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Oksen D, Aslan M. Impact of oxidative stress on myocardial performance in patients with diabetes: a focus on subclinical left ventricular dysfunction. BMJ Open Diabetes Res Care 2024; 12:e004153. [PMID: 38886070 PMCID: PMC11184181 DOI: 10.1136/bmjdrc-2024-004153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 06/02/2024] [Indexed: 06/20/2024] Open
Abstract
INTRODUCTION Oxidative stress is known to affect left ventricular functions negatively. There is a strong bidirectional connection between diabetes mellitus (DM) and oxidative stress. In parallel, left ventricular dysfunction is observed more frequently, even in patients with DM without other risk factors. In this context, the objective of this study is to comparatively investigate the potential relationship between oxidative stress and subclinical left ventricular dysfunction (SCLVD) assessed by Myocardial Performance Index (MPI) in patients with and without DM. RESEARCH DESIGN AND METHODS The sample of this observational cross-sectional single-center study consisted of 151 patients who were evaluated for oxidative stress and SCLVD by tissue Doppler echocardiography. Patients' total oxidant status (TOS), total antioxidant status (TAS), and Oxidative Stress Index (OSI) values were calculated. The effects of oxidative stress and DM on MPI were analyzed. RESULTS There were 81 patients with DM (mean age: 46.17±10.33 years) and 70 healthy individuals (mean age: 45.72±9.04 years). Mean TOS and OSI values of the DM group were higher than healthy individuals (5.72±0.55 vs 5.31±0.50, p = <0.001; and 4.92±1.93 vs 1.79±0.39, p = <0.001; respectively). The mean TAS value of the DM group was significantly lower than the healthy group (1.21±0.40 vs 3.23±0.51, p = <0.001). There was a significant correlation between OSI and MPI mitral in the DM group (R 0.554, p = <0.001) but not in the healthy group (R -0.069, p=0.249). CONCLUSIONS Both oxidative stress and myocardial dysfunction were found to be more common in patients with DM. The study's findings indicated the negative effect of oxidative stress on myocardial functions. Accordingly, increased oxidative stress caused more significant deterioration in MPI in patients with DM compared with healthy individuals.
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Affiliation(s)
- Dogac Oksen
- Cardiology Department, Altinbas Universitesi, Istanbul, Turkey
| | - Muzaffer Aslan
- Cardiology Department, Siirt University, Siirt, Siirt, Turkey
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Gözüküçük D, İleri BA, Başkan SK, Öztarhan E, Güller D, Önal H, Öztarhan K. Evaluation of cardiac autonomic dysfunctions in children with type 1 diabetes mellitus. BMC Pediatr 2024; 24:229. [PMID: 38561716 PMCID: PMC10986024 DOI: 10.1186/s12887-024-04644-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/13/2024] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND Cardiovascular autonomic neuropathy (CAN) is a serious complication of diabetes, impacting the autonomic nerves that regulate the heart and blood vessels. Timely recognition and treatment of CAN are crucial in averting the onset of cardiovascular complications. Both clinically apparent autonomic neuropathy and subclinical autonomic neuropathy, particularly CAN pose a significant risk of morbidity and mortality in children with type 1 diabetes mellitus (T1DM). Notably, CAN can progress silently before manifesting clinically. In our study, we assessed patients with poor metabolic control, without symptoms, following the ISPAD 2022 guideline. The objective is is to determine which parameters we can use to diagnose CAN in the subclinical period. METHODS Our study is a cross-sectional case-control study that includes 30 children diagnosed with T1DM exhibiting poor metabolic control (average HbA1c > 8.5% for at least 1 year) according to the ISPAD 2022 Consensus Guide. These patients, who are under the care of the pediatric diabetes clinic, underwent evaluation through four noninvasive autonomic tests: echocardiography, 24-h Holter ECG for heart rate variability (HRV), cardiopulmonary exercise test, and tilt table test. RESULTS The average age of the patients was 13.73 ± 1.96 years, the average diabetes duration was 8 ± 3.66 years, and the 1-year average HbA1c value was 11.34 ± 21%. In our asymptomatic and poorly metabolically controlled patient group, we found a decrease in HRV values, the presence of postural hypotension with the tilt table test, and a decrease in ventricular diastolic functions that are consistent with the presence of CAN. Despite CAN, the systolic functions of the ventricles were preserved, and the dimensions of the cardiac chambers and cardiopulmonary exercise test were normal. CONCLUSIONS CAN is a common complication of T1DM, often associated with the patient's age and poor glycemic control. HRV, active orthostatic tests, and the evaluation of diastolic dysfunctions play significant roles in the comprehensive assessment of CAN. These diagnostic measures are valuable tools in identifying autonomic dysfunction at an early stage, allowing for timely intervention and management to mitigate the impact of cardiovascular complications associated with T1DM.
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Affiliation(s)
- Davut Gözüküçük
- Department of Medicine, Division of Pediatrics, Sağlık Bilimleri University, Kanuni Sultan Süleyman Training and Research Hospital, Atakent Mh, Turgut Özal Bulvari No:46/1, Küçükçekmece, 34303, Istanbul, Turkey
| | - Berkut A İleri
- Department of Medicine, T.C. Demiroğlu Bilim University İstanbul Florence Nightingale Hospital, İzzetpaşa Mah, Abide-I Hürriyet Cd No:166, Şişli, 34381, Istanbul, Turkey
| | - Serra Karaca Başkan
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine Training and Research Hospital, Turgut Özal Millet St., Istanbul, Fatih, Topkapı, 34093, Turkey
| | - Ece Öztarhan
- Department of Medicine, Yeditepe University, Yeditepe Faculty of Medicine Training and Research Hospital, Koşuyolu, Koşuyolu Cd. No: 168, Kadıköy, 34718, Istanbul, Turkey
| | - Dilek Güller
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Gastroenterology, T.C. Demiroğlu Bilim University, İstanbul Florence Nightingale Hospital, İzzetpaşa Mah, Abide-I Hürriyet Cd No:166, Şişli, 34381, Istanbul, Turkey
| | - Hasan Önal
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Endocrinology and Metabolism, Sağlık Bilimleri University, Başakşehir Çam ve Sakura City Hosptial, Başakşehir Mahallesi G-434 Caddesi No: 2L, Başakşehir, Istanbul, Turkey
| | - Kazım Öztarhan
- Department of Medicine, Division of Pediatrics, Subdivision of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine Training and Research Hospital, Turgut Özal Millet St., Istanbul, Fatih, Topkapı, 34093, Turkey.
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Kocabaş A, Çağlak E, Turan Ö, Özdemir G, Yıldırım-Baştuhan I, Tamburacı DZ, Öztürk-Gömeç BT, Türkkahraman D. Effects of childhood obesity on myocardial performance, autonomic and conduction properties of the heart. Cardiol Young 2024; 34:513-518. [PMID: 37489526 DOI: 10.1017/s1047951123002627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023]
Abstract
BACKGROUND Childhood obesity tends to persist into adulthood and associated with increase in developing ischemic and non-ischemic cardiovascular diseases. We aimed to evaluate the effect of obesity on cardiac functions, atrial electromechanical coupling, and heart rate response, which are considered to be predictors of atrial fibrillation and sudden cardiac arrest. METHODS Study population included 52 obese children and 52 healthy controls. We performed 12-lead electrocardiography, echocardiographic examination, and treadmill exercise testing. Mitral, septal, and tricuspid segments were analysed by tissue Doppler imaging. RESULTS Myocardial performance index (p = 0.011, p < 0.001, and p = 0.001, respectively) was higher and E'/A' ratio (p = 0.011, p < 0.001, and p < 0.001, respectively) was lower in obese group than controls. Atrial electromechanical coupling was longer in the obese group at all three segments (p < 0.001, p = 0.009, and p = 0.04, respectively). They had significantly longer interatrial (p < 0.001) and intra-atrial (p = 0.003) electromechanical conduction delay. While chronotropic index was similar between two groups, heart rate reserve was lower in obese children than controls (p = 0.043). The 1st- and 2nd-minute heart rate recovery indices of the obese group were lower compared to controls (p < 0.001 and p = 0.03, respectively). Body mass index was positively correlated with intra- and inter-atrial conduction times, whereas it was negatively correlated with heart rate recovery indices. CONCLUSION We showed a deterioration in the diastolic function, atrial conduction, and heart rate response properties in children with obesity. Given the prognostic importance of these parameters, obese patients are might be at risk for atrial fibrillation and severe dysrhythmias from a young age.
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Affiliation(s)
- Abdullah Kocabaş
- Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Elifnur Çağlak
- Department of Pediatrics, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Özlem Turan
- Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Gökmen Özdemir
- Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Işıl Yıldırım-Baştuhan
- Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Diyar Z Tamburacı
- Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Burcu T Öztürk-Gömeç
- Department of Pediatric Cardiology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
| | - Doğa Türkkahraman
- Department of Pediatric Endocrinology, Antalya Training and Research Hospital, University of Health Sciences, Antalya, Turkey
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Karabacak M, Peynirci A, Ozdil O, Tayyar S, Kuyumcu MS. The Relationship Between Global Left Ventricular Function, as Indicated by the Tei Index, and Long-Term Survival in Patients With Non-Ischemic, Dilated Cardiomyopathy. KARDIOLOGIIA 2023; 63:78-83. [PMID: 37970859 DOI: 10.18087/cardio.2023.10.n2297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/28/2022] [Indexed: 11/19/2023]
Abstract
AIM Idiopathic dilated cardiomyopathy (DCM) is one of the leading causes of low ejection fraction (EF) heart failure (HF). The Tei index is a reliable marker that reflects both left ventricular (LV) systolic and diastolic function, and it has prognostic value in patients with DCM. We aimed to investigate the relationship between the Tei index and long-term survival in non-ischemic, DCM patients. MATERIAL AND METHODS The present study included 98 patients with non-ischemic DCM. The mean survival time of the patients was 59 mos. RESULTS The Tei index was prominently higher in patients who died (0.64±0.08 vs 0.71±0.12, respectively; p=0.01). LV end-systolic volume and LV ejection fraction (LVEF) were independent prognostic factors and predicted worse long-term survival. Additionally, the patients with LVEF ≥32.7 % and the Tei index ≤0.76 had significantly longer survival. CONCLUSION The present study showed that the Tei index was significantly associated with mortality and the patients with both low LVEF (≤32.7 %) and high Tei index (≥0.76) values had a shorter life expectancy. As a result, we suggest that the Tei index may be a useful echocardiographic marker to predict long-term survival in DCM patients.
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Affiliation(s)
- M Karabacak
- Suleyman Demirel University, Department of Cardiology, Medical Faculty
| | - A Peynirci
- Suleyman Demirel University, Department of Cardiology, Medical Faculty
| | - O Ozdil
- Suleyman Demirel University, Department of Cardiology, Medical Faculty
| | - Senol Tayyar
- Private Meddem Hospital, Department of Cardiology
| | - M S Kuyumcu
- Suleyman Demirel University, Department of Cardiology, Medical Faculty
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Kılıç R, Aslan M, Nas N, Güzel T. Relationship between presystolic wave and subclinical left ventricular dysfunction as assessed by myocardial performance index in patients with metabolic syndrome. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2175-2182. [PMID: 37594699 DOI: 10.1007/s10554-023-02929-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/06/2023] [Indexed: 08/19/2023]
Abstract
The myocardial performance index (MPI) is an index that shows both systolic and diastolic functions of the ventricle. Presystolic wave (PSW) is a late diastolic wave encountered in the left ventricular outflow tract (LVOT) and is associated with increased left ventricular stiffness and decreased left ventricular compliance. In our study, MPI was compared between patients with metabolic syndrome and normal patients, and we also investigated whether PSW could predict subclinical left ventricular dysfunction (SCLVD) in patients with metabolic syndrome. A total of 119 patients, 59 with metabolic syndrome and 60 healthy volunteers, were included in our study. Our study is a two-center prospective study. The patient groups were compared in terms of demographic, laboratory and echocardiographic parameters. Univariate and multivariate regression analyzes were performed to detect predictors of SCLVD. Higher MPI and PSW were found in patients with metabolic syndrome compared to the normal population (0.56 ± 0.11 vs. 0.46 ± 0.07, p < 0.001, 34 (57.6%) vs. 19 (31.7%), p = 0.004, respectively). MPI was found to be higher in patients with metabolic syndrome with PSW ( +) (0.59 ± 0.13 vs. 0.52 ± 0.05, p = 0.005). Smoking and PSW were found as Independent Predictors of Subclinical Left Ventricular Dysfunction in the Multivariate Logistic Regression Analysis Model (OR 0.146, 95%CI 0.028-0.767, p = 0.023 and OR 10.689, 95%CI 2.176-52.515, p = 0.004, respectively). Higher MPI and SCLVD were detected in patients with metabolic syndrome compared to the normal population. In addition, PSW positivity was associated with SCLVD in this patient group.
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Affiliation(s)
- Raif Kılıç
- Department of Cardiology, Çermik State Hospital, Diyarbakır, Turkey.
| | - Muzaffer Aslan
- Department of Cardiology, Siirt Training and Research Hospital, Siirt, Turkey
| | - Necip Nas
- Department of Cardiology, Siirt Training and Research Hospital, Siirt, Turkey
| | - Tuncay Güzel
- Department of Cardiology, Health Science University, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey
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Bahrami HSZ, Jørgensen PG, Hove JD, Dixen U, Biering-Sørensen T, Rossing P, Jensen MT. Prognostic value of myocardial performance index in individuals with type 1 and type 2 diabetes: Thousand&1 and Thousand&2 studies. Eur Heart J Cardiovasc Imaging 2023; 24:1555-1562. [PMID: 37638773 DOI: 10.1093/ehjci/jead178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 07/15/2023] [Indexed: 08/29/2023] Open
Abstract
AIMS Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in type 1 (T1D) and type 2 diabetes (T2D). Despite diabetes affects the myocardium, risk prediction models do not include myocardial function parameters. Myocardial performance index (MPI) reflects left ventricular function. The prognostic value of MPI has not been evaluated in large-scale diabetes populations. METHODS AND RESULTS We evaluated two prospective cohort studies: Thousand&1 (1093 individuals with T1D) and Thousand&2 (1030 individuals with T2D). Clinical data, including echocardiography, were collected at baseline. We collected follow-up data from national registries. We defined major adverse cardiovascular events (MACE) as incident events of hospital admission for acute coronary syndrome, heart failure, stroke, or all-cause mortality. For included individuals (56% male, 54 ± 15 years, MPI 0.51 ± 0.1, 63% T1D), follow-up was 100% after median of 5.3 years (range: 4.8-6.3). MPI was associated with MACE (HR 1.2, 95%CI 1.0-1.3, P = 0.012, per 0.10-unit increase) and heart failure (HR 1.3, 95%CI 1.1-1.6, P = 0.005, per 0.10-unit increase) after adjusting for clinical and echocardiographic variables. MPI predicted MACE and heart failure better in T1D than T2D (P = 0.031 for interaction). MPI added discriminatory power to the Steno T1 Risk Engine, based on clinical characteristics, in predicting MACE [area under the curve (AUC) from 0.77 to 0.79, P = 0.030] and heart failure (AUC from 0.77 to 0.83, P = 0.009) in T1D. CONCLUSION MPI is independently associated with MACE and heart failure in T1D but not T2D and improves prediction in T1D. Echocardiographic assessment in T1D may enhance risk prediction.
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Affiliation(s)
- Hashmat Sayed Zohori Bahrami
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
| | - Peter Godsk Jørgensen
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Cardiology, Copenhagen University Hospital, Herlev & Gentofte, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Jens Dahlgaard Hove
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Ulrik Dixen
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Gentofte Hospitalsvej 1, 2900 Hellerup, Denmark
| | - Peter Rossing
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3b, 2200 Copenhagen, Denmark
| | - Magnus T Jensen
- Department of Cardiology, Copenhagen University Hospital, Amager & Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Denmark
- Department of Clinical Research, Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark
- William Harvey Research Institute, NIHR Barts Biomedical Centre, Queen Mary University London, Charterhouse Square, London EC1M 6BQ, UK
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Ma Y, Sun X, Liu X, Hu L, Song Y, Ye X. Fetal echocardiography changes of the right ventricle of well-controlled gestational diabetes mellitus. BMC Cardiovasc Disord 2023; 23:493. [PMID: 37803261 PMCID: PMC10559588 DOI: 10.1186/s12872-023-03539-7] [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: 01/30/2023] [Accepted: 09/27/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND There is few evidence of right ventricular (RV) function in fetuses with gestational diabetes mellitus (GDM). Therefore, the aim of this study was to assess the RV function of fetuses using routine and two-dimensional speckle-tracking echocardiography (2D STE) to determine the effects of well-controlled GDM in the third trimester. METHODS We used a Philips Epiq7C ultrasound instrument to obtain RV data sets from 63 subjects from July 2019 to February 2022. We compared the free wall thickness (FWT), fractional area change (FAC), Tei index (TEI), tricuspid annular plane systolic excursion (TAPSE) and free wall longitudinal strain(FWLS)of the RV in mothers with well-controlled GDM and normal gestational age-matched fetuses. RESULTS 63 third trimester fetuses (32 GDM; 31 healthy controls) met the enrolment criteria. Significant differences in fetal RV were detected between the GDM and control groups for the FAC (36.35 ± 6.19 vs. 41.59 ± 9.11; P = 0.008) and the FWLS (-18.28 ± 4.23 vs. -20.98 ± 5.49; P = 0.021). There was a significant difference among the segmental strains of the base, middle and apex of the RV free wall in the healthy controls (P = 0.003), but in the GDM group, there was no statistical difference (p = 0.076). RV FWLS had a strong correlation with FAC (r = 0.467; P = 0.0002). CONCLUSIONS In well-controlled GDM, there was measurable fetal RV hypertrophy and significant systolic function decline, indicating the presence of ventricular remodeling and dysfunction. 2D-STE can evaluate the RV free wall contraction in a more comprehensive way.
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Affiliation(s)
- Ying Ma
- Department of Ultrasound, Zhou Pu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - XueSong Sun
- Department of Obstetrics and Gynecology, Zhou Pu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - XiaoZhi Liu
- Department of Obstetrics and Gynecology, Zhou Pu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - LiHua Hu
- Department of Ultrasound, Zhou Pu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Ye Song
- Department of Ultrasound, Zhou Pu Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Xiong Ye
- School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, China.
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Ansalone G, Boriani G, Sassone B, Camastra G, Donal E, Calò L, Casella M, Delarche N, Lozano IF, Biffi M, Boulogne E, Guidotto T, Leclercq C. Biventricular versus left ventricular only stimulation: an echocardiographic substudy of the B-LEFT HF trial. J Cardiovasc Med (Hagerstown) 2023; 24:453-460. [PMID: 37285276 DOI: 10.2459/jcm.0000000000001480] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND The noninferiority of left ventricular pacing alone (LVp) compared with biventricular pacing (BIV) has not been yet definitely documented. In this study, we reviewed all the original echocardiographic measures of the Biventricular versus Left Univentricular Pacing with ICD Back-up in Heart Failure Patients (B-LEFT HF) trial in order to investigate mechanisms underlying LV remodelling with both pacing modalities. METHODS Patients with New York Heart Association functional class (NYHA) III or IV despite optimal medical therapy, LVEF 35% or less, left ventricular end-diastolic diameter (LVEDD) more than 55 mm, QRS duration at least 130 ms were randomized to BIV or LVp for 6 months. The primary end point was a composite of at least 1 point decrease in NYHA class and at least 5 mm decrease in left ventricular end-systolic diameter (LVESD). An additional end point was a LVp reverse remodelling defined as at least 10% decrease in LVESD. Mitral regurgitation and all echocardiographic measures were reassessed after 6-month follow-up. RESULTS One hundred and forty-three patients were enrolled. Seventy-six patients were in the BIV and 67 were in the LVp group. Left ventricular volumes decreased significantly without difference between groups (P = 0.8447). Similarly, left ventricular diameters decreased significantly in both groups with a significant decrease in LVESD with BIV (P < 0.0001), but not with LVp (P = 0.1383). LVEF improved in both groups without difference (P = 0.8072). Mitral regurgitation did not improve either with BIV, or with LVp. CONCLUSION The echocardiographic sub-analysis of B-LEFT study showed the substantial equivalence of LVp in favouring left ventricular reverse remodelling as compared with BIV.
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Affiliation(s)
| | - Giuseppe Boriani
- Cardiology Division, Department of Diagnostics, Clinical and Public Health Medicine, University of Modena and Reggio Emilia, Policlinico di Modena, Modena
| | - Biagio Sassone
- Department of Cardiology, Ospedale SS.ma Annunziata, Azienda Unità Sanitaria Locale Ferrara, Cento, Italy
| | | | | | | | - Michela Casella
- Heart Rhythm Center, Centro Cardiologico Monzino, Milan, Italy
| | | | | | - Mauro Biffi
- Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy
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O'Riordan CE, Trochet P, Steiner M, Fuchs D. Standardisation and future of preclinical echocardiography. Mamm Genome 2023; 34:123-155. [PMID: 37160810 DOI: 10.1007/s00335-023-09981-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 01/31/2023] [Indexed: 05/11/2023]
Abstract
Echocardiography is a non-invasive imaging technique providing real-time information to assess the structure and function of the heart. Due to advancements in technology, ultra-high-frequency transducers have enabled the translation of ultrasound from humans to small animals due to resolutions down to 30 µm. Most studies are performed using mice and rats, with ages ranging from embryonic, to neonatal, and adult. In addition, alternative models such as zebrafish and chicken embryos are becoming more frequently used. With the achieved high temporal and spatial resolution in real-time, cardiac function can now be monitored throughout the lifespan of these small animals to investigate the origin and treatment of a range of acute and chronic pathological conditions. With the increased relevance of in vivo real-time imaging, there is still an unmet need for the standardisation of small animal echocardiography and the appropriate cardiac measurements that should be reported in preclinical cardiac models. This review focuses on the development of standardisation in preclinical echocardiography and reports appropriate cardiac measurements throughout the lifespan of rodents: embryonic, neonatal, ageing, and acute and chronic pathologies. Lastly, we will discuss the future of cardiac preclinical ultrasound.
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Affiliation(s)
| | | | | | - Dieter Fuchs
- FUJIFILM VisualSonics, Inc, Amsterdam, The Netherlands.
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Marshall AG, Neikirk K, Vue Z, Beasley HK, Garza-Lopez E, Vang L, Barongan T, Evans Z, Crabtree A, Spencer E, Anudokem J, Parker R, Davis J, Stephens D, Damo S, Pham TT, Gomez JA, Exil V, Dai DF, Murray SA, Entman ML, Taffet GE, Hinton AO, Reddy AK. Cardiovascular hemodynamics in mice with tumor necrosis factor receptor-associated factor 2 mediated cytoprotection in the heart. Front Cardiovasc Med 2023; 10:1064640. [PMID: 37229235 PMCID: PMC10203617 DOI: 10.3389/fcvm.2023.1064640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 04/03/2023] [Indexed: 05/27/2023] Open
Abstract
Introduction Many studies in mice have demonstrated that cardiac-specific innate immune signaling pathways can be reprogrammed to modulate inflammation in response to myocardial injury and improve outcomes. While the echocardiography standard parameters of left ventricular (LV) ejection fraction, fractional shortening, end-diastolic diameter, and others are used to assess cardiac function, their dependency on loading conditions somewhat limits their utility in completely reflecting the contractile function and global cardiovascular efficiency of the heart. A true measure of global cardiovascular efficiency should include the interaction between the ventricle and the aorta (ventricular-vascular coupling, VVC) as well as measures of aortic impedance and pulse wave velocity. Methods We measured cardiac Doppler velocities, blood pressures, along with VVC, aortic impedance, and pulse wave velocity to evaluate global cardiac function in a mouse model of cardiac-restricted low levels of TRAF2 overexpression that conferred cytoprotection in the heart. Results While previous studies reported that response to myocardial infarction and reperfusion was improved in the TRAF2 overexpressed mice, we found that TRAF2 mice had significantly lower cardiac systolic velocities and accelerations, diastolic atrial velocity, aortic pressures, rate-pressure product, LV contractility and relaxation, and stroke work when compared to littermate control mice. Also, we found significantly longer aortic ejection time, isovolumic contraction and relaxation times, and significantly higher mitral early/atrial ratio, myocardial performance index, and ventricular vascular coupling in the TRAF2 overexpression mice compared to their littermate controls. We found no significant differences in the aortic impedance and pulse wave velocity. Discussion While the reported tolerance to ischemic insults in TRAF2 overexpression mice may suggest enhanced cardiac reserve, our results indicate diminished cardiac function in these mice.
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Affiliation(s)
- Andrea G. Marshall
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Kit Neikirk
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Zer Vue
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Heather K. Beasley
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Edgar Garza-Lopez
- Department of Internal Medicine, University of Iowa, Iowa City, IA, United States
| | - Larry Vang
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Taylor Barongan
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Zoe Evans
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Amber Crabtree
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Elsie Spencer
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Josephs Anudokem
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
- Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville, TN, United States
| | - Remi Parker
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
- Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville, TN, United States
| | - Jamaine Davis
- Department of Biochemistry and Cancer Biology, Meharry Medical College, Nashville, TN, United States
| | - Dominique Stephens
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
- Department of Life and Physical Sciences, Fisk University, Nashville, TN, United States
| | - Steven Damo
- Department of Life and Physical Sciences, Fisk University, Nashville, TN, United States
| | - Thuy T. Pham
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, United States
| | - Jose A. Gomez
- Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Vernat Exil
- Department of Pediatrics, Div. of Cardiology, St. Louis University School of Medicine, St. Louis, MO, United States
- Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Dao-fu Dai
- Department of Pathology, Carver College of Medicine, University of Iowa, Iowa City, IA, United States
| | - Sandra A. Murray
- Department of Cell Biology, College of Medicine, University of Pittsburgh, Pittsburgh, United States
| | - Mark L. Entman
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, United States
| | - George E. Taffet
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, United States
| | - Antentor O. Hinton
- Department of Molecular Physiology and Biophysics, Vanderbilt University, Nashville, TN, United States
| | - Anilkumar K. Reddy
- Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX, United States
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11
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Khot N, Joshi S, Malwade S, Chavan S, Mane SV, Agarkhedkar S, Arora A. A Comprehensive Echocardiographic Assessment of Neonatal Right Ventricular Function in Neonatal Intensive Care Unit Babies. Cureus 2023; 15:e37166. [PMID: 37153277 PMCID: PMC10162581 DOI: 10.7759/cureus.37166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2023] [Indexed: 05/09/2023] Open
Abstract
Background The right ventricle (RV) in the fetus is the predominant chamber, accounting for about 60% of the total cardiac output. The majority of the RV outflow volume is diverted from the pulmonary artery via the ductus arteriosus to the descending aorta. After birth, the RV undergoes extensive structural and functional modifications. The RV undergoes an improper transition from fetal to neonatal circulation in sick neonatal intensive care unit (NICU) babies. Functional echocardiography is now commonly being used in most NICUs as it is a noninvasive and bedside investigation that gives an immediate evaluation of hemodynamics and can be taken into consideration as an extension of clinical assessment to study a critically unwell neonate. Therefore, a study of RV functions in NICU neonates will help in better understanding the neonatal cardiopulmonary response to different diseases. Thus, this study aimed to assess RV functions in neonates getting admitted to the NICU of a tertiary care institute. Methodology This observational, cross-sectional study was approved by the Research & Recognition Committee of Dr. D. Y. Patil Vidyapeeth, Pune. In total, 35 cases of term neonates admitted to the NICU at Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune who fulfilled the inclusion criteria were enrolled in this study after obtaining consent from their parents. Two-dimensional echocardiography was performed by a trained pediatric cardiologist, and the findings were substantiated by a neonatologist trained in echocardiography. Results Our study found a strong association between tricuspid inflow velocity and neonates with sepsis. Similarly, a significant association was observed between abnormal tricuspid Inflow velocity (E/A and E/E') and neonates requiring inotropic support. Conclusions Data on the normal values of different echocardiographic parameters of the systolic and diastolic function of the RV during the neonatal phase of life are currently limited. Our data offer preliminary insights into this topic. Early echocardiography and intervention are advisable, especially in neonates with sepsis and requiring inotropic support.
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Affiliation(s)
- Nikita Khot
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Santosh Joshi
- Pediatric Cardiology, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sudhir Malwade
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sanjay Chavan
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Shailaja V Mane
- Pediatric Medicine, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Sharad Agarkhedkar
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
| | - Amodini Arora
- Pediatrics, Dr. D. Y. Patil Medical College, Hospital & Research Centre, Pune, IND
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12
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Cinato M, Mardani I, Miljanovic A, Drevinge C, Laudette M, Bollano E, Henricsson M, Tolö J, Bauza Thorbrügge M, Levin M, Lindbom M, Arif M, Pacher P, Andersson L, Olofsson CS, Borén J, Levin MC. Cardiac Plin5 interacts with SERCA2 and promotes calcium handling and cardiomyocyte contractility. Life Sci Alliance 2023; 6:e202201690. [PMID: 36717246 PMCID: PMC9887753 DOI: 10.26508/lsa.202201690] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 01/31/2023] Open
Abstract
The adult heart develops hypertrophy to reduce ventricular wall stress and maintain cardiac function in response to an increased workload. Although pathological hypertrophy generally progresses to heart failure, physiological hypertrophy may be cardioprotective. Cardiac-specific overexpression of the lipid-droplet protein perilipin 5 (Plin5) promotes cardiac hypertrophy, but it is unclear whether this response is beneficial. We analyzed RNA-sequencing data from human left ventricle and showed that cardiac PLIN5 expression correlates with up-regulation of cardiac contraction-related processes. To investigate how elevated cardiac Plin5 levels affect cardiac contractility, we generated mice with cardiac-specific overexpression of Plin5 (MHC-Plin5 mice). These mice displayed increased left ventricular mass and cardiomyocyte size but preserved heart function. Quantitative proteomics identified sarcoplasmic/endoplasmic reticulum Ca2+ ATPase 2 (SERCA2) as a Plin5-interacting protein. In situ proximity ligation assay further confirmed the Plin5/SERCA2 interaction. Live imaging showed increases in intracellular Ca2+ release during contraction, Ca2+ removal during relaxation, and SERCA2 function in MHC-Plin5 versus WT cardiomyocytes. These results identify a role of Plin5 in improving cardiac contractility through enhanced Ca2+ signaling.
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Affiliation(s)
- Mathieu Cinato
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ismena Mardani
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Azra Miljanovic
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Drevinge
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marion Laudette
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Entela Bollano
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marcus Henricsson
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Johan Tolö
- Department of Physiology/Metabolic Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Marcos Bauza Thorbrügge
- Department of Physiology/Metabolic Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Max Levin
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malin Lindbom
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Muhammad Arif
- Laboratory of Cardiovascular Physiology and Tissue Injury, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Pal Pacher
- Laboratory of Cardiovascular Physiology and Tissue Injury, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, MD, USA
| | - Linda Andersson
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Charlotta S Olofsson
- Department of Physiology/Metabolic Physiology, Institute of Neuroscience and Physiology, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Jan Borén
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Malin C Levin
- Department of Molecular and Clinical Medicine/Wallenberg Laboratory, Institute of Medicine, Sahlgrenska Academy at University of Gothenburgand Sahlgrenska University Hospital, Gothenburg, Sweden
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13
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Vasciaveo L, Zanzarelli E, D'Antonio F. Fetal cardiac function evaluation: A review. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:215-224. [PMID: 36785505 DOI: 10.1002/jcu.23421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 12/20/2022] [Accepted: 12/22/2022] [Indexed: 06/18/2023]
Abstract
The aim of this review is to provide an up to date on the current use of fetal echocardiography in assessing the fetal cardiac function and its potential research and clinical applications. Despite classically is been used for prenatal diagnosis of fetal heart defects, assessment of fetal cardiac function has been recently proposed as a fundamental tool to assess pregnancies complicated by several disorders with long-term impact on post-natal cardiovascular health, such as placental insufficiency and fetal growth restriction. In this review we present anatomical and functional fetal cardiac development mechanisms and an overview of the currently available techniques for evaluating fetal heart function.
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Affiliation(s)
- Lorenzo Vasciaveo
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Erika Zanzarelli
- Maternal Fetal Medicine Unit, Department of Obstetrics and Gynaecology, University of Foggia, Foggia, Italy
| | - Francesco D'Antonio
- Centre for High-Risk Pregnancy and Fetal Care, Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
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14
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Hariri E, Layoun H, Hansen J, Abou Hassan O, Kassab J, Kassis N, Cremer PC, Hanna M, Mentias A, Flamm SD, Daou R, Griffin B, Elgharably H, Unai S, Pettersson G, Kapadia S, Harb SC. Imaging and haemodynamic parameters associated with clinical outcomes following isolated tricuspid valve surgery. Open Heart 2022; 9:openhrt-2022-002124. [PMID: 36522126 PMCID: PMC9756202 DOI: 10.1136/openhrt-2022-002124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 10/24/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Isolated tricuspid valve surgery (TVS) may be associated with high morbidity and mortality. The aim of this study was to investigate the association of preoperative imaging and haemodynamic data derived from echocardiography (ECHO), cardiac magnetic resonance (CMR) and right heart catheterisation (RHC) with postoperative outcomes following TVS. METHODS In a retrospective cohort study, patients who underwent isolated TVS at our institution between 2012 and 2020 were screened and followed up to 1 year. We only included those who had all three tests before surgery: ECHO, CMR and RHC. Patients with congenital heart disease, infective endocarditis and those who underwent concomitant valve or pericardial surgery were excluded. The primary outcome was a composite of mortality and congestive heart failure at 1 year. Time-to-event analyses at 1 year and Cox proportional hazards regression analyses were performed. RESULTS A total of 60 patients were included (mean age of 60±14 years, 63% women), of whom 67% underwent TV repair. The primary outcome occurred in 16 patients (27%) with a 1-year mortality of 7%. It was associated with ECHO-derived right ventricular (RV) free wall strain and RHC-derived RV systolic and diastolic as well as mean pulmonary pressures. On multivariable Cox regression analysis, only RV systolic and diastolic pressures were significantly associated with the primary outcome at 1 year (HRs=5.9 and 3.4, respectively, p<0.05). CONCLUSION Baseline invasive haemodynamic assessment could have a strong association with clinical outcomes and help risk-stratify patients undergoing isolated TVS.
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Affiliation(s)
- Essa Hariri
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Habib Layoun
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Jonathan Hansen
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Ossama Abou Hassan
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Joseph Kassab
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Nicholas Kassis
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Paul C Cremer
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mazen Hanna
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Amgad Mentias
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Scott D Flamm
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Remy Daou
- Family Medicine Department, Hotel-Dieu De France, Achrafieh, Lebanon
| | - Brian Griffin
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Haytham Elgharably
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shinya Unai
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Gosta Pettersson
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Samir Kapadia
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Serge C Harb
- Heart Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio, USA
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15
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Al Atroush HH, Mohammed KH, Nasr FM, Al Desouky MI, Rabie MA. Cardiac dysfunction in patients with end-stage liver disease, prevalence, and impact on outcome: a comparative prospective cohort study. EGYPTIAN LIVER JOURNAL 2022. [DOI: 10.1186/s43066-022-00200-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Without firm diagnostic criteria, the exact prevalence of cirrhotic cardiomyopathy still remains unknown. Its estimation is rather a difficult task as the disease is generally latent and shows itself only when the patient is subjected to overt stress such as body position changes, exercise, drugs, hemorrhage, and surgery. In this study, we aim to assess cardiac dysfunction in patients with end-stage liver disease, study the correlation between cardiac dysfunction and Child-Pugh classification of patients with liver cell failure, and study the prevalence and impact of cardiac dysfunction on the clinical outcome of patients with child B and child C liver disease.
Results
Diastolic dysfunction was more prevalent among the patients’ group (p < 0.001). It was absent in 28 (70%) of control group, with grade 1 diastolic dysfunction in 12 (30%). Only one patient (2.5%) had no diastolic dysfunction, 21 patients (52.5%) had grade 1 diastolic dysfunction, 12 (30%) patients had grade 2 diastolic dysfunction, and 6 patients (15%) had grade 3 diastolic dysfunction. QTc interval was significantly prolonged in the patients’ group when compared to controls (p < 0.001). Echocardiographic parameters and QTc interval were comparable in child B and child C patients. All patients were followed up for a period of 3 months. Sixteen of 40 patients died in this period of time. Only child classification was found to significantly predict mortality, and patients with child C liver cirrhosis had worse survival when compared to patients with child B liver cirrhosis.
Conclusion
Most of the patients had cardiac dysfunction, mainly diastolic dysfunction (87.5%). The study detected the prevalence of diastolic dysfunction among end-stage liver disease when measuring E/É using TDI which proved to be more accurate than E/A ratio. Diastolic dysfunction is proved to be the most sensitive parameter in the diagnosis of cirrhotic cardiomyopathy, being the most parameter affected early. No correlation was found between cardiac dysfunction and the severity of hepatic illness, but the severity of hepatic illness affects the outcome rather than cardiac dysfunction.
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16
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Ushida T, Cotechini T, Protopapas N, Atallah A, Collyer C, Toews AJ, Macdonald-Goodfellow SK, Tse MY, Winn LM, Pang SC, Adams MA, Othman M, Kotani T, Kajiyama H, Graham CH. Aberrant inflammation in rat pregnancy leads to cardiometabolic alterations in the offspring and intrauterine growth restriction in the F2 generation. J Dev Orig Health Dis 2022; 13:706-718. [PMID: 35593438 DOI: 10.1017/s2040174422000265] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Children of women with pre-eclampsia have increased risk of cardiovascular (CV) and metabolic disease in adult life. Furthermore, the risk of pregnancy complications is higher in daughters born to women affected by pre-eclampsia than in daughters born after uncomplicated pregnancies. While aberrant inflammation contributes to the pathophysiology of pregnancy complications, including pre-eclampsia, the contribution of maternal inflammation to subsequent risk of CV and metabolic disease as well as pregnancy complications in the offspring remains unclear. Here, we demonstrate that 24-week-old female rats (F1) born to dams (F0) exposed to lipopolysaccharide (LPS) during pregnancy (to induce inflammation) exhibited mild systolic dysfunction, increased cardiac growth-related gene expression, altered glucose tolerance, and coagulopathy; whereas male F1 offspring exhibited altered glucose tolerance and increased visceral fat accumulation compared with F1 sex-matched offspring born to saline-treated dams. Both male and female F1 offspring born to LPS-treated dams had evidence of anemia. Fetuses (F2) from F1 females born to LPS-treated dams were growth restricted, and this reduction in fetal growth was associated with increased CD68 positivity (indicative of macrophage presence) and decreased expression of glucose transporter-1 in their utero-placental units. These results indicate that abnormal maternal inflammation can contribute to increased risk of CV and metabolic disease in the offspring, and that the effects of inflammation may cross generations. Our findings provide evidence in support of early screening for CV and metabolic disease, as well as pregnancy complications in offspring affected by pre-eclampsia or other pregnancy complications associated with aberrant inflammation.
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Affiliation(s)
- Takafumi Ushida
- Department of Gynecology and Obstetrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tiziana Cotechini
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Nicole Protopapas
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Aline Atallah
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Charlotte Collyer
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Alexa J Toews
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | | | - M Yat Tse
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Louise M Winn
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Stephen C Pang
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Michael A Adams
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Maha Othman
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
- School of Baccalaureate Nursing, St. Lawrence College, Kingston, Ontario, Canada
| | - Tomomi Kotani
- Department of Gynecology and Obstetrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroaki Kajiyama
- Department of Gynecology and Obstetrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Charles H Graham
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
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17
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Di Maria MV, Goldberg DJ, Zak V, Hu C, Lubert AM, Dragulescu A, Mackie AS, McCrary A, Weingarten A, Parthiban A, Goot B, Goldstein BH, Taylor C, Lindblade C, Petit C, Spurney C, Harrild D, Urbina EM, Schuchardt E, Kim GB, Yoon JK, Colombo JN, Files M, Schoessling M, Ermis P, Wong P, Garg R, Swanson S, Menon S, Srivastava S, Thorsson T, Johnson TR, Krishnan US, Paridon SM, Frommelt PC. Impact of Udenafil on Echocardiographic Indices of Single Ventricle Size and Function in FUEL Study Participants. Circ Cardiovasc Imaging 2022; 15:e013676. [PMID: 36378780 PMCID: PMC9674374 DOI: 10.1161/circimaging.121.013676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 10/11/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND The FUEL trial (Fontan Udenafil Exercise Longitudinal) demonstrated statistical improvements in exercise capacity following 6 months of treatment with udenafil (87.5 mg po BID). The effect of udenafil on echocardiographic measures of single ventricle function in this cohort has not been studied. METHODS The 400 enrolled participants were randomized 1:1 to udenafil or placebo. Protocol echocardiograms were obtained at baseline and 26 weeks after initiation of udenafil/placebo. Linear regression compared change from baseline indices of single ventricle systolic, diastolic and global function, atrioventricular valve regurgitation, and mean Fontan fenestration gradient in the udenafil cohort versus placebo, controlling for ventricular morphology (left ventricle versus right ventricle/other) and baseline value. RESULTS The udenafil participants (n=191) had significantly improved between baseline and 26 weeks visits compared to placebo participants (n=195) in myocardial performance index (P=0.03, adjusted mean difference [SE] of changes between groups -0.03[0.01]), atrioventricular valve inflow peak E (P=0.009, 3.95 [1.50]), and A velocities (P=0.034, 3.46 [1.62]), and annular Doppler tissue imaging-derived peak e' velocity (P=0.008, 0.60[0.23]). There were no significant differences in change in single ventricle size, systolic function, atrioventricular valve regurgitation severity, or mean fenestration gradient. Participants with a dominant left ventricle had significantly more favorable baseline values of indices of single ventricle size and function (lower volumes and areas, E/e' ratio, systolic:diastolic time and atrioventricular valve regurgitation, and higher annular s' and e' velocity). CONCLUSIONS FUEL participants who received udenafil demonstrated a statistically significant improvement in some global and diastolic echo indices. Although small, the changes in diastolic function suggest improvement in pulmonary venous return and/or augmented ventricular compliance, which may help explain improved exercise performance in that cohort. REGISTRATION URL: https://clinicaltrials.gov; Unique Identifier: NCT02741115.
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Affiliation(s)
- Michael V. Di Maria
- Children’s Hospital Colorado, University of Colorado School of Medicine, Aurora, CO
| | - David J. Goldberg
- Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| | | | | | - Adam M. Lubert
- Cincinnati Children’s Hospital, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | | | - Andrew S. Mackie
- Stollery Children’s Hospital, University of Alberta, Edmonton, Alberta, Canana
| | | | | | - Anitha Parthiban
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Benjamin Goot
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Bryan H. Goldstein
- Cincinnati Children’s Hospital, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
- UPMC Children’s Hospital of Pittsburgh, University of Pittsburgh, Pittsburgh, PA
| | - Carolyn Taylor
- Shawn Jenkins Children’s Hospital, Medical University of South Carolina, Charleston, SC
| | | | - Christopher Petit
- Children’s Heart Center, Emory University School of Medicine, Atlanta, GA
| | | | | | - Elaine M. Urbina
- Cincinnati Children’s Hospital, Heart Institute, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Eleanor Schuchardt
- Rady Children’s Hospital, University of California San Diego, San Diego, CA
| | - Gi Beom Kim
- Seoul National University Children’s Hospital, Seoul National University College of Medicine, Seoul, South Korea
| | - Ja Kyoung Yoon
- Sejong Hospital Cardiovascular Center, Department of Pediatrics, Bucheon, South Korea
| | - Jamie N. Colombo
- St. Louis Children’s Hospital, Washington University School of Medicine, St. Louis, MO
| | - Matthew Files
- Seattle Children’s Hospital, University of Washington, Seattle, WA
| | - Megan Schoessling
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
| | - Peter Ermis
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | - Pierre Wong
- Children’s Hospital of Los Angeles, Keck School of Medicine of USC, Los Angeles, CA
| | - Ruchira Garg
- Smidt Heart Institute, Cedars-Sinai, Los Angeles, CA
| | - Sara Swanson
- Children’s Hospital and Medical Center, Omaha, NE
| | - Shaji Menon
- Primary Children’s Hospital, University of Utah, Salt Lake City, UT
| | | | - Thor Thorsson
- C.S. Mott Children’s Hospital, University of Michigan Congenital Heart Center, Ann Arbor, MI
| | | | - Usha S. Krishnan
- Columbia University Irving Medical Center, Morgan Stanley Children’s Hospital of New York, New York, NY
| | - Stephen M Paridon
- Children’s Hospital of Philadelphia, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Peter C. Frommelt
- Children’s Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee, WI
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18
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Hoyt RH, Kelley BP, Harry MJ, Marcus RH. Hemodynamic Doppler echocardiographic evaluation of permanent His bundle and biventricular pacing after AV nodal ablation. IJC HEART & VASCULATURE 2022; 42:101102. [PMID: 36161234 PMCID: PMC9493057 DOI: 10.1016/j.ijcha.2022.101102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/19/2022] [Accepted: 08/05/2022] [Indexed: 12/01/2022]
Abstract
placing after atrioventricular (AV) nodal ablation for permanent atrial fibrillation (AF) may include cardiac resynchronization therapy (CRT) with either His bundle pacing (HBP) or biventricular pacing (BVP), or conventional single site right ventricular apical pacing (RVAP). To determine the relationship between pacing method and hemodynamic outcome, we used Doppler echocardiographic methods to evaluate left ventricular (LV) hemodynamics after AV nodal ablation and either HBP, BVP, or RVAP. Method 20 patients were evaluated > 6 months after AV nodal ablation, 10 each with chronic HBP or BVP, and all with RVAP lead. Doppler echocardiography was used to measure 3 parameters indicative of CRT: 1) LV dP/dt, 2) the LV pre-ejection interval, and 3) myocardial performance index, relative to intra-patient RVAP. Results Primary endpoint of LV dP/dt on average improved by > 17% with both HBP and BVP, compared to RVAP. HBP but not BVP, had improvement across all three parameters. Conclusion HBP provides LV electromechanical synchrony across multiple echo Doppler parameters. Both HBP and BVP were hemodynamically superior to RVAP following AV nodal ablation.
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Affiliation(s)
- Robert H Hoyt
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
| | - Brian P Kelley
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
| | - Mark J Harry
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
| | - Richard H Marcus
- Iowa Heart Center, West Des Moines, Iowa. Dr. Kelley is affiliated with Des Moines University of Osteopathic Medicine, Iowa
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19
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Gicana KRB, Pinidmontree C, Kosalathip K, Sirirut S, Komolvanich S, Asawakarn S, Sakcamduang W, Naiyanetr P, Tachampa K. Use of proposed systolic and myocardial performance indices derived from simultaneous ECG and PCG recordings to assess cardiac function in healthy Beagles. Vet World 2022; 15:1785-1797. [PMID: 36185531 PMCID: PMC9394128 DOI: 10.14202/vetworld.2022.1785-1797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/07/2022] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Cardiac time intervals (CTIs) can provide important information on the electrical and mechanical properties of the heart. We hypothesized that cardiac function can be described using the combined power of electrocardiography (ECG) and phonocardiography (PCG) signals. This study aimed to (1) validate a novel custom device in measuring CTI parameters; (2) compare CTI parameters with a commercially available device and standard transthoracic echocardiography (STE); and (3) compare calculated systolic performance index (SPI) and myocardial performance index (MPI) with Tei index from the STE. Materials and Methods: This study determined CTIs based on simultaneous ECG and PCG recordings in 14 healthy Beagle dogs using the custom-built device. These CTI parameters were compared with a commercially available device (Eko DUO ECG + Digital Stethoscope; Eko DUO) and the STE. Agreement of CTI parameters between the custom device and the commercially available device or STE was evaluated. Calculated SPI and MPI based on Wigger’s diagram were proposed, compared with SPI and Tei index, and correlated with STE parameters. Results: We found that the ECG and PCG parameters measured from the custom-built device did not differ from the commercially available device and the STE. By combining ECG and PCG signals, we established CTI parameters in healthy dogs including indices for systolic function (SPI: QS1/S1S2) and global cardiac function {F1 ([QS1+S2]/S1S2), F2 ([RS1+S2]/S1S2), and F3 (RS1 + [QS2-QT]/S1S2)}. The SPI, F2, and F3 were comparable with echocardiographic parameters describing systolic (Pre-ejection period/left ventricular ejection time [LVET]) and Tei index ([MCOdur-LVET]/LVET), respectively. Only SPI and F3 were correlated significantly with MCOdur and heart rate, respectively. Conclusion: We have validated the use of the custom-built device to describe CTIs that are comparable to the commercially available device and STE in healthy Beagles. The proposed SPI and MPI derived from CTI parameters can be useful in clinical practice to describe the cardiac function, especially in areas where access to STE is constrained.
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Affiliation(s)
- Karlo Romano B. Gicana
- The International Graduate Program of Veterinary Science and Technology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand; Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of the Philippines Los Baños, Laguna, Philippines
| | - Chirutchaya Pinidmontree
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Kitchanan Kosalathip
- Cardiovascular Engineering and Artificial Organs (CardioArt) Laboratory, Department of Biomedical Engineering Department, Mahidol University, Nakhon Pathom, Thailand
| | - Siraphop Sirirut
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Siripen Komolvanich
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Sariya Asawakarn
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand; Biomarkers in Animal Parasitology Research Group, Chulalongkorn University, Bangkok, Thailand
| | - Walasinee Sakcamduang
- Department of Clinical Sciences and Public Health, Faculty of Veterinary Science, Mahidol University, Nakhon Pathom, Thailand
| | - Phornphop Naiyanetr
- Cardiovascular Engineering and Artificial Organs (CardioArt) Laboratory, Department of Biomedical Engineering Department, Mahidol University, Nakhon Pathom, Thailand
| | - Kittipong Tachampa
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand; Biomarkers in Animal Parasitology Research Group, Chulalongkorn University, Bangkok, Thailand
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20
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Zhao C, Hao X, Xue C, Zhao Y, Han J, Jia Y, Hou X, Wang J. Impact of Extracorporeal Membrane Oxygenation on Right Ventricular Function After Heart Transplantation. Front Cardiovasc Med 2022; 9:938442. [PMID: 35911545 PMCID: PMC9335007 DOI: 10.3389/fcvm.2022.938442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
Aims Acute right ventricular failure remains a common challenging clinical syndrome in heart transplant (HTx) recipients. While extracorporeal membrane oxygenation (ECMO) is a proven strategy for the treatment of this condition, the outcomes after weaning and during follow up remain understudied. We aimed to evaluate the right-sided heart function in ECMO survivors following HTx. Methods Between September 2005 and December 2019, 205 patients with end-stage heart failure who underwent standard orthotopic HTx were enrolled. In total, 68 (33.2%) patients were included in the ECMO group and 137 (66.8%) patients were included in the non-ECMO group. Results Of the 68 patients in the ECMO group, 42 (61.8%) were successfully weaned from ECMO. After a median follow-up period of 53 months, there were 25 (59.5%) and 27 (23.7%) deaths in the ECMO and non-ECMO groups (P = 0.023), respectively. Systolic pulmonary artery pressure (SPAP) before discharge (P = 0.003) was the unique predictor of all-cause mortality during follow up. Meanwhile, patients in the ECMO group with more than moderate SPAP increase before discharge had higher mortality than patients in the non-ECMO group without such increase (P = 0.005). Conclusions Recipient right-sided heart characteristics were strong predictors of ECMO need after HTx. ECMO patients had high mortality in the perioperative and follow-up periods, and the changes in right ventricular function in ECMO patients may be associated with pulmonary vessel injury before and after HTx.
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Affiliation(s)
- Cheng Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xing Hao
- Department of Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Chao Xue
- Department of Ultrasonography, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yichen Zhao
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jie Han
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yixin Jia
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiaotong Hou
- Department of Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- *Correspondence: Xiaotong Hou
| | - Jiangang Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
- Jiangang Wang
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21
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Figueiredo AM, Cardoso AC, Pereira BLB, Silva RAC, Ripa AFGD, Pinelli TFB, Oliveira BC, Rafacho BPM, Ishikawa LLW, Azevedo PS, Okoshi K, Fernandes AAH, Zornoff LAM, Minicucci MF, Polegato BF, Paiva SAR. Açai supplementation (Euterpe oleracea Mart.) attenuates cardiac remodeling after myocardial infarction in rats through different mechanistic pathways. PLoS One 2022; 17:e0264854. [PMID: 35245316 PMCID: PMC8896726 DOI: 10.1371/journal.pone.0264854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Accepted: 02/17/2022] [Indexed: 11/18/2022] Open
Abstract
Myocardial infarction has a high mortality rate worldwide. Therefore, clinical intervention in cardiac remodeling after myocardial infarction is essential. Açai pulp is a natural product and has been considered a functional food because of its antioxidant/anti-inflammatory properties. The aim of the present study was to analyze the effect of açai pulp supplementation on cardiac remodeling after myocardial infarction in rats. After 7 days of surgery, male Wistar rats were assigned to six groups: sham animals fed standard chow (SA0, n = 14), fed standard chow with 2% açai pulp (SA2, n = 12) and fed standard chow with 5% açai pulp (SA5, n = 14), infarcted animals fed standard chow (IA0, n = 12), fed standard chow with 2% açai pulp (IA2, n = 12), and fed standard chow with 5% açai pulp (IA5, n = 12). After 3 months of supplementation, echocardiography and euthanasia were performed. Açai pulp supplementation, after myocardial infarction, improved energy metabolism, attenuated oxidative stress (lower concentration of malondialdehyde, P = 0.023; dose-dependent effect), modulated the inflammatory process (lower concentration of interleukin-10, P<0.001; dose-dependent effect) and decreased the deposit of collagen (lower percentage of interstitial collagen fraction, P<0.001; dose-dependent effect). In conclusion, açai pulp supplementation attenuated cardiac remodeling after myocardial infarction in rats. Also, different doses of açai pulp supplementation have dose-dependent effects on cardiac remodeling.
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Affiliation(s)
- Amanda Menezes Figueiredo
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
- * E-mail:
| | - Ana Carolina Cardoso
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Bruna Leticia Buzati Pereira
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Renata Aparecida Candido Silva
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | | | - Bruna Camargo Oliveira
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Bruna Paola Murino Rafacho
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Larissa Lumi Watanabe Ishikawa
- Chemistry and Biochemistry Department, Institute of Biosciences, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Paula Schmidt Azevedo
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Katashi Okoshi
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Ana Angelica Henrique Fernandes
- Chemistry and Biochemistry Department, Institute of Biosciences, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | | | - Marcos Ferreira Minicucci
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Bertha Furlan Polegato
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
| | - Sergio Alberto Rupp Paiva
- Internal Medicine Department, Botucatu Medical School, Universidade Estadual Paulista (UNESP), Botucatu, São Paulo, Brazil
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22
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Zhang H, Kan J, Zhang C, Yang Z, Gu H, Fan F, Gu H, Wang Q, Zhang J, Xie D, Zhang G, Guo X, Yin Y, Chen SL. Long-term mortality after pulmonary artery denervation stratified by baseline functional class in patients with pulmonary arterial hypertension: Long-term mortality after PADN stratified by functional class. ASIAINTERVENTION 2022; 8:58-68. [PMID: 35350791 PMCID: PMC8922462 DOI: 10.4244/aij-d-21-00033] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 11/23/2021] [Indexed: 06/14/2023]
Abstract
AIMS This study aimed to assess the long-term effects of pulmonary artery denervation (PADN) on mortality in patients with pulmonary arterial hypertension (PAH). METHODS AND RESULTS Between March 2012 and March 2018, a total of 120 patients with PAH, who underwent PADN treatment and were prospectively followed up, were analysed. Patients were classified into World Health Organization (WHO) Functional Class I and II (FC 1-2; n=46) and Functional Class III and IV (FC 3-4; n=74) according to their FC prior to PADN. The primary endpoint was lung transplantation-free mortality until March 2021. The secondary endpoint was a change in the six-minute walk distance (6MWD). During the median of 4.8 years of follow-up, 23 (19.2%) patients died, predominantly from the FC 3-4 group (25.7%), compared to 8.7% in the FC 1-2 group (p=0.034). The mortality rate at one year (2.2% vs 12.2%, p=0.087) and three years (6.5% vs 17.6%, p=0.102) was numerically low in the FC 1-2 group versus the FC 3-4 group, respectively. The median net increase of 6MWD was +29 m in the FC 1-2 group, compared to +60.5 m in the FC 3-4 group (p=0.037). CONCLUSIONS PADN results in significant improvements in survival at long-term follow-up, especially in patients with PAH in FC 3-4. This study was the continuation of the PADN-1 study which was registered at URL: http://www.chictr.trc.com.cn. Unique identifier: chiCTR-ONC-12002085.
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Affiliation(s)
- Han Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Jing Kan
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Caojing Zhang
- Guangdong Provincial Peoples Hospital, Guangdong Academy of Medical Sciences, Guangdong Cardiovascular Institute, Guangzhou, China
| | - Zhenweng Yang
- General Hospital of Tianjin Medical University, Tianjin, China
| | - Heping Gu
- The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Fenling Fan
- First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Gu
- Beijing Anzhen Hospital, Beijing, China
| | - Qiguang Wang
- General Hospital of Northern Theater Command, Shenyang, China
| | - Juan Zhang
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | - Dujiang Xie
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
| | | | - Xiaomei Guo
- Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yuehui Yin
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Shao-Liang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, China
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23
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Kaya H, Asoglu R, Afsin A, Tibilli H, Kurt E, Kafadar S, Gulacti U, Kafadar H. Assessment of myocardial performance index in patients with COVID-19: An echocardiographic follow-up study. Rev Port Cardiol 2022; 41:455-461. [PMID: 35194312 PMCID: PMC8849847 DOI: 10.1016/j.repc.2021.03.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 03/16/2021] [Indexed: 01/08/2023] Open
Abstract
Introduction and Objectives Myocardial performance may be impaired in cytokine-mediated immune reactions. The myocardial performance index (MPI) is a practical parameter that reflects systolic and diastolic cardiac function. We aimed to assess the MPI in patients with COVID-19. Methods The study population consisted of 40 healthy controls and 40 patients diagnosed with COVID-19 who had mild pneumonia and did not need intensive care treatment. All participants underwent echocardiographic examination. First, the MPI and laboratory parameters were compared between healthy controls and patients in the acute period of infection. Second, the MPI and laboratory parameters were compared between the acute infection period and after clinical recovery. Results Compared with healthy controls, patients with COVID-19 had a significantly higher MPI (0.56±0.09 vs. 0.41±0.06, p<0.001), longer isovolumic relaxation time (IRT) (112.3±13.4 vs. 90.6±11.2 ms, p<0.001), longer deceleration time (DT) (182.1±30.6 vs. 160.8±42.7 ms, p=0.003), shorter ejection time (ET) (279.6±20.3 vs. 299.6±34.7 ms, p<0.001) and higher E/A ratio (1.53±0.7 vs. 1.21±0.3, p<0.001). Statistically significantly higher MPI (0.56±0.09 vs. 0.44±0.07, p<0.001), longer IRT (112.3±13.4 vs. 91.8±12.1 ms, p<0.001), longer DT (182.1±30.6 vs. 161.5±43.5 ms, p=0.003), shorter ET 279.6±20.3 vs. 298.8±36.8 ms, p<0.001) and higher E/A ratio (1.53±0.7 vs. 1.22±0.4, p<0.001) were observed during the acute infection period than after clinical recovery. Left ventricular ejection fraction was similar in the controls, during the acute infection period and after clinical recovery. Conclusions Subclinical diastolic impairment without systolic involvement may be observed in patients with COVID-19. This impairment may be reversible on clinical recovery.
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Affiliation(s)
- Hakan Kaya
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey.
| | - Ramazan Asoglu
- Department of Cardiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Abdulmecit Afsin
- Department of Cardiology, Kahta State Hospital, Adiyaman, Turkey
| | - Hakan Tibilli
- Department of Cardiology, Kahta State Hospital, Adiyaman, Turkey
| | - Ercan Kurt
- Department of Otorhinolaryngology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Safiye Kafadar
- Department of Radiology, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Umut Gulacti
- Department of Emergency, Adiyaman Training and Research Hospital, Adiyaman, Turkey
| | - Huseyin Kafadar
- Department of Foresic Medicine, Faculty of Medicine, Adiyaman University, Adiyaman, Turkey
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24
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Farrell C, Balasubramanian A, Hays AG, Hsu S, Rowe S, Zimmerman SL, Hassoun PM, Mathai SC, Mukherjee M. A Clinical Approach to Multimodality Imaging in Pulmonary Hypertension. Front Cardiovasc Med 2022; 8:794706. [PMID: 35118142 PMCID: PMC8804287 DOI: 10.3389/fcvm.2021.794706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
Pulmonary hypertension (PH) is a clinical condition characterized by progressive elevations in mean pulmonary artery pressures and right ventricular dysfunction, associated with significant morbidity and mortality. For resting PH to develop, ~50-70% of the pulmonary vasculature must be affected, suggesting that even mild hemodynamic abnormalities are representative of advanced pulmonary vascular disease. The definitive diagnosis of PH is based upon hemodynamics measured by right heart catheterization; however this is an invasive and resource intense study. Early identification of pulmonary vascular disease offers the opportunity to improve outcomes by instituting therapies that slow, reverse, or potentially prevent this devastating disease. Multimodality imaging, including non-invasive modalities such as echocardiography, computed tomography, ventilation perfusion scans, and cardiac magnetic resonance imaging, has emerged as an integral tool for screening, classifying, prognosticating, and monitoring response to therapy in PH. Additionally, novel imaging modalities such as echocardiographic strain imaging, 3D echocardiography, dual energy CT, FDG-PET, and 4D flow MRI are actively being investigated to assess the severity of right ventricular dysfunction in PH. In this review, we will describe the utility and clinical application of multimodality imaging techniques across PH subtypes as it pertains to screening and monitoring of PH.
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Affiliation(s)
- Christine Farrell
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Aparna Balasubramanian
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Allison G. Hays
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Hsu
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
| | - Steven Rowe
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Stefan L. Zimmerman
- Division of Radiology, Johns Hopkins University, Baltimore, MD, United States
| | - Paul M. Hassoun
- Division of Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Stephen C. Mathai
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Monica Mukherjee
- Division of Cardiology, Johns Hopkins University, Baltimore, MD, United States
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25
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Madajczak D, Daboval T, Lauterbach R, Łoniewska B, Błaż W, Szczapa T, Sadowska-Krawczenko I, Michalak-Kloc M, Sławska H, Borszewska-Kornacka M, Bokiniec R. Protocol for a multicenter, double-blind, randomized, placebo-controlled phase III trial of the inhaled β2-adrenergic receptor agonist salbutamol for transient tachypnea of the newborn (the REFSAL trial). Front Pediatr 2022; 10:1060843. [PMID: 36714639 PMCID: PMC9879660 DOI: 10.3389/fped.2022.1060843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/20/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Transient tachypnea of the newborn (TTN), which results from inadequate absorption of fetal lung fluid, is the most common cause of neonatal respiratory distress. Stimulation of β-adrenergic receptors enhances alveolar fluid absorption. Therefore, the β2-adrenergic receptor agonist salbutamol has been proposed as a treatment for TTN. This study aims to evaluate the efficacy and safety of salbutamol as supportive pharmacotherapy together with non-invasive nasal continuous positive airway pressure (NIV/nCPAP) for the prevention of persistent pulmonary hypertension of the newborn (PPHN) in infants with TTN. METHODS AND ANALYSIS This multicenter, double-blind, phase III trial will include infants with a gestational age between 32 and 42 weeks who are affected by respiratory disorders and treated in eight neonatal intensive care units in Poland. A total of 608 infants within 24 h after birth will be enrolled and randomly assigned (1:1) to receive nebulized salbutamol with NIV or placebo (nebulized 0.9% NaCl) with NIV. The primary outcome is the percentage of infants with TTN who develop PPHN. The secondary outcomes are the severity of respiratory distress (assessed with the modified TTN Silverman score), frequency of need for intubation, duration of NIV and hospitalization, acid-base balance (blood pH, partial pressure of O2 and CO2, and base excess), and blood serum ionogram for Na+, K+, and Ca2+. DISCUSSION The Respiratory Failure with Salbutamol (REFSAL) study will be the first clinical trial to evaluate the efficacy and safety of salbutamol in the prevention of persistent pulmonary hypertension in newborns with tachypnea, and will improve short term outcomes. If successful, the study will demonstrate the feasibility of early intervention with NIV/nCPAP together with nebulized salbutamol in the management of TTN. ETHICS AND DISSEMINATION The study protocol was approved by the Bioethics Committee of the Medical University of Warsaw, Warsaw, Poland on November 16, 2020 (decision number KB/190/2020). All procedures will follow the principles of the Declaration of Helsinki. The results of the study will be submitted for knowledge translation in peer-reviewed journals and presented at national and international pediatric society conferences. CLINICAL TRIAL REGISTRATION It is registered at ClinicalTrials.gov NCT05527704, EudraCT 2020-003913-36; Protocol version 5.0 from 04/01/2022.
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Affiliation(s)
- Dariusz Madajczak
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
| | - Thierry Daboval
- Department of Pediatrics - Division of Neonatology, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | | | - Beata Łoniewska
- Department of Neonatology and Intensive Neonatal Care, Pomeranian Medical University, Szczecin, Poland
| | - Witold Błaż
- Clinical Department of Neonatology With Neonatal Intensive Care Unit, University of Rzeszow, Saint Jadwiga the Queen Clinical Provincial Hospital No 2, Rzeszow, Poland
| | - Tomasz Szczapa
- Department of Neonatology, Poznań University of Medical Sciences, Poznań, Poland
| | - Iwona Sadowska-Krawczenko
- Department of Neonatology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland
| | - Marzena Michalak-Kloc
- Neonatology Clinical Department, Karol Marcinkowski University Hospital, Zielona Góra, Poland
| | - Helena Sławska
- Neonatology Unit, Specialist Hospital No 2, Bytom, Medical University of Silesia, Bytom, Poland
| | | | - Renata Bokiniec
- Department of Neonatology and Neonatal Intensive Care, Medical University of Warsaw, Warsaw, Poland
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26
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Boissier F, Aissaoui N. Septic cardiomyopathy: Diagnosis and management. JOURNAL OF INTENSIVE MEDICINE 2021; 2:8-16. [PMID: 36789232 PMCID: PMC9923980 DOI: 10.1016/j.jointm.2021.11.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 11/14/2021] [Accepted: 11/25/2021] [Indexed: 12/12/2022]
Abstract
There is an extensive body of literature focused on sepsis-induced myocardial dysfunction, but results are conflicting and no objective definition of septic cardiomyopathy (SCM) has been established. SCM may be defined as a sepsis-associated acute syndrome of non-ischemic cardiac dysfunction with systolic and/or diastolic left ventricular (LV) dysfunction and/or right ventricular dysfunction. Physicians should consider this diagnosis in patients with sepsis-associated organ dysfunction, and particularly in cases of septic shock that require vasopressors. Echocardiography is currently the gold standard for diagnosis of SCM. Left ventricular ejection fraction is the most common parameter used to describe LV function in the literature, but its dependence on loading conditions, particularly afterload, limits its use as a measure of intrinsic myocardial contractility. Therefore, repeated echocardiography evaluation is mandatory. Evaluation of global longitudinal strain (GLS) may be more sensitive and specific for SCM than LV ejection fraction (LVEF). Standard management includes etiological treatment, adapted fluid resuscitation, use of vasopressors, and monitoring. Use of inotropes remains uncertain, and heart rate control could be an option in some patients.
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Affiliation(s)
- Florence Boissier
- Service de Médecine Intensive Réanimation, CHU de Poitiers, Poitiers 86021, France,Université de Poitiers, Poitiers INSERM CIC 1402 (ALIVE group), France
| | - Nadia Aissaoui
- Service de Médecine Intensive Réanimation, Hôpital Cochin, APHP, Paris 75014, France,Université de Paris, Paris Cardiovascular Research Center, INSERM U970, Paris 75015, France,Corresponding author: Nadia Aissaoui, Service de Médecine Intensive–Réanimation, Hôpital Cochin Assistance Publique–Hôpitaux de Paris, 27 Rue du Faubourg Saint-Jacques, 75014 Paris, France.
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Şaylık F, Akbulut T. A presystolic wave could easily detect subclinical left ventricular dysfunction in prediabetic patients with no history of hypertension. Echocardiography 2021; 39:74-81. [PMID: 34913193 DOI: 10.1111/echo.15278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/17/2021] [Accepted: 12/02/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prediabetes is associated with left ventricular (LV) systolic and diastolic dysfunction. A presystolic wave (PSW) is detected on late diastole from the Doppler examination of the LV outflow tract and is related to LV dysfunction. LV dysfunction could be detected with different echocardiographic methods, including conventional Doppler and Tissue Doppler imaging (TDI), 2D speckle tracking echocardiography, and myocardial performance index (MPI). In this study, we aimed to investigate the association of the presence of PSW with LV dysfunction assessed by different echocardiographic methods. METHODS A total of 137 prediabetic normotensive patients were enrolled in this study. Eighty-one (59.1%) patients had a PSW and 36 (40.9%) patients had not PSW on the Doppler examinations. Echocardiographic features were compared between these groups. LV dysfunction was determined based on MPI, LV global longitudinal strain (LVGLS), and conventional Doppler and TDI measurements. RESULTS There were no differences between groups regarding clinical and laboratory parameters, except LDL, which was significantly higher in the PSW-positive group. The PSW-positive group had lower E, Em, Ea, E/A, Em/Am, Ea/Aa, LVGLS and higher A, Am, Aa, E/e', isovolumetric relaxation time, and MPI than PSW-negatives. PSW velocity was moderately correlated with MPI (R = .33, p = .003) and LVGLS (R = .35, p = .001). The presence of PSW was independently associated with LV dysfunction assessed by MPI (OR = 3.87, p < .001), LVGLS (OR = 10.29, p < .001), and conventional Doppler and TDI parameters (OR = 8.87, p < .001). CONCLUSION PSW was significantly associated with subclinical LV dysfunction in prediabetic normotensive patients assessed with three echocardiographic methods.
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Affiliation(s)
- Faysal Şaylık
- Department of Cardiology, Van Training and Education Hospital, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Training and Education Hospital, Van, Turkey
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Kizilca O, Ozmen D, Bahaettin Öncü S, Zihni C, Kir M, Soylu A, Unal N, Kavukcu S. Assessments of left ventricular systolic and diastolic functions with tissue Doppler imaging and myocardial performance index in children with chronic kidney disease. Pediatr Int 2021; 63:1483-1489. [PMID: 33760342 DOI: 10.1111/ped.14705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/29/2021] [Accepted: 02/08/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to document early left ventricular (LV) dysfunction in chronic kidney disease (CKD) using methods such as tissue Doppler imaging and the myocardial performance index (MPI). METHODS A total of 40 patients diagnosed with CKD (mean age, 10.1 ± 4.1 years) and 40 sex- and age-matched healthy controls (mean age, 9.6 ± 4.3 years) were examined. In the patient group, 20 patients had early stage (Stage 2-3) CKD and 20 patients had late-stage (stage 4-5) CKD, and 18 patients had hypertension. RESULTS The pulmonary artery systolic pressure (PAPs) and LV mass index (LVMI) were significantly higher in the patient group (P < 0.05). The LV septal and lateral margins of the mitral annulus E'/A' ratio, E/E' ratio and MPI results were significantly different between the groups (P < 0.05). The MPI scores were higher in late-stage CKD than in early stage CKD (P < 0.05). The E'/A' ratio was lower and the MPI was higher in the hypertensive CKD group compared with the normotensive CKD group (P < 0.05). The E/E' ratio was correlated positively with the LVMI, and the PAPs, and negatively with glomerular filtration rate, S' value, E'/A' ratio. The MPI was correlated positively with blood pressure, LVMI, PAPs, and the S value, and negatively with the E'/A' ratio. CONCLUSIONS The E'/A' ratio, the E/E' ratio, and the isovolumetric relaxation time measured by tissue Doppler imaging is highly accurate and easily applicable for detecting diastolic LV function, and the MPI is suitable for detecting both systolic and diastolic LV dysfunction. Their routine use may be useful in evaluating LV functions in children with CKD.
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Affiliation(s)
- Ozgur Kizilca
- Department of Pediatric Cardiology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
| | - Derya Ozmen
- Department of Pediatric Nephrology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
| | - Seyyit Bahaettin Öncü
- Department of Pediatric Cardiology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
| | - Cuneyt Zihni
- Department of Pediatric Cardiology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
| | - Mustafa Kir
- Department of Pediatric Cardiology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
| | - Alper Soylu
- Department of Pediatric Nephrology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
| | - Nurettin Unal
- Department of Pediatric Cardiology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
| | - Salih Kavukcu
- Department of Pediatric Nephrology, Medical Faculty of Dokuz Eylul University, Izmir, Turkey
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Gicana KRB, Lertwanakarn T, Tachampa K. Novel Approach to Assess Cardiac Function Using Systolic Performance and Myocardial Performance Indices From Simultaneous Electrocardiography and Phonocardiography Recordings in Dogs With Various Stages of Myxomatous Mitral Valve Disease. Front Vet Sci 2021; 8:741115. [PMID: 34746282 PMCID: PMC8566337 DOI: 10.3389/fvets.2021.741115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 09/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objective: Myxomatous mitral valve disease (MMVD) progression entails changes in the structural and functional properties of the heart affecting cardiac timings and intervals within the cardiac cycle. Conventionally, echocardiography is used to determine the cardiac time intervals (CTIs) including systolic and myocardial performance indices (SPI and MPI) in evaluating cardiac function. Alternatively, these CTIs can also be measured using simultaneous recordings of electrocardiography (ECG) and phonocardiography (PCG), but their values in different MMVD stages remain to be established. This study aimed to establish and prove the use of derived SPI and MPI from a dedicated device as a novel approach to assess cardiac function in different stages of MMVD dogs. Materials and Methods: A prospective study in 52 dogs with different MMVD stages measured the CTIs using a novel device. These were compared and correlated with standard echocardiographic parameters. The predictive value of SPI and three new proposed formulas to estimate MPI (i.e., F1, F2, and F3) in association with asymptomatic from symptomatic MMVD dogs were investigated. Results: Our findings revealed that CTI parameters measured from a novel device including QS1, QS2, S1S2, MPI-F1, and MPI-F2 were altered at different stages of MMVD. The SPI and all proposed MPI formulas were comparable with the systolic time interval and Tei index from echocardiography. In addition, the SPI, MPI-F1, and MPI-F2 were significantly correlated with the Tei index. However, the SPI was not able to differentiate the various stages of MMVD. Conversely, only the MPI-F1 (i.e., (QS1 + S2)/S1S2) demonstrated good predictive accuracy when compared between asymptomatic and symptomatic MMVD dogs similar to the Tei index. Moreover, this formula was able to differentiate stages B1 and C with remarkable predictive accuracy, higher sensitivity, and high specificity when compared with the Tei index. Conclusion: We have successfully described the CTI parameters in different MMVD stages using simultaneous ECG and PCG recordings in dogs. Furthermore, we have proven that the concept of using the newly proposed parameters from a novel device is equivalent to the Tei index. Thus, we established a novel approach to evaluate cardiac function and its supportive use in the diagnosis of MMVD patients.
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Affiliation(s)
- Karlo Romano B Gicana
- The International Graduate Program of Veterinary Science and Technology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand.,Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of the Philippines Los Baños, Los Baños, Philippines
| | - Tuchakorn Lertwanakarn
- Department of Physiology, Faculty of Veterinary Medicine, Kasetsart University, Bangkok, Thailand
| | - Kittipong Tachampa
- Department of Physiology, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
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30
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Saylik F, Akbulut T. The association of presystolic wave with subclinical left-ventricular dysfunction in patients with subclinical hypothyroidism. J Echocardiogr 2021; 20:97-105. [PMID: 34633627 DOI: 10.1007/s12574-021-00556-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 09/29/2021] [Accepted: 10/06/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Subclinical hypothyroidism (SCH) patients develop left-ventricular dysfunction (LVD) in an earlier stage. LVD could be detected with myocardial performance index (MPI), left -ventricular global longitudinal strain (LVGLS), and conventional and tissue-Doppler imaging (TDI). A presystolic wave (PSW) detected on late diastole is associated with LVD. We aimed to determine whether there is an association between PSW and subclinical LVD assessed by different echocardiographic methods in SCH patients. METHODS We prospectively enrolled 105 patients diagnosed with SCH in this study. Patients were divided into two groups based on the presence of PSW. Both groups were compared with respect to demographic, clinical, and echocardiographic properties. Multivariable regression analysis was performed to detect predictors of subclinical LVD. RESULTS The study included 70 PSW-positive patients (66%, mean age: 50.2) and 35 PSW-negative patients (34%, mean age: 46.5). PSW-positive patients had a lower platelet and a higher RDW level compared to PSW-negative patients. PSW-positive patients had more frequent subclinical LVD, which was assessed by MPI, by conventional and TDI parameters, and by LVGLS. PSW velocity was significantly correlated with MPI velocity (r = 0.31, p = 0.009), TSH level (r = 0.44, p < 0.001), and with LVGLS (r = 0.33, p = 0.005). The presence of PSW was an independent predictor of subclinical LVD in multivariable logistic regression analysis detected with MPI, LVGLS, and TDI parameters (OR = 5.409, p = 0.03; OR = 4.872, p = 0.005; OR = 5.632, p = 0.014, respectively). CONCLUSION PSW prevalence was 66% in SCH patients. PSW velocity was significantly correlated with MPI and LVGLS. The presence of PSW was independently associated with subclinical LVD in SCH patients.
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Affiliation(s)
- Faysal Saylik
- Department of Cardiology, Van Education and Research Hospital, Süphan Street, Airway Road, Edremit, 65100, Van, Turkey.
| | - Tayyar Akbulut
- Department of Cardiology, Van Education and Research Hospital, Süphan Street, Airway Road, Edremit, 65100, Van, Turkey
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Saylik F, Akbulut T, Oguz M, Sipal A, Ormeci T. Association of echocardiographic parameters with chest computed tomography score in patients with COVID-19 disease. Adv Med Sci 2021; 66:403-410. [PMID: 34454343 PMCID: PMC8379090 DOI: 10.1016/j.advms.2021.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 06/11/2021] [Accepted: 08/18/2021] [Indexed: 12/11/2022]
Abstract
Purpose Although coronavirus disease 2019 (COVID-19) primarily affects the pulmonary system, the involvement of the heart has become a well-known issue. Pulmonary CT plays an additive role in the diagnosis and prognosis of the disease. We aimed to investigate the association of echocardiographic indices with pulmonary CT scores and mortality in COVID-19 patients. Materials and methods A total of 123 patients diagnosed with COVID-19 were included in this study. The British Society of Thoracic Imaging (BSTI) score and echocardiographic parameters were calculated, and echocardiographic indices were compared between BSTI score grades. Results During in-hospital follow-up, 36 of 123 patients (29.3%) had died. BSTI score, IVS, LVPWd, RV mid-diameter, RV basal diameter, RV longitudinal diameter, sPAP, and RVMPI were higher, and RVFAC, TAPSE, and RVS were lower in the non-survivor group than in the survivor group. There were statistically significant changes between BSTI scores in terms of LVPWd, RV mid diameter, RV basal diameter, RV longitudinal diameter, sPAP, RVFAC, RVMPI, and TAPSE. BSTI score was positively correlated with sPAP and RV basal diameter and negatively correlated with TAPSE and RVFAC. Multivariate logistic regression analysis demonstrated that sPAP (OR = 1.071, p = 0.002) and RV basal diameter (OR = 1.184, p = 0.005) were independent predictors of high BSTI scores (grade 4 and 5). Furthermore, age, sPAP, and a high BSTI score (grade 5) were independent predictors of in-hospital mortality in COVID-19 patients. Conclusion Echocardiographic indices were correlated with BSTI scores, and patients with higher BSTI scores had more cardiac involvement in COVID-19.
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Dörner MF, Boknik P, Köpp F, Buchwalow IB, Neumann J, Gergs U. Mechanisms of Systolic Cardiac Dysfunction in PP2A, PP5 and PP2AxPP5 Double Transgenic Mice. Int J Mol Sci 2021; 22:ijms22179448. [PMID: 34502355 PMCID: PMC8431312 DOI: 10.3390/ijms22179448] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/26/2021] [Accepted: 08/26/2021] [Indexed: 12/15/2022] Open
Abstract
As part of our ongoing studies on the potential pathophysiological role of serine/threonine phosphatases (PP) in the mammalian heart, we have generated transgenic mice with cardiac muscle cell-specific overexpression of PP2Acα (PP2A) and PP5 (PP5). For further studies we crossbred PP2A and PP5 mice to obtain PP2AxPP5 double transgenic mice (PP2AxPP5, DT) and compared them with littermate wild-type mice (WT) serving as a control. The mortality of DT mice was greatly enhanced vs. other genotypes. Cardiac fibrosis was noted histologically and mRNA levels of collagen 1α, collagen 3α and fibronectin 1 were augmented in DT. DT and PP2A mice exhibited an increase in relative heart weight. The ejection fraction (EF) was reduced in PP2A and DT but while the EF of PP2A was nearly normalized after β-adrenergic stimulation by isoproterenol, it was almost unchanged in DT. Moreover, left atrial preparations from DT were less sensitive to isoproterenol treatment both under normoxic conditions and after hypoxia. In addition, levels of the hypertrophy markers atrial natriuretic peptide and B-type natriuretic peptide as well as the inflammation markers interleukin 6 and nuclear factor kappa B were increased in DT. PP2A enzyme activity was enhanced in PP2A vs. WT but similar to DT. This was accompanied by a reduced phosphorylation state of phospholamban at serine-16. Fittingly, the relaxation times in left atria from DT were prolonged. In summary, cardiac co-overexpression of PP2A and PP5 were detrimental to animal survival and cardiac function, and the mechanism may involve dephosphorylation of important regulatory proteins but also fibrosis and inflammation.
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Affiliation(s)
- Mara-Francine Dörner
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097 Halle, Germany; (M.-F.D.); (F.K.); (J.N.)
- Mibe GmbH Arzneimittel, D-06796 Brehna, Germany
| | - Peter Boknik
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Westfälische Wilhelms-Universität, D-48149 Münster, Germany;
| | - Friedrich Köpp
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097 Halle, Germany; (M.-F.D.); (F.K.); (J.N.)
| | - Igor B. Buchwalow
- Institute for Hematopathology, Fangdieckstr. 75a, D-22547 Hamburg, Germany;
| | - Joachim Neumann
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097 Halle, Germany; (M.-F.D.); (F.K.); (J.N.)
| | - Ulrich Gergs
- Institut für Pharmakologie und Toxikologie, Medizinische Fakultät, Martin-Luther-Universität Halle-Wittenberg, D-06097 Halle, Germany; (M.-F.D.); (F.K.); (J.N.)
- Correspondence: ; Tel.: +49-345-557-4093
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Saylik F, Akbulut T. The relationship between presystolic wave and subclinical left ventricular dysfunction assessed by myocardial performance ındex in patients with polycystic ovary syndrome. Echocardiography 2021; 38:1534-1542. [PMID: 34296457 DOI: 10.1111/echo.15166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Revised: 06/22/2021] [Accepted: 07/10/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Polycystic ovary syndrome (PCOS) patients have left ventricular dysfunction (LVD) in an earlier stage. Myocardial performance index (MPI) reflects both systolic and diastolic dysfunction. A presystolic wave (PSW) detected on late diastole has been found to be associated with LVD. AIMS We sought to determine whether there is an association between PSW and subclinical LVD assessed by MPI in PCOS patients. METHODS We prospectively enrolled 106 patients diagnosed with PCOS in this study. Patients were divided into two groups based on the presence of PSW. Both groups were compared with respect to demographic, clinical, and echocardiographic properties. Univariable and multivariable regression analyses were performed to detect predictors of subclinical LVD. RESULTS The study included 58 patients with PSW-positive (54.7%, mean age: 23) and 48 patients with PSW-negative (45.3%, mean age: 25). PSW-positive patients had a higher waist-to-hip ratio, fasting insulin, and HOMA-IR compared to PSW-negative patients. Higher MPI velocities and more frequent subclinical LVD were observed in PSW-positive group than in PSW-negatives (p < 0.001, p = 0.0031, respectively). PSW velocity was significantly correlated with MPI velocity (r:.404, p = 0.0016). The presence of PSW, HOMA-IR, and waist-to-hip ratio > 85 were predictors of subclinical LVD in univariate logistic regression analysis. Only the presence of PSW was an independent predictor of subclinical LVD in multivariable logistic regression analysis (OR:3.257, p = 0.028). CONCLUSION PSW prevalence was 54.7% in PCOS patients. PSW velocity was significantly correlated with MPI velocity. The presence of PSW was independently associated with subclinical LVD in PCOS women.
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Affiliation(s)
- Faysal Saylik
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
| | - Tayyar Akbulut
- Department of Cardiology, Van Education and Research Hospital, Van, Turkey
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Harbalıoğlu H, Kaypaklı O. Morning blood pressure surge is associated with the severity of stable coronary artery disease in hypertensive patients. Clin Exp Hypertens 2021; 43:334-340. [PMID: 33576694 DOI: 10.1080/10641963.2021.1883050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: We aimed to investigate the association between morning surge (MS) of blood pressure (BP) and SYNTAX score (SS) which gives information regarding the complexity and extent of coronary artery disease (CAD) in hypertensive patients. Methods: We included 187 hypertensive patients (134 males, 53 females; mean age: 62.5 ± 10.9 years) who underwent elective coronary angiography. Patients with the acute coronary syndrome and a history of coronary intervention were excluded from the study. The MBPS was calculated as the difference between the average BP during the 2 hours after awakening (four BP readings) and the lowest nighttime BP. The severity of coronary lesions was evaluated based on the SS assessed by coronary angiography. Patients were classified into two groups according to SS: low SS (SS ≤ 22) and intermediate-to-high SS (>22).Results: Patients in the intermediate-to-high SS group were found to be older, have higher uric acid levels, average daytime systolic BP (SBP), nighttime SBP, morning SBP, MS of BP and have higher rates of diabetes (DM) and female gender. There was no significant difference in terms of hypertensive treatment. In multivariate analysis, MS of BP (OR: 2.151, p: 0.005) and DM (OR: 0.014, p: 0.015) were independent parameters for predicting intermediate-to-high SS. The cutoff value of MS of BP obtained by ROC curve analysis was 18,5 mmHg for prediction of intermediate-high SS (sensitivity: 76.5%, specificity: 71.2%). The area under the curve was 0.762 (p < .001).Conclusion: MS of BP significantly correlates with the severity of coronary stenosis in hypertensive patients, suggesting that it could be a potential predictive marker of CAD.
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Affiliation(s)
- Hazar Harbalıoğlu
- Department of Cardiology, Duzce Ataturk State Hospital, Duzce, Turkey
| | - Onur Kaypaklı
- Department of Cardiology, Hatay Mustafa Kemal University, Hatay, Turkey
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Dunkley JC, Irion CI, Yousefi K, Shehadeh SA, Lambert G, John-Williams K, Webster KA, Goldberger JJ, Shehadeh LA. Carvedilol and exercise combination therapy improves systolic but not diastolic function and reduces plasma osteopontin in Col4a3-/- Alport mice. Am J Physiol Heart Circ Physiol 2021; 320:H1862-H1872. [PMID: 33769915 PMCID: PMC8163658 DOI: 10.1152/ajpheart.00535.2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 02/16/2021] [Accepted: 03/19/2021] [Indexed: 11/22/2022]
Abstract
There are currently no Food and Drug Administration-approved treatments for heart failure with preserved ejection fraction (HFpEF). Here we compared the effects of exercise with and without α/β-adrenergic blockade with carvedilol in Col4a3-/- Alport mice, a model of the phenogroup 3 subclass of HFpEF with underlying renal dysfunction. Alport mice were assigned to the following groups: no treatment control (n = 29), carvedilol (n = 11), voluntary exercise (n = 9), and combination carvedilol and exercise (n = 8). Cardiac function was assessed by echocardiography after 4-wk treatments. Running activity of Alport mice was similar to wild types at 1 mo of age but markedly reduced at 2 mo (1.3 ± 0.40 vs. 4.5 ± 1.02 km/day, P < 0.05). There was a nonsignificant trend for increased running activity at 2 mo by carvedilol in the combination treatment group. Combination treatments conferred increased body weight of Col4a3-/- mice (22.0 ± 1.18 vs. 17.8 ± 0.29 g in untreated mice, P < 0.01), suggesting improved physiology, and heart rates declined by similar increments in all carvedilol-treatment groups. The combination treatment improved systolic parameters; stroke volume (30.5 ± 1.99 vs. 17.8 ± 0.77 μL, P < 0.0001) as well as ejection fraction and global longitudinal strain compared with controls. Myocardial performance index was normalized by all interventions (P < 0.0001). Elevated osteopontin plasma levels in control Alport mice were significantly lowered only by combination treatment, and renal function of the Alport group assessed by urine albumin creatinine ratio was significantly improved by all treatments. The results support synergistic roles for exercise and carvedilol to augment cardiac systolic function of Alport mice with moderately improved renal functions but no change in diastole.NEW & NOTEWORTHY In an Alport mouse model of heart failure with preserved ejection fraction (HFpEF), exercise and carvedilol synergistically improved systolic function without affecting diastole. Carvedilol alone or in combination with exercise also improved kidney function. Molecular analyses indicate that the observed improvements in cardiorenal functions were mediated at least in part by effects on serum osteopontin and related inflammatory cytokine cascades. The work presents new potential therapeutic targets and approaches for HFpEF.
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MESH Headings
- Adrenergic beta-Antagonists/pharmacology
- Animals
- Autoantigens/genetics
- Biomarkers/blood
- Carvedilol/pharmacology
- Collagen Type IV/deficiency
- Collagen Type IV/genetics
- Combined Modality Therapy
- Diastole
- Disease Models, Animal
- Down-Regulation
- Exercise Therapy
- Heart Failure/blood
- Heart Failure/genetics
- Heart Failure/physiopathology
- Heart Failure/therapy
- Mice, 129 Strain
- Mice, Knockout
- Nephritis, Hereditary/blood
- Nephritis, Hereditary/genetics
- Nephritis, Hereditary/physiopathology
- Nephritis, Hereditary/therapy
- Osteopontin/blood
- Recovery of Function
- Systole
- Ventricular Dysfunction, Left/blood
- Ventricular Dysfunction, Left/genetics
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/therapy
- Ventricular Function, Left/drug effects
- Mice
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Affiliation(s)
- Julian C Dunkley
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Camila I Irion
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Keyvan Yousefi
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Department of Molecular and Cellular Pharmacology, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Serene A Shehadeh
- Department of Surgery, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Guerline Lambert
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Krista John-Williams
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Keith A Webster
- Vascular Biology Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Jeffrey J Goldberger
- Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Lina A Shehadeh
- Interdisciplinary Stem Cell Institute, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Division of Cardiology, Department of Medicine, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
- Peggy and Harold Katz Family Drug Discovery Center, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
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Chen S, Zhuang Z, Chen Q, Du X, Li W, Tan X. Evaluation of right myocardial performance index of in vitro fertilization fetuses and spontaneous pregnancy fetuses: a cross-sectional study. Cardiovasc Ultrasound 2021; 19:13. [PMID: 33514379 PMCID: PMC7847019 DOI: 10.1186/s12947-021-00242-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 01/20/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Whether the in vitro fertilization (IVF) has an effect on the cardiac function of the fetus is very important to evaluate the safety of the technique. The aim of this paper is to establish normal reference range for the fetal right myocardial performance index (RMPI), and compare the reference range between IVF fetuses and spontaneous pregnancy (SP) fetuses by automatic measurement of the RMPI. METHODS Three hundred seventy-one spontaneous singleton pregnancies (the control group) and 39 singleton pregnancies conceived by IVF (the experimental group) were enrolled into the current study. An automatic measurement system was used to acquire the RMPI. The cardiac function of the two groups was compared by t-test. RESULTS There was no significant difference in normal reference range of RMPI between IVF fetuses and SP fetuses (RMPI 0.42 ± 0.05 vs 0.43 ± 0.05). No strong correlation was also noted between RMPI with gestational age and heart rate. CONCLUSIONS Normal reference ranges of RMPI of IVF fetuses and SP fetuses were established, and no significant difference between IVF fetuses and SP fetuses in RMPI was found. Thus, these findings may suggest that IVF has little impact on cardiac function of the fetus.
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Affiliation(s)
- Shaoqi Chen
- Department of Ultrasound, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- The Clinical Research Center of the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Zemin Zhuang
- Department of Ultrasound, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- The Clinical Research Center of the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Qingzi Chen
- Department of Ultrasound, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- The Clinical Research Center of the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Xiya Du
- Department of Ultrasound, First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
- The Clinical Research Center of the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China
| | - Weiping Li
- The Clinical Research Center of the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
| | - Xuerui Tan
- The Clinical Research Center of the First Affiliated Hospital of Shantou University Medical College, Shantou, 515041, China.
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Kidney function and the prognostic value of myocardial performance index. Int J Cardiovasc Imaging 2021; 37:1637-1647. [PMID: 33475871 DOI: 10.1007/s10554-020-02149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
A decreased glomerular filtration rate (GFR) is a risk factor for cardiovascular disease even after adjustment for conventional risk factors. The myocardial performance index (MPI) is defined as (isovolumetric relaxation time (IVRT) + isovolumetric contraction time (IVCT))/ejection time (ET). It has been shown to be an independent predictor of cardiovascular events. We hypothesized the MPI could prove valuable for assessing cardiac risk in subjects of the general population with decreased estimated GFR (eGFR). MPI was measured in 1915 subjects from a large general population prospective cohort study using color tissue Doppler imaging (TDI) M-mode through the mitral valve. We compared the prognostic capabilities of the MPI between subjects with eGFR ≥ 75 mL/min/1.73 m2 and subjects with eGFR < 75 mL/min/1.73 m2 using multivariable adjusted Cox regression models. The composite endpoint was heart failure, myocardial infarction or cardiovascular death. Mean age was 58 years (SD 16.2), 58% were women, 42% had hypertension and 8.3% diabetes. During a median follow-up time of 12.4 years [IQR 10.6-12.7 years] 269 participants reached the combined endpoint. eGFR modified the prognostic capability of MPI (p-value for interaction < 0.001): After multivariable adjustment, MPI remained an independent predictor of the composite endpoint only in participants with eGFR < 75 mL/min/1.73 m2: HR 1.18 (95% CI 1.02-1.38), p = 0.03, vs. in subjects with eGFR ≥ 75 mL/min/1.73 m2: HR 1.14 (95% CI 0.94-1.39), p = 0.17. These results suggest the MPI could be particularly valuable for identifying elevated cardiac risk in individuals from the general population with decreased eGFR.
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Perez JET, Ortiz-Urbina J, Heredia CP, Pham TT, Madala S, Hartley CJ, Entman ML, Taffet GE, Reddy AK. Aortic acceleration as a noninvasive index of left ventricular contractility in the mouse. Sci Rep 2021; 11:536. [PMID: 33436716 PMCID: PMC7804023 DOI: 10.1038/s41598-020-79866-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 12/11/2020] [Indexed: 11/09/2022] Open
Abstract
The maximum value of the first derivative of the invasively measured left ventricular (LV) pressure (+ dP/dtmax or P') is often used to quantify LV contractility, which in mice is limited to a single terminal study. Thus, determination of P' in mouse longitudinal/serial studies requires a group of mice at each desired time point resulting in "pseudo" serial measurements. Alternatively, a noninvasive surrogate for P' will allow for repeated measurements on the same group of mice, thereby minimizing physiological variability and requiring fewer animals. In this study we evaluated aortic acceleration and other parameters of aortic flow velocity as noninvasive indices of LV contractility in mice. We simultaneously measured LV pressure invasively with an intravascular pressure catheter and aortic flow velocity noninvasively with a pulsed Doppler probe in mice, at baseline and after the administration of the positive inotrope, dobutamine. Regression analysis of P' versus peak aortic velocity (vp), peak velocity squared/rise time (vp2/T), peak (+ dvp/dt or v'p) and mean (+ dvm/dt or v'm) aortic acceleration showed a high degree of association (P' versus: vp, r2 = 0.77; vp2/T, r2 = 0.86; v'p, r2 = 0.80; and v'm, r2 = 0.89). The results suggest that mean or peak aortic acceleration or the other parameters may be used as a noninvasive index of LV contractility.
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Affiliation(s)
- Jorge Enrique Tovar Perez
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
- Texas A&M University, Houston, TX, USA
| | - Jesus Ortiz-Urbina
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
| | - Celia Pena Heredia
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - Thuy T Pham
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
| | - Sridhar Madala
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
- Indus Instruments, Webster, TX, USA
| | - Craig J Hartley
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
| | - Mark L Entman
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
| | - George E Taffet
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA
- Houston Methodist Hospital, Houston, TX, USA
| | - Anilkumar K Reddy
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, MS:BCM285, Houston, TX, 77030, USA.
- Indus Instruments, Webster, TX, USA.
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Ardahanlı İ, Celik M. Can myocardial performance index predict early cardiac risks in erectile dysfunction? Aging Male 2020; 23:1355-1361. [PMID: 32429725 DOI: 10.1080/13685538.2020.1768367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Myocardial performance index (MPI) is an easy-to-apply and non-invasive method that shows both systolic and diastolic functions of the heart. In this study, it was aimed to evaluate the relationship between erectile dysfunction (ED) and MPI. Methods: The study included 45 male patients admitted to the urology outpatient clinic for ED and 48 healthy male volunteers. Echocardiographic evaluation of all participants was performed. Isovolumetric contraction time (IVCT), isovolumetric relaxation time (IVRT) and ejection time (ET) were measured. MPI was calculated using the IVCT + IVRT/ET formula. Results: The average age of the study population was 50 ± 5.3. Early diastolic mitral inflow (E)/late diastolic mitral inflow (A) ratio was significantly lower in the ED group (p ≤ 0.05). In the TDI evaluation between the groups, while early diastolic mitral annular velocity (Em) was significantly higher in the ED group, there was no significant difference in late diastolic mitral annular velocity (Am) and systolic peak velocities (Sm) (p < 0.01 and p = 0.417 and p = 0.092, respectively). While IVRT was significantly lower in the ED group (p < 0.05), there was no significant difference in IVCT and ET (p = 311 and p = 0.261, respectively). MPI was statistically significantly higher in the ED group (p < 0.05). Conclusion: ED has been found to affect MPI. This parameter, which is easily and non-invasively measured, can be used to predict the risk of CVDs in ED.
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Affiliation(s)
- İsa Ardahanlı
- Department of Cardiology, Ministry of Health of Turkey, Bilecik, Turkey
| | - Mehmet Celik
- Department of Endocrinology and Metabolism, Trakya University, Edirne, Turkey
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Subtle cardiac dysfunction in nephropathic cystinosis: insight from tissue Doppler imaging and 2D speckle tracking echocardiography. Pediatr Nephrol 2020; 35:2307-2317. [PMID: 32666370 DOI: 10.1007/s00467-020-04657-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 05/28/2020] [Accepted: 06/09/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Nephropathic cystinosis is a rare autosomal recessive lysosomal storage disorder that initially affects the kidney progressing to multi-organ failure due to accumulation of cystine in all tissue compartments. OBJECTIVE The main objective of this study is the evaluation of cardiac function in cystinosis patients using non-conventional echocardiographic modalities like pulsed wave tissue Doppler imaging (PW-TDI) and 2D speckle tracking echocardiography (2D-STE). METHODS This is a case control study conducted on fifteen patients with cystinosis and 15 normal controls. Echocardiography was done for all participants and PW-TDI was performed for measurement of S', E', A' velocities and myocardial performance index (MPI) at basal parts of septal, left ventricle (LV), and right ventricle (RV) free walls. 2D-STE was done for evaluation of global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) of LV. Mitral E and A velocities and tricuspid annular plane systolic excursion (TAPSE) were also measured. RESULTS The GLS, GRS, and S' velocity at basal septum and LV lateral wall were significantly lower in patients denoting LV systolic dysfunction (p = 0.005, p < 0.0001, p = 0.001, p = 0.006, respectively), while E/E' were significantly higher in patients group denoting LV diastolic dysfunction (p < 0.001). For RV function, TAPSE, S', and E' velocity were significantly lower in patients group (p 0.013, p < 0.01, p = 0.05, respectively) indicating RV systolic and diastolic dysfunction. The TDI-derived MPI for both LV and RV were significantly higher in patients group (p < 0.0001, p < 0.01, respectively) indicating both ventricular systolic and diastolic dysfunction. For prediction of cardiac dysfunction among patients, the receiver operating characteristic (ROC) curve showed that GRS ≤ 29% had sensitivity 93.3% and specificity 100%, GLS > - 20.1% had sensitivity 66.7% and specificity 93.3%, LV-E/E' >7.87 had sensitivity 73.3% and specificity 93.3%, and MPI-LV > 0.36 had sensitivity 100% and specificity 93.3% while MPI-RV > 0.29 had sensitivity 80% and specificity 93.3% and TAPSE ≤ 19 mm had sensitivity 80% and specificity 73.3%. CONCLUSIONS Patients with cystinosis have significant both left and right ventricular dysfunction, which can be better evaluated using the non-conventional echocardiographic modalities like TDI and 2D-STE for early detection of subtle cardiac dysfunction.
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Effect of septoplasty on left ventricular myocardial performance in patients with nasal septum deviation. Braz J Otorhinolaryngol 2020; 88:589-593. [PMID: 33067133 PMCID: PMC9422691 DOI: 10.1016/j.bjorl.2020.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/10/2020] [Accepted: 08/22/2020] [Indexed: 11/23/2022] Open
Abstract
Introduction Nasal septum deviation is the leading cause of upper airway obstruction. Chronic upper airway obstruction may cause myocardial injury due to chronic hypoxia. Effects of septoplasty on left venticular diastolic and sistolic functions are not well known. The myocardial performance index is an easy-to-apply and reliable parameter that reflects systolic and diastolic cardiac functions. Objective The present study aimed to investigate the effect of nasal septoplasty on the myocardial performance index in patients with nasal septal deviation. Methods This prospective study consisted of 50 consecutive patients who underwent septoplasty due to symptomatic prominent C- or S-shaped nasal septal deviation. Transthoracic echocardiogarphy was performed in all patients before and 3 months after septoplasty. Calculated myocardial performance indices were compared. Results Significantly higher left ventricular myocardial performance index (0.52 ± 0.06 vs. 0.41 ± 0.04, p < 0.001), longer isovolumic relaxation time (95.0 ± 12.5 vs. 78.0 ± 8.6 ms, p < 0.001), longer isovolumic contraction time (45.5 ± 7.8 vs. 39.5 ± 8.6 ms, p < 0.001), longer deceleration time (184.3 ± 32.5 vs. 163.6 ± 45.4 ms, p = 0.004), higher ratio of transmitral early to late peak velocities (E/A) (1.42 ± 0.4 vs. 1.16 ± 0.2, p = 0.006) and shorter ejection time (270.1 ± 18.3 vs. 286.5 ± 25.8 ms, p < 0.001) were observed before septoplasty when compared to values obtained 3 months after septoplasty. Left ventricular systolic ejection fraction was similar before and after septoplasty (63.8±2.8% vs. 64.6±3.2%, p = 0.224). Conclusion Septoplasty surgery not only reduces nasal blockage symptoms in nasal septal deviation patients but also may improve left ventricular performance. Thus, treatment of nasal septal deviation without delay is suggested to prevent possible future cardiovascular events.
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Zia J, Kimball J, Rozell C, Inan OT. Harnessing the Manifold Structure of Cardiomechanical Signals for Physiological Monitoring During Hemorrhage. IEEE Trans Biomed Eng 2020; 68:1759-1767. [PMID: 32749958 DOI: 10.1109/tbme.2020.3014040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Local oscillation of the chest wall in response to events during the cardiac cycle may be captured using a sensing modality called seismocardiography (SCG), which is commonly used to infer cardiac time intervals (CTIs) such as the pre-ejection period (PEP). An important factor impeding the ubiquitous application of SCG for cardiac monitoring is that morphological variability of the signals makes consistent inference of CTIs a difficult task in the time-domain. The goal of this work is therefore to enable SCG-based physiological monitoring during trauma-induced hemorrhage using signal dynamics rather than morphological features. METHODS We introduce and explore the observation that SCG signals follow a consistent low-dimensional manifold structure during periods of changing PEP induced in a porcine model of trauma injury. Furthermore, we show that the distance traveled along this manifold correlates strongly to changes in PEP ( ∆PEP). RESULTS ∆PEP estimation during hemorrhage was achieved with a median R2 of 92.5% using a rapid manifold approximation method, comparable to an ISOMAP reference standard, which achieved an R2 of 95.3%. CONCLUSION Rapidly approximating the manifold structure of SCG signals allows for physiological inference abstracted from the time-domain, laying the groundwork for robust, morphology-independent processing methods. SIGNIFICANCE Ultimately, this work represents an important advancement in SCG processing, enabling future clinical tools for trauma injury management.
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Andreou D, Saetre P, Fors BM, Nilsson BM, Kullberg J, Jönsson EG, Ebeling Barbier C, Agartz I. Cardiac left ventricular ejection fraction in men and women with schizophrenia on long-term antipsychotic treatment. Schizophr Res 2020; 218:226-232. [PMID: 31959509 DOI: 10.1016/j.schres.2019.12.042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/01/2022]
Abstract
Patients with schizophrenia exhibit a higher cardiovascular mortality compared to the general population which has been attributed to life-style factors, genetic susceptibility and antipsychotic medication. Recent echocardiographic studies have pointed to an association between clozapine treatment and reduced left ventricular ejection fraction (LVEF), a measure that has been inversely associated with adverse outcomes including all-cause mortality. Cardiovascular magnetic resonance (CMR) is considered the reference method for LVEF measurement. The aim of the present study was to investigate the LVEF in patients with schizophrenia on long-term treatment with antipsychotics and healthy controls. Twenty-nine adult patients with schizophrenia on long-term medication with antipsychotics and 27 age-, sex- and body mass index-matched healthy controls (mean ages 44 and 45 years, respectively) were recruited from outpatient psychiatric clinics in Uppsala, Sweden. The participants were interviewed and underwent physical examination, biochemical analyses, electrocardiogram and CMR. Men with schizophrenia on long-term antipsychotic treatment showed significantly lower LVEF than controls (p = 0.0076), whereas no such difference was evident among women (p = 0.44). Specifically, clozapine-treated male patients had 10.6% lower LVEF than male controls (p = 0.0064), whereas the LVEF was 5.5% below that of controls among male patients treated with non-clozapine antipsychotics (p = 0.047). Among medicated men with schizophrenia, we found significantly lower LVEF compared to healthy individuals, suggesting the need of routine cardiac monitoring in this patient group. This is the first study showing a significant negative association between treatment with non-clozapine antipsychotics and LVEF.
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Affiliation(s)
- Dimitrios Andreou
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; 1st Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece; Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - Peter Saetre
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | | | | | - Joel Kullberg
- Department of Surgical Sciences, Section of Radiology, Uppsala University, Uppsala, Sweden
| | - Erik Gunnar Jönsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - Ingrid Agartz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden; Norwegian Centre for Mental Disorders Research (NORMENT), Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
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A novel index equivalent to the myocardial performance index for right ventricular functional assessment in children and adolescent patients. Sci Rep 2019; 9:19975. [PMID: 31882794 PMCID: PMC6934714 DOI: 10.1038/s41598-019-56564-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 12/13/2019] [Indexed: 11/19/2022] Open
Abstract
The aims of the present study were to develop and check the utility and feasibility of a novel right ventricular (RV) functional index (RV angular velocity; RVω, s−1) derived from the angular velocity in harmonic oscillator kinematics obtained from the RV pressure waveform. We hypothesized that RVω reflects the myocardial performance index (MPI), which represents global RV function. A total of 132 consecutive patients, ranging in age from 3 months to 34 years with various cardiac diseases were included in this prospective study. RVω was defined as the difference between the peak derivative of pressure (dP/dt_max − dP/dt_min) divided by the difference between the maximum and minimum pressure (Pmax – Pmin). RVω showed significant negative correlations with the pulsed-wave Doppler-derived myocardial performance index (PWD-MPI) and the tissue Doppler imaging-derived MPI (TDI-MPI) (r = −0.52 and −0.51, respectively; both p < 0.0001). RVω also showed significant positive correlations with RV fractional area change (RVFAC) and RV ejection fraction (RVEF) (r = 0.41 and 0.39, respectively; both p < 0.0001), as well as a significant negative correlation with tricuspid E/e′ (r = −0.19, p = 0.0283). The clinical feasibility and utility of RVω for assessing global RV performance, incorporating both systolic and diastolic function, were demonstrated.
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Samyn MM, Yan K, Masterson C, Goot BH, Saudek D, Lavoie J, Kinney A, Krolikowski M, Hor K, Cohen S. Echocardiography vs cardiac magnetic resonance imaging assessment of the systemic right ventricle for patients with d-transposition of the great arteries status post atrial switch. CONGENIT HEART DIS 2019; 14:1138-1148. [PMID: 31816182 DOI: 10.1111/chd.12861] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 10/22/2019] [Accepted: 10/25/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Patients with Dextro-transposition of the great arteries status post atrial switch (dTGA s/p atrial switch) are "at-risk" for systemic right ventricular (RV) dysfunction. Due to complex RV geometry, echocardiography (Echo) does not allow accurate determination of ejection fraction (EF), but cardiac magnetic resonance imaging (CMR) allows quantitative right ventricular assessment. Measures of ventricular deformation may be precursors to global ventricular dysfunction. The primary aim of this study was to characterize imaging and clinical findings for adult patients with dTGA s/p atrial switch. DESIGN This was a retrospective cohort study of patients with dTGA s/p atrial switch operation (February 1966 to August 1988) with CMR performed at Children's Hospital of Wisconsin (from September 2005 to May 2015). Eligible patients had clinic visit, Echo, and exercise stress test within 1 year of CMR. RESULTS This study enrolled twenty-seven patients (16 males, 11 females) with dTGA s/p atrial switch (18 with Mustard operation and 9 with Senning operation; median age 30 years; 74% New York Heart Association class 1 and 26% class 2). Seventy-four percentage had normal RV systolic function (RV EF >45% by CMR). No correlation was observed between Echo strain data and clinical status (EF, exercise endurance, VO2 max, or New York Heart Association class). Cardiac magnetic resonance imaging RV global circumferential strain GCS and RV EF had moderate negative correlation (r = -0.65, P < .001). Global circumferential strain was significantly different for those with RV EF above and below 45%, while global peak longitudinal strain (GLS) was not. Patients had reduced CMR myocardial strain values compared with healthy controls. CONCLUSIONS Reduced RV CMR GCS (for those with RV EF <45%) suggests that CMR evaluation may enhance early detection of detrimental changes in the systemic RV myocardium.
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Affiliation(s)
- Margaret M Samyn
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Ke Yan
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Conor Masterson
- Department of Radiology, Aurora St. Luke's Medical Center, Milwaukee, WI, USA
| | - Benjamin H Goot
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - David Saudek
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Julie Lavoie
- Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Aaron Kinney
- Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
| | - Mary Krolikowski
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kan Hor
- Department of Clinical Pediatrics, Ohio State University College of Medicine, Columbus, OH, USA.,Heart Center, Nationwide Children's Hospital, Columbus, OH, USA
| | - Scott Cohen
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA.,Herma Heart Institute, Children's Hospital of Wisconsin, Milwaukee, WI, USA
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Pérez JM, Alessi C, Grzech-Wojciechowska M. Diagnostic methods for the canine idiopathic dilated cardiomyopathy: A narrative evidence-based rapid review. Res Vet Sci 2019; 128:205-216. [PMID: 31821959 DOI: 10.1016/j.rvsc.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 09/19/2019] [Accepted: 12/01/2019] [Indexed: 11/24/2022]
Abstract
Idiopathic dilated cardiomyopathy (DCM) is an important etiology of mortality and morbidity in dogs and its diagnosis relies on systolic dysfunction, chambers dilation, electrical instability and congestion. During the last decades veterinary cardiologists have been joining efforts to obtain diagnostic resources to correctly identify canine DCM in the preclinical stage. Unfortunately, most diagnostic resources have been used with the support of research with weak evidence, without high quality methodologies such as systematic reviews or meta-analysis. Therefore, the support of evidence-based medicine is tailored by empiricism and diagnostic criteria lose'out the ability to properly classify dogs suffering DCM. The presentation of the evidence in medicine is established by multiple sources and the most reliable source has been the presentation of evidence-based medicine from systematic reviews and meta-analysis. Rapid reviews can be interpreted as a pragmatic approach to systematic reviews and although a rapid review follows most of the critical steps of a systematic review to provide timely evidence, some components of a systematic review process are either simplified or omitted. The objective of this narrative evidence-based rapid review is twofold. First: To recognize and to stratify the level of evidence offered by rigorous selected papers about the diagnosis of DCM. Second: To classify the degree of clinical recommendation of the diagnostic resources available.
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Affiliation(s)
- Jeff M Pérez
- Advanced Veterinary Centre- المستوصف البيطرى المتقدمة, Doha Expy, Amr Bin Alass St. Madynat Khalefa South, PO.BOX: 1234, Doha, Qatar.
| | - Chiara Alessi
- Faculty of Agricultural Science, Universidad de Caldas, PO.BOX: 170004, Street 65, 26-10 Manizales, Colombia
| | - Magdalena Grzech-Wojciechowska
- Wydział Medycyny Weterynaryjnej, Uniwersytet Warmiński-Mazurszki w Olsztynie ul, Michała Oczapowskiego, PO.BOX. 2 10-719, Olsztyn, Poland; Cor-Vet Kardiologia Weterynaryjna, PO.BOX 76-200, Słupsk, Poland
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Abdelmohsen G, Mohamed H, Mohsen M, Abdelaziz O, Ahmed D, Abdelsalam M, Dohain A. Evaluation of cardiac function in pediatric patients with mild to moderate bronchial asthma in the era of cardiac strain imaging. Pediatr Pulmonol 2019; 54:1905-1913. [PMID: 31424175 DOI: 10.1002/ppul.24485] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Accepted: 08/05/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Bronchial asthma is a common chronic inflammatory airway disease, which may be associated with pulmonary hypertension and cardiac dysfunction. The aim of this study was to evaluate the ability of 2D-speckle tracking echocardiography (2D-STE) and tissue doppler imaging (TDI) to detect subtle cardiac dysfunction in pediatric patients with mild to moderate bronchial asthma. METHODOLOGY The study included 30 children with mild to moderate bronchial asthma and 27 age-matched healthy controls. Both groups underwent pulmonary function tests, TDI and 2D-STE. Myocardial performance index (MPI), S', E', A' velocities, global strain of left ventricle (LV), right ventricle (RV), and right atrium (RA) were measured. RESULTS RV diastolic function was impaired in the patient group, as the tricuspid E' velocity was significantly lower in the patients when compared with the controls (16 [14-17] vs 16 [17-19] cm/s, P = .044), while the RV-MPI was significantly higher in patients when compared to controls (0.30 [0.27-0.36] vs 0.30 [0.30-0.30], P = .001). The global RV longitudinal strain, RA strain, and LV strain did not show significant differences between the test and the control groups. RV systolic parameters and LV systolic and diastolic parameters did not differ significantly between the two groups. CONCLUSION Pediatric patients with mild to moderate bronchial asthma may have early RV diastolic dysfunction with preserved other cardiac functions.
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Affiliation(s)
- Gaser Abdelmohsen
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Hossam Mohamed
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Mona Mohsen
- Pediatric Pulmonology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Osama Abdelaziz
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | - Doaa Ahmed
- Pediatric Pulmonology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
| | | | - Ahmed Dohain
- Pediatric Cardiology Division, Department of Pediatrics, Cairo University, Cairo, Egypt
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Abstract
Heart disease is the most important cause of non-cancer death for patients with cancer. Addressing the cardiotoxic effects of anticancer therapies to prevent increased cardiovascular risk in this population is crucial. Echocardiography plays a big role in monitoring cardiotoxicity induced by cancer treatment. Many emerging modalities, including tissue Doppler imaging measures, speckle tracking imaging, and three-dimensional echocardiography, may provide improved sensitivity and specificity to detect cancer treatment-induced cardiotoxicity. Additional research is critical to define the value of both conventional and novel indices in guiding the clinical management of cancer treatment-induced cardiotoxicity.
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Affiliation(s)
- Yu Kang
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - Marielle Scherrer-Crosbie
- Division of Cardiovascular Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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Tao K, Hara Y, Ishihara Y, Ohshima Y. Cesarean section predominantly affects right ventricular diastolic function during the early transitional period. Pediatr Neonatol 2019; 60:523-529. [PMID: 30713044 DOI: 10.1016/j.pedneo.2019.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/10/2018] [Accepted: 01/15/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Although the mode of delivery is well known to affect pulmonary function, the effects of a cesarean delivery on postnatal changes in cardiac mechanics have not been clearly defined. METHODS To evaluate whether delivery mode influences cardiac function in the early transitional period, 42 infants delivered by cesarean section (CS) and 110 by vaginal delivery (VD) were enrolled, and they underwent serial echocardiography at 0, 1, 2, and 5 days of age. Longitudinal changes in ejection fraction (EF), fractional area change (FAC), mitral annular plane systolic excursion (MAPSE), tricuspid annular plane systolic excursion (TAPSE), Tei index, ratio of peak early diastolic flow velocity (E) to peak early diastolic annular velocity (e') (E/e'), and deceleration time (DcT) were compared between the two groups. RESULTS FAC and DcT of both ventricles increased during the first week, whereas Tei index of each chamber decreased irrespective of delivery mode. E/e's of both ventricles were significantly higher and MAPSE was significantly lower in the CS than VD group throughout the observation period. After adjustment for the effects of birth weight, gestational age, and oxygen administration by multivariate analysis, right ventricular E/e', which reflects diastolic function of the right ventricle, was most affected by delivery mode. CONCLUSION CS affected diastolic function of the right ventricle in the 2nd day after giving birth and did not persist. Delayed adaptation of the neonatal myocardium and/or persistence of pulmonary hypertension might explain the hemodynamic changes in neonates born by CS.
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Affiliation(s)
- Katsuo Tao
- Department of Pediatrics, Fukui Aiiku Hospital, Fukui, Japan; Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
| | - Yoshikazu Hara
- Department of Pediatrics, Sugita Genpaku Memorial Obama Municipal Hospital, Fukui, Japan.
| | | | - Yusei Ohshima
- Department of Pediatrics, Faculty of Medical Sciences, University of Fukui, Fukui, Japan.
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50
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Graupner O, Enzensberger C, Axt-Fliedner R. New Aspects in the Diagnosis and Therapy of Fetal Hypoplastic Left Heart Syndrome. Geburtshilfe Frauenheilkd 2019; 79:863-872. [PMID: 31423021 PMCID: PMC6690741 DOI: 10.1055/a-0828-7968] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 12/29/2018] [Accepted: 12/30/2018] [Indexed: 12/26/2022] Open
Abstract
Fetal hypoplastic left heart syndrome (HLHS) is a severe congenital heart disease with a lethal prognosis without postnatal therapeutic intervention or surgery. The aim of this article is to give a brief overview of new findings in the field of prenatal diagnosis and the therapy of HLHS. As cardiac output in HLHS children depends on the right ventricle (RV), prenatal assessment of fetal RV function is of interest to predict poor functional RV status before the RV becomes the systemic ventricle. Prenatal cardiac interventions such as fetal aortic valvuloplasty and non-invasive procedures such as maternal hyperoxygenation seem to be promising treatment options but will need to be evaluated with regard to long-term outcomes. Novel approaches such as stem cell therapy or neuroprotection provide important clues about the complexity of the disease. New aspects in diagnostics and therapy of HLHS show the potential of a targeted prenatal treatment planning. This could be used to optimize parental counseling as well as pre- and postnatal management of affected children.
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Affiliation(s)
- Oliver Graupner
- Department of Obstetrics and Gynecology, University Hospital rechts der Isar, Technical University of Munich, Munich, Germany
| | - Christian Enzensberger
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
| | - Roland Axt-Fliedner
- Department of Obstetrics and Gynecology, Division of Prenatal Medicine, University Hospital UKGM, Justus-Liebig University, Giessen, Germany
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