Lexis CPH, Hummel YM, Lipsic E, van Melle JP, van Veldhuisen DJ, Voors AA, van der Horst ICC, van der Harst P. The Effect of Metformin on Diastolic Function in Patients Presenting with ST-Elevation Myocardial Infarction. PLoS One 2016; 11:e0168340. [PMID: 27977774 PMCID: PMC5158040 DOI: 10.1371/journal.pone.0168340] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 11/24/2016] [Indexed: 12/28/2022] Open
Abstract
Introduction Diastolic dysfunction is an important predictor of poor outcome after myocardial infarction. Metformin treatment improved diastolic function in animal models and patients with diabetes. Whether metformin improves diastolic function in patients presenting with ST-segment elevation myocardial infarction (STEMI) is unknown. Methods The GIPS-III trial randomized STEMI patients, without known diabetes, to metformin or placebo initiated directly after PCI. The previously reported primary endpoint was left ventricular ejection fraction at 4 months, which was unaffected by metformin treatment. This is a predefined substudy to determine an effect of metformin on diastolic function. For this substudy trans-thoracic echocardiography was performed during hospitalization and after 4 months. Diastolic dysfunction was defined as having the combination of a functional alteration (i.e. decreased tissue velocity: mean of septal e’ and lateral e’) and a structural alteration (i.e. increased left atrial volume index (LAVI)). In addition, left ventricular mass index and transmitral flow velocity (E) to mean e' ratio (E/e’) were measured to determine an effect of metformin on individual echocardiographic markers of diastolic function. Results In 237 (63%) patients included in the GIPS-III trial diastolic function was measured during hospitalization as well as at 4 months. Diastolic dysfunction was present in 11 (9%) of patients on metformin and 11 (9%) patients on placebo treatment (P = 0.98) during hospitalization. After 4 months 22 (19%) of patients with metformin and 18 (15%) patients with placebo (P = 0.47) had diastolic dysfunction. In addition, metformin did not improve any of the individual echocardiographic markers of diastolic function. Conclusions In contrast to experimental and observational data, our randomized placebo controlled trial did not suggest a beneficial effect of short-term metformin treatment on diastolic function in STEMI patients.
Collapse
Affiliation(s)
- Lawien Al Ali
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Minke T. Hartman
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Chris P. H. Lexis
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Yoran M. Hummel
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Erik Lipsic
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Joost P. van Melle
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Dirk J. van Veldhuisen
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Adriaan A. Voors
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Iwan C. C. van der Horst
- Department of Critical Care, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pim van der Harst
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- * E-mail:
| |
Collapse
|
21
|
Nguyen TL, Phan J, Hogan J, Hee L, Moses D, Otton J, Premawardhana U, Rajaratnam R, Juergens CP, Dimitri H, French JK, Richards D, Thomas L. Adverse diastolic remodeling after reperfused ST-elevation myocardial infarction: An important prognostic indicator. Am Heart J 2016; 180:117-27. [PMID: 27659890 DOI: 10.1016/j.ahj.2016.05.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 05/09/2016] [Indexed: 01/29/2023]
Abstract
OBJECTIVES We sought to determine the relationship of adverse diastolic remodeling (ie, worsening diastolic or persistent restrictive filling) with infarct scar characteristics, and to evaluate its prognostic value after ST-segment elevation myocardial infarction (STEMI). BACKGROUND Severe diastolic dysfunction (restrictive filling) has known prognostic value post STEMI. However, ongoing left ventricular (LV) remodeling post STEMI may alter diastolic function even if less severe. METHODS AND RESULTS There were 218 prospectively recruited STEMI patients with serial echocardiograms (transthoracic echocardiography) and cardiac magnetic resonance imaging (CMR) performed, at a median of 4 days (early) and 55 days (follow-up). LV ejection fraction and infarct characteristics were assessed by CMR, and comprehensive diastolic function assessment including a diastolic grade was evaluated on transthoracic echocardiography. 'Adverse diastolic remodeling' occurred if diastolic function grade either worsened (≥1 grade) between early and follow-up imaging, or remained as persistent restrictive filling at follow-up. Follow-up infarct scar size (IS) predicted adverse diastolic remodeling (area under the curve 0.86) and persistent restrictive filling (area under the curve 0.89). The primary endpoint of major adverse cardiovascular events (MACE) occurred in 48 patients during follow-up (mean, 710±79 days). Kaplan-Meier analysis showed that adverse diastolic remodeling (n=50) and persistent restrictive filling alone (n=33) were significant predictors of MACE (both P<.001). Multivariate Cox analysis, when adjusted for TIMI risk score and CMR IS, microvascular obstruction, and LV ejection fraction, showed adverse diastolic remodeling (HR 3.79, P<.001) was an independent predictor of MACE, as was persistent restrictive filling alone (HR 2.61, P=.019). CONCLUSIONS Larger IS is associated with adverse diastolic remodeling. Following STEMI, adverse diastolic remodeling is a powerful prognostic marker, and identifies a larger group of 'at-risk' patients, than does persistent restrictive filling alone.
Collapse
|
22
|
Flint N, Kaufman N, Gal-Oz A, Margolis G, Topilsky Y, Keren G, Shacham Y. Echocardiographic correlates of left ventricular filling pressures and acute cardio-renal syndrome in ST segment elevation myocardial infarction patients. Clin Res Cardiol 2016; 106:120-126. [DOI: 10.1007/s00392-016-1031-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/17/2016] [Indexed: 12/24/2022]
|
23
|
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Alexandru Popescu B, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2016; 17:1321-1360. [PMID: 27422899 DOI: 10.1093/ehjci/jew082] [Citation(s) in RCA: 1522] [Impact Index Per Article: 190.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
| | | | | | - Benjamin F Byrd
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
| | - Bogdan Alexandru Popescu
- The University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Alan D Waggoner
- Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
24
|
Posada D, Poree J, Pellissier A, Chayer B, Tournoux F, Cloutier G, Garcia D. Staggered Multiple-PRF Ultrafast Color Doppler. IEEE TRANSACTIONS ON MEDICAL IMAGING 2016; 35:1510-1521. [PMID: 26780789 DOI: 10.1109/tmi.2016.2518638] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Color Doppler imaging is an established pulsed ultrasound technique to visualize blood flow non-invasively. High-frame-rate (ultrafast) color Doppler, by emissions of plane or circular wavefronts, allows severalfold increase in frame rates. Conventional and ultrafast color Doppler are both limited by the range-velocity dilemma, which may result in velocity folding (aliasing) for large depths and/or large velocities. We investigated multiple pulse-repetition-frequency (PRF) emissions arranged in a series of staggered intervals to remove aliasing in ultrafast color Doppler. Staggered PRF is an emission process where time delays between successive pulse transmissions change in an alternating way. We tested staggered dual- and triple-PRF ultrafast color Doppler, 1) in vitro in a spinning disc and a free jet flow, and 2) in vivo in a human left ventricle. The in vitro results showed that the Nyquist velocity could be extended to up to 6 times the conventional limit. We found coefficients of determination r(2) ≥ 0.98 between the de-aliased and ground-truth velocities. Consistent de-aliased Doppler images were also obtained in the human left heart. Our results demonstrate that staggered multiple-PRF ultrafast color Doppler is efficient for high-velocity high-frame-rate blood flow imaging. This is particularly relevant for new developments in ultrasound imaging relying on accurate velocity measurements.
Collapse
|
25
|
Shacham Y, Khoury S, Flint N, Steinvil A, Sadeh B, Arbel Y, Topilsky Y, Keren G. Serial Echocardiographic Assessment of Left Ventricular Filling Pressure and Remodeling among ST-Segment Elevation Myocardial Infarction Patients Treated by Primary Percutaneous Intervention. J Am Soc Echocardiogr 2016; 29:745-749. [PMID: 27215803 DOI: 10.1016/j.echo.2016.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Indexed: 01/20/2023]
Abstract
BACKGROUND Acute myocardial infarction and remodeling of the left ventricle is associated with significant changes in systolic and diastolic echocardiographic derived indices. The investigators have tried to determine whether persistence of increased ratio of transmitral flow velocity (E) to early mitral annulus velocity (e'), signifying increased cardiac filling pressure, is associated with left ventricular (LV) remodeling and increased chamber size among patients presenting with ST-segment elevation myocardial infarction, who underwent successful reperfusion with primary percutaneous coronary intervention. METHODS Fifty-two patients (76% men; mean age, 61 ± 10 years) with first ST-segment elevation myocardial infarctions who underwent primary percutaneous coronary intervention were retrospectively studied. Echocardiography was performed at baseline (days 1-3) and after 178 ± 62 days. Patients were stratified according to E/septal e' ratio >15 and ≤15 in both examinations. All patients received optimal medical therapy according to guidelines and local practice. RESULTS Patients with maintained or worsened E/septal e' ratios to >15 demonstrated on the second examination worse LV ejection fractions (mean, 45 ± 12% vs 52 ± 8%; P = .03) and higher indexed LV end-diastolic volumes (mean, 81.3 ± 22.9 vs 69.2 ± 13.4 mL/m(2); P = .01) and end-systolic volumes (mean, 33.0 ± 12.2 vs 23.7 ± 13.4 mL/m(2); P = .02) compared with the first examination, representing LV remodeling. Patients with E/septal e' ratios > 15 on the second examination demonstrated a positive correlation between the change in E/septal e' ratio and the change in indexed LV end-diastolic volume (linear R(2) = 0.344, P = .03). CONCLUSIONS Among patients with ST-segment elevation myocardial infarctions undergoing primary percutaneous coronary intervention, early and persistent elevation of the E/septal e' ratio may be associated with LV remodeling.
Collapse
Affiliation(s)
- Yacov Shacham
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
| | - Shafik Khoury
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Nir Flint
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Arie Steinvil
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ben Sadeh
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Yan Topilsky
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Gad Keren
- Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| |
Collapse
|
26
|
Nagueh SF, Smiseth OA, Appleton CP, Byrd BF, Dokainish H, Edvardsen T, Flachskampf FA, Gillebert TC, Klein AL, Lancellotti P, Marino P, Oh JK, Popescu BA, Waggoner AD. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2016; 29:277-314. [PMID: 27037982 DOI: 10.1016/j.echo.2016.01.011] [Citation(s) in RCA: 3278] [Impact Index Per Article: 409.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
| | | | | | - Benjamin F Byrd
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | | | | | | | | | - Jae K Oh
- Mayo Clinic, Rochester, Minnesota
| | - Bogdan Alexandru Popescu
- University of Medicine and Pharmacy "Carol Davila," Institute of Cardiovascular Diseases, Bucharest, Romania
| | - Alan D Waggoner
- Washington University School of Medicine, St. Louis, Missouri
| |
Collapse
|
27
|
Left atrial volume index as a predictor of left ventricular remodeling in patients with anterior STEMI treated with primary PCI. Egypt Heart J 2016. [DOI: 10.1016/j.ehj.2015.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
28
|
Kim TH, Lee JS, Park J, Park JK, Uhm JS, Joung B, Lee MH, Pak HN. Blunted rate-dependent left atrial pressure response during isoproterenol infusion in atrial fibrillation patients with impaired left ventricular diastolic function: a comparison to pacing. Europace 2016; 17 Suppl 2:ii89-96. [DOI: 10.1093/europace/euv239] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
29
|
Acar RD, Bulut M, Acar Ş, Izci S, Fidan S, Yesin M, Efe SC. Evaluation of the P Wave Axis in Patients With Systemic Lupus Erythematosus. J Cardiovasc Thorac Res 2015; 7:154-7. [PMID: 26702344 PMCID: PMC4685281 DOI: 10.15171/jcvtr.2015.33] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/23/2015] [Indexed: 11/09/2022] Open
Abstract
Introduction: P wave axis is one of the most practical clinical tool for evaluation of cardiovascular disease. The aim of our study was to evaluate the P wave axis in electrocardiogram (ECG), left atrial function and association between the disease activity score in patients with systemic lupus erythematosus (SLE).
Methods: Standard 12-lead surface ECGs were recorded by at a paper speed of 25 m/s and an amplifier gain of 10 mm/mV. The heart rate (HR), the duration of PR, QRS, QTd (dispersion), the axis of P wave were measured by ECG machine automatically.
Results: The P wave axis was significantly increased in patients with SLE (49 ± 20 vs. 40 ± 18, P = 0.037) and the disease activity score was found positively correlated with P wave axis (r: 0.382, P = 0.011). The LA volume and the peak systolic strain of the left atrium (LA) were statistically different between the groups (P = 0.024 and P = 0.000). The parameters of the diastolic function; E/A and E/e’ were better in the control group than the patients with SLE (1.1 ± 0.3 vs. 1.3 ± 0.3, P = 0.041 and 6.6 ± 2.8 vs. 5.4 ± 1.4, P = 0.036, respectively).
Conclusion: P wave axis was found significantly increased in patients with SLE and positively correlated with SELENA-SLEDAI score. As the risk score increases in patients with SLE, P wave axis changes which may predict the risk of all-cause and cardiovascular mortality.
Collapse
Affiliation(s)
- Rezzan Deniz Acar
- Kartal Kosuyolu Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mustafa Bulut
- Kartal Kosuyolu Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Şencan Acar
- Department of Internal Medicine, Bilim University, Istanbul, Turkey
| | - Servet Izci
- Kartal Kosuyolu Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Serdar Fidan
- Kartal Kosuyolu Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Mahmut Yesin
- Kartal Kosuyolu Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| | - Suleyman Cagan Efe
- Kartal Kosuyolu Education and Research Hospital, Department of Cardiology, Istanbul, Turkey
| |
Collapse
|
30
|
Egemnazarov B, Schmidt A, Crnkovic S, Sydykov A, Nagy BM, Kovacs G, Weissmann N, Olschewski H, Olschewski A, Kwapiszewska G, Marsh LM. Pressure Overload Creates Right Ventricular Diastolic Dysfunction in a Mouse Model: Assessment by Echocardiography. J Am Soc Echocardiogr 2015; 28:828-43. [PMID: 25840639 DOI: 10.1016/j.echo.2015.02.014] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Noninvasive diagnostic tools for right ventricular (RV) dysfunction measurements are increasingly being used, although their association with the pathologic mechanisms of dysfunction is poorly understood. Although investigations have focused mainly on RV systolic function, RV diastolic function remains mostly neglected. The aim of this study was to test which echocardiographic parameters best reflect RV diastolic function in mice. METHODS Pulmonary artery banding (PAB) was used to induce RV pressure overload in mice. Transthoracic echocardiography and invasive hemodynamic measurements were performed after 3 weeks in PAB and sham-operated mice. Subsequently, the hearts were investigated by histology and analyzed for gene expression. RESULTS PAB-induced pressure overload (RV systolic pressure PAB 52.6 ± 11.8 mm Hg vs sham 27.0 ± 2.7 mm Hg) resulted in RV hypertrophy and remodeling, as reflected by increased Fulton index (PAB 0.37 ± 0.05 vs sham 0.25 ± 0.02, P = .001). Masson's trichrome staining revealed increased interstitial fibrosis (PAB 12.25 ± 3.12% vs sham 3.97 ± 1.58%, P = .002). This was associated with significant systolic RV dysfunction as demonstrated by reduced contractility index and diastolic dysfunction as demonstrated by end-diastolic pressure (PAB 2.66 ± 0.83 mm Hg vs sham 1.49 ± 0.50 mm Hg, P < .001) and τ (PAB 40.0 ± 16.1 msec vs sham 13.0 ± 3.5 msec, P < .001). Messenger ribonucleic acid expression of β-myosin heavy chain, atrial and brain natriuretic peptides, collagen family members was elevated, and the sarco/endoplasmic reticulum Ca(2+)-ATPase was decreased. Echocardiography revealed significant increases in RV free wall thickness and isovolumic relaxation time and a decrease in left ventricular eccentricity index, E', and tricuspid annular plane systolic excursion. Isovolumic relaxation time and E' were significantly correlated with end-diastolic pressure (rs = 0.511 and -0.451) and τ (rs = 0.739 and -0.445, respectively). Moreover, E' was negatively correlated with the degree of RV fibrosis (rs = -0.717). CONCLUSIONS Within 3 weeks, PAB causes pressure overload-induced RV hypertrophy and remodeling with compensated systolic and diastolic dysfunction in mice. RV free wall thickness, tricuspid annular plane systolic excursion, E', E/E' ratio, and isovolumic relaxation time appear to be the most reliable echocardiographic parameters for the assessment of RV dysfunction.
Collapse
Affiliation(s)
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Slaven Crnkovic
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Akylbek Sydykov
- University of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Giessen, Germany
| | - Bence M Nagy
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Gabor Kovacs
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Norbert Weissmann
- University of Giessen and Marburg Lung Center, Excellence Cluster Cardio-Pulmonary System, Giessen, Germany
| | - Horst Olschewski
- Division of Pulmonology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Andrea Olschewski
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Experimental Anesthesiology, Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Grazyna Kwapiszewska
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria; Experimental Anesthesiology, Department of Anesthesia and Intensive Care Medicine, Medical University of Graz, Graz, Austria
| | - Leigh M Marsh
- Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| |
Collapse
|
31
|
Palmiero P, Zito A, Maiello M, Cameli M, Modesti PA, Muiesan ML, Novo S, Saba PS, Scicchitano P, Pedrinelli R, Ciccone MM. Left ventricular diastolic function in hypertension: methodological considerations and clinical implications. J Clin Med Res 2014; 7:137-44. [PMID: 25584097 PMCID: PMC4285058 DOI: 10.14740/jocmr2050w] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2014] [Indexed: 12/30/2022] Open
Abstract
The assessment of left ventricular (LV) diastolic function should be an integral part of a routine examination of hypertensive patient; indeed when LV diastolic function is impaired, it is possible to have heart failure even with preserved LV ejection fraction. Left ventricular diastolic dysfunction (LVDD) occurs frequently and is associated to heart disease. Doppler echocardiography is the best tool for early LVDD diagnosis. Hypertension affects LV relaxation and when left ventricular hypertrophy (LVH) occurs, it decreases compliance too, so it is important to calculate Doppler echocardiography parameters, for diastolic function evaluation, in all hypertensive patients. The purpose of our review was to discuss about the strong relationship between LVDD and hypertension, and their relationship with LV systolic function. Furthermore, we aimed to assess the relationship between the arterial stiffness and LV structure and function in hypertensive patients.
Collapse
Affiliation(s)
| | - Annapaola Zito
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Maria Maiello
- ASL Department of Cardiology, Brindisi District, Italy
| | - Matteo Cameli
- Department of Cardiovascular Diseases, University of Siena, Italy
| | - Pietro Amedeo Modesti
- Department of Clinical and Experimental Medicine, University of Florence, Florence, Italy
| | - Maria Lorenza Muiesan
- Clinica Medica, Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Salvatore Novo
- Department of Internal Medicine and Cardiovascular Diseases, Palermo, Italy
| | - Pier Sergio Saba
- Cardiologia, Azienda Ospedaliero-Universitaria di Sassari, Italy
| | - Pietro Scicchitano
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
| | - Roberto Pedrinelli
- Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Universita di Pisa, Pisa, Italy
| | - Marco Matteo Ciccone
- Cardiovascular Disease Section, Department of Emergency and Organ Transplantation, University of Bari, Italy
| |
Collapse
|
32
|
Rigolli M, Rossi A, Quintana M, Klein AL, Yu CM, Ghio S, Dini FL, Prior D, Troughton RW, Temporelli PL, Poppe KK, Doughty RN, Whalley GA. The prognostic impact of diastolic dysfunction in patients with chronic heart failure and post-acute myocardial infarction: Can age-stratified E/A ratio alone predict survival? Int J Cardiol 2014; 181:362-8. [PMID: 25555281 DOI: 10.1016/j.ijcard.2014.12.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 11/13/2014] [Accepted: 12/21/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the prognostic implications of diastolic filling grades and identify whether age-stratified E/A ratio alone can identify patients at high risk of death post-AMI and HF. We hypothesized that in response to ageing and pathology, a normal E/A (>1) could be considered abnormal in patients post-AMI older than 65years, and that in patients with symptomatic HF, a normal E/A always represents advanced diastolic dysfunction. METHODS AND RESULTS This is a sub-analysis of the Meta-analysis Research Group in Echocardiography (MeRGE) which combined individual patient data from 30 prospective studies and demonstrated that restrictive filling was an important and independent predictor of all-cause mortality. This sub-analysis is restricted to those studies in which continuous E/A data were available (20 studies) and includes a total of 3082 AMI and 2321 HF patients. Patients were classified at the time of echocardiography into four filling patterns: normal, abnormal relaxation, pseudonormal, and restrictive filling. Post-AMI patients were divided into four groups on the basis of age and E/A, while patients with HF were classified into three groups, based on only E/A. Mortality across groups was compared using Kaplan-Meier survival analysis and Cox proportional hazards. In multivariable analyses in the AMI patients, age-stratified E/A was an independent predictor of outcome (HR 1.43 (95% CI: 1.31-1.56)), and in the HF cohort, E/A was confirmed as an independent predictor of mortality (HR 1.12 (95% CI 1.09-1.16)) alongside age and ejection fraction. CONCLUSIONS Age-stratified E/A is an independent predictor of mortality after AMI and in HF patients, regardless of left ventricular ejection fraction, age and gender. E/A ratio could be a first step echocardiographic risk stratification, which could precede and indicate the need for more advanced diagnostic and prognostic considerations in high-risk AMI and HF patients.
Collapse
Affiliation(s)
- Marzia Rigolli
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; University of Verona, Verona, Italy
| | | | | | | | - Cheuk-Man Yu
- Chinese University of Hong Kong, Hong Kong, China
| | - Stefano Ghio
- Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Frank L Dini
- Santa Chiara Hospital, University of Pisa, Pisa, Italy
| | | | - Richard W Troughton
- Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
| | | | - Katrina K Poppe
- Department of Medicine, University Of Auckland, Auckland, New Zealand
| | - Robert N Doughty
- Department of Medicine, University Of Auckland, Auckland, New Zealand
| | - Gillian A Whalley
- Awhina Health Campus, Waitemata District Health Board, Auckland, New Zealand; Unitec Institute of Technology, Auckland, New Zealand.
| | | |
Collapse
|
33
|
Shacham Y, Topilsky Y, Leshem-Rubinow E, Arbel Y, Ben Assa E, Keren G, Roth A, Steinvil A. Association between C-reactive protein level and echocardiography assessed left ventricular function in first ST-segment elevation myocardial infarction patients who underwent primary coronary intervention. J Cardiol 2014; 63:402-8. [DOI: 10.1016/j.jjcc.2013.10.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 10/16/2013] [Accepted: 10/25/2013] [Indexed: 10/26/2022]
|
34
|
Moore A, Shindikar A, Fomison-Nurse I, Riu F, Munasinghe PE, Ram TP, Saxena P, Coffey S, Bunton RW, Galvin IF, Williams MJA, Emanueli C, Madeddu P, Katare R. Rapid onset of cardiomyopathy in STZ-induced female diabetic mice involves the downregulation of pro-survival Pim-1. Cardiovasc Diabetol 2014; 13:68. [PMID: 24685144 PMCID: PMC4073808 DOI: 10.1186/1475-2840-13-68] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Accepted: 03/21/2014] [Indexed: 02/06/2023] Open
Abstract
Background Diabetic women are five times more likely to develop congestive heart failure compared with two fold for men. The underlying mechanism for this gender difference is not known. Here we investigate the molecular mechanisms responsible for this female disadvantage and attempt safeguarding cardiomyocytes viability and function through restoration of pro-survival Pim-1. Methods and Results Diabetes was induced by injection of streptozotocin in CD1 mice of both genders. Functional and dimensional parameters measurement using echocardiography revealed diastolic dysfunction in female diabetic mice within 8 weeks after STZ-induced diabetes. This was associated with significant downregulation of pro-survival Pim-1 and upregulation of pro-apoptotic Caspase-3, microRNA-1 and microRNA-208a. Male diabetic mice did not show any significant changes at this time point (P < 0.05 vs. female diabetic). Further, the onset of ventricular remodelling was quicker in female diabetic mice showing marked left ventricular dilation, reduced ejection fraction and poor contractility (P < 0.05 vs. male diabetic at 12 and 16 weeks of STZ-induced diabetes). Molecular analysis of samples from human diabetic hearts confirmed the results of pre-clinical studies, showing marked downregulation of Pim-1 in the female diabetic heart (P < 0.05 vs. male diabetic). Finally, in vitro restoration of Pim-1 reversed the female disadvantage in diabetic cardiomyocytes. Conclusions We provide novel insights into the molecular mechanisms behind the rapid onset of cardiomyopathy in female diabetics. These results suggest the requirement for the development of gender-specific treatments for diabetic cardiomyopathy.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Rajesh Katare
- Department of Physiology-HeartOtago, Otago School of Medical Sciences, University of Otago, PO Box 913, Dunedin 9054, New Zealand.
| |
Collapse
|
35
|
Prognostic importance of a short deceleration time in symptomatic congestive heart failure☆. Eur J Heart Fail 2014; 10:689-95. [DOI: 10.1016/j.ejheart.2008.05.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2008] [Revised: 04/10/2008] [Accepted: 05/15/2008] [Indexed: 11/21/2022] Open
|
36
|
Whalley GA, Wasywich CA, Walsh H, Doughty RN. Role of echocardiography in the contemporary management of chronic heart failure. Expert Rev Cardiovasc Ther 2014; 3:51-70. [PMID: 15723575 DOI: 10.1586/14779072.3.1.51] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Echocardiography is an excellent noninvasive tool for the assessment of ventricular size and both systolic and diastolic function, and it is routinely used in patients with heart failure. This review will discuss the role of echocardiography in heart failure diagnosis, prognostic assessment and in the management of heart failure patients.
Collapse
Affiliation(s)
- Gillian A Whalley
- University of Auckland, Department of Medicine, Private Bag 92019, Auckland, New Zealand.
| | | | | | | |
Collapse
|
37
|
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
|
38
|
Arasaratnam P, Lee E. Prognostic value of the E/e′ ratio among octogenarians in Singapore. HEART ASIA 2013; 5:176-80. [DOI: 10.1136/heartasia-2013-010361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2013] [Revised: 07/11/2013] [Accepted: 07/21/2013] [Indexed: 11/03/2022]
|
39
|
Iwahashi N, Kimura K, Kosuge M, Tsukahara K, Hibi K, Ebina T, Saito M, Umemura S. E/e′ Two Weeks after Onset Is a Powerful Predictor of Cardiac Death and Heart Failure in Patients with a First-Time ST Elevation Acute Myocardial Infarction. J Am Soc Echocardiogr 2012. [DOI: 10.1016/j.echo.2012.09.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
40
|
Oraby MA, Ibrahim MF, Nasr GM, El Hawary AA. Relationship between restrictive Doppler mitral inflow pattern and myocardial viability after a first acute myocardial infarction. Egypt Heart J 2012. [DOI: 10.1016/j.ehj.2012.06.002] [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] Open
|
41
|
Fuchs T, Baron EL, Leitman M, Burgsdorf O, Torjman A, Vered Z. Does Chronic Atrial Fibrillation Induce Cardiac Remodeling? Echocardiography 2012; 30:140-6. [DOI: 10.1111/echo.12003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
| | - Elvera L. Baron
- Department of Medicine; Mount Sinai School of Medicine; New York; New York
| | | | | | - Amram Torjman
- Business School; College of Management; Rishon-Le-Zion; Israel
| | | |
Collapse
|
42
|
Zhang Z, Friedman D, Dione DP, Lin BA, Duncan JS, Sinusas AJ, Sampath S. Assessment of left ventricular 2D flow pathlines during early diastole using spatial modulation of magnetization with polarity alternating velocity encoding: a study in normal volunteers and canine animals with myocardial infarction. Magn Reson Med 2012; 70:766-75. [PMID: 23044637 DOI: 10.1002/mrm.24517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Revised: 08/23/2012] [Accepted: 09/12/2012] [Indexed: 11/10/2022]
Abstract
A high-temporal resolution 2D flow pathline analysis method to study early diastolic filling is presented. Filling patterns in normal volunteers (n = 8) and canine animals [baseline (n = 1) and infarcted (n = 6)] are studied. Data are acquired using spatial modulation of magnetization with polarity alternating velocity encoding, which permits simultaneous quantification of 1D blood velocities (using phase contrast encoding) and myocardial strain (using spatial modulation of magnetization tagging and harmonic phase analysis) at high-temporal resolution of 14 ms within a single breath hold. Virtual emitter particles, released from the mitral valve plane every time frame during rapid filling, are tracked to depict the 2D pathlines on the imaged plane. The pathline regional distribution is compared with myocardial longitudinal strains and to regional pressure gradients. Quantitative analysis of net kinetic energy of pathlines is finally performed. Our results demonstrate a linear correlation (r(2) = 0.85) between pathline spatial distribution and myocardial strain. Peak net kinetic energy of 0.06 ± 0.01 mJ in normal volunteers, 0.043 mJ in baseline dog, 0.143 ± 0.03 mJ in infarcted dogs with nominal flow dysfunction, and 0.016 ± 0.007 mJ in infarcted dogs with severe flow dysfunction is observed. In conclusion, 2D pathline analysis provides a direct regional assessment of early diastolic filling patterns and is sensitive to abnormalities in early diastolic filling.
Collapse
Affiliation(s)
- Ziheng Zhang
- Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA
| | | | | | | | | | | | | |
Collapse
|
43
|
Gunasekaran R, Maskon O, Hassan HHC, Safian N, Sakthiswary R. Left Atrial Volume Index Is an Independent Predictor of Major Adverse Cardiovascular Events in Acute Coronary Syndrome. Can J Cardiol 2012; 28:561-6. [DOI: 10.1016/j.cjca.2012.02.015] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2012] [Revised: 02/25/2012] [Accepted: 02/27/2012] [Indexed: 11/29/2022] Open
|
44
|
Andersen MJ, Ersbøll M, Bro-Jeppesen J, Gustafsson F, Hassager C, Køber L, Borlaug BA, Boesgaard S, Kjærgaard J, Møller JE. Exercise Hemodynamics in Patients With and Without Diastolic Dysfunction and Preserved Ejection Fraction After Myocardial Infarction. Circ Heart Fail 2012; 5:444-51. [DOI: 10.1161/circheartfailure.112.967919] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Affiliation(s)
- Mads J. Andersen
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Mads Ersbøll
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - John Bro-Jeppesen
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Finn Gustafsson
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Christian Hassager
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Lars Køber
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Barry A. Borlaug
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Søren Boesgaard
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Jasper Kjærgaard
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| | - Jacob E. Møller
- From the Department of Cardiology, the Heart Centre, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (M.J.A., M.E., J.B-J., F.G., C.H., L.K., S.B., J.K., J.E.M.); and Division of Cardiovascular Diseases, Department of Medicine, Mayo Clinic, Rochester, MN (B.A.B.)
| |
Collapse
|
45
|
Tanindi A, Olgun H, Celik B, Boyaci B. Heart rate variability in patients hospitalized for decompensated diastolic heart failure at admission and after clinical stabilization. Future Cardiol 2012; 8:473-82. [DOI: 10.2217/fca.12.24] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Aims: We investigated heart rate variability (HRV) in patients hospitalized for decompensated diastolic heart failure and the effect of compensation course on HRV parameters. We also examined the association between the degree of diastolic dysfunction and HRV indices. Patients & methods: A total of 42 patients hospitalized for decompensated heart failure, who had a measured ejection fraction ≥50%, and ten age- and sex-matched healthy volunteers were enrolled. Results: All HRV indices were lower compared with the control group both at admission (p < 0.001) and after compensation, although a significant increase was observed in each index measured after clinical stabilization (p < 0.001). Improvement in HRV indices was lowest in patients with a restrictive pattern among groups of different degrees of diastolic dysfunction. Conclusion: Impairment in HRV in decompensated diastolic heart failure is more pronounced with increasing grade of diastolic dysfunction. It remains to be investigated whether decompensation may be predicted by marked depression in these indexes or if severely impaired HRV is a consequence of decompensation.
Collapse
|
46
|
Vizzardi E, D'Aloia A, Rocco E, Lupi L, Rovetta R, Quinzani F, Bontempi L, Curnis Md A, Dei Cas L. How should we measure left atrium size and function? JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:155-166. [PMID: 22271659 DOI: 10.1002/jcu.21871] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Accepted: 11/14/2011] [Indexed: 05/31/2023]
Abstract
Echocardiographic assessment of left atrial size from M-mode or 2D echocardiography measurements has been used in clinical and research studies for years, but its accuracy is now questioned. New techniques, such as 3D and tissue Doppler imaging, assessing velocities, strain and strain rate, provide improved prognostic value in a wide range of diseases. 2D strain imaging using speckle tracking on B-mode images may yield even better, angle-independent, results than tissue Doppler imaging-derived strain echocardiography. Finally, velocity vector imaging is a novel image analysis technique that may be used to quantify left atrial volume.
Collapse
Affiliation(s)
- Enrico Vizzardi
- Applied and Experimental Medicine Department, Chair of Cardiology University of Brescia, Brescia, Italy
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Hsiao SH, Lin KL, Chiou KR. Comparison of left atrial volume parameters in detecting left ventricular diastolic dysfunction versus tissue Doppler recordings. Am J Cardiol 2012; 109:748-55. [PMID: 22152972 DOI: 10.1016/j.amjcard.2011.10.040] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2011] [Revised: 10/25/2011] [Accepted: 10/25/2011] [Indexed: 10/14/2022]
Abstract
Because of diastolic coupling between the left atrium and left ventricle, we hypothesized that left atrial (LA) function mirrors the diastolic function of left ventricle. The aims of this study were to assess whether LA volume parameters can be good indexes of left ventricular diastolic dysfunction. Six hundred fifty-nine patients underwent cardiac catheterization and measurements of left ventricular filling pressure (LVFP). Echocardiographic examinations including tissue Doppler and LA volumes were also assessed. Ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity and LVFP tended to increase after progression of diastolic dysfunction. The inverse phenomenon existed in LA ejection and LA distensibility. LA distensibility was superior to LA ejection fraction and early diastolic mitral inflow velocity/early diastolic mitral annular velocity for identifying LVFP >15 mm Hg (areas under receiver operating characteristic curve 0.868, 0.834, and 0.759, respectively) and for differentiating pseudonormal from normal diastolic filling (areas under receiver operating characteristic curve 0.962, 0.907, and 0.741, respectively). Multivariate logistic regression showed that LA ejection fraction and LA distensibility were associated significantly with the presence of pseudonormal/restrictive ventricular filling. In conclusion, LA volume parameters can identify LVFP >15 mm Hg and differentiate among patterns of ventricular diastolic dysfunction. For assessing diastolic function LA parameters offer better performance than even tissue Doppler.
Collapse
|
48
|
Pellicori P, Calicchia A, Lococo F, Cimino G, Torromeo C. Subclinical Anthracycline Cardiotoxicity in Patients With Acute Promyelocytic Leukemia in Long-Term Remission After the AIDA Protocol. ACTA ACUST UNITED AC 2012; 18:217-21. [DOI: 10.1111/j.1751-7133.2011.00278.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
49
|
Sawaya H, Plana JC, Scherrer-Crosbie M. Newest echocardiographic techniques for the detection of cardiotoxicity and heart failure during chemotherapy. Heart Fail Clin 2011; 7:313-21. [PMID: 21749883 DOI: 10.1016/j.hfc.2011.03.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Chemotherapy-induced cardiotoxicity has become a significant public health issue. Left ventricular ejection fraction is routinely used to monitor cardiotoxicity but fails to detect subtle alterations in cardiac function. Improvements in the measurement of left ventricular ejection fraction, physical or pharmacologic stressors, and novel cardiac functional indices may be useful in the detection of cardiotoxicity. The improvements in the detection and therapy of cancer have led to the emergence of chemotherapy-induced cardiotoxicity. New echocardiographic techniques may be useful in the detection of patients undergoing chemotherapy treatments who could benefit from alternative cancer treatments, therefore decreasing the incidence of cardiotoxicity.
Collapse
Affiliation(s)
- Heloisa Sawaya
- Cardiac Ultrasound Laboratory, Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
| | | | | |
Collapse
|
50
|
Sakaguchi E, Yamada A, Sugimoto K, Ito Y, Shiino K, Takada K, Iwase M, Ozaki Y. Prognostic value of left atrial volume index in patents with first acute myocardial infarction. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:440-4. [DOI: 10.1093/ejechocard/jer058] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
|