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Agabiti-Rosei E, Muiesan ML, Salvetti M. Review: New approaches to the assessment of left ventricular hypertrophy. Ther Adv Cardiovasc Dis 2016; 1:119-28. [DOI: 10.1177/1753944707086350] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
In hypertension, Left ventricular hypertrophy is initially a useful compensatory process that represents an adaptation to increased ventricular wall stress; however, it is also the first step toward the development of overt clinical disease. For this reason most international guidelines recommend the assessment of cardiac target organ damage in hypertensive patients for cardiovascular risk stratification. It is therefore of great importance to keep in mind the strengths and weakness of the different available methods for LVH assessment. Several methods are currently available for the assessment of LVH; however the various techniques differ in cost, availability, sensitivity and specificity. Due to its wide availability and its low cost, eLectrocardiography should be part of all routine assessment of subjects with high blood pressure; however, despite its good specificity, the sensitivity for LVH detection is low. Several other methods have been proposed for LVH detection. Cardiac magnetic resonance imaging allows 3D reconstruction of the heart with high spatial resolution; however its main limitation is represented by the relatively low availability and by its costs. Echocardiography certainly represents a valuable method for the detection of LVH in hypertensive patients, due to its wide availability and its relatively low cost. The main limitations of the technique are represented by the lower spatial resolution and reproducibility in comparison with magnetic resonance. The development of new matrix-array transducers and new software for 3D reconstruction with echocardiography make this approach particularly promising for the future; in the meantime, standard echocardiography, widely available and with low cost, will probably remain the most used tool for the evaluation of left ventricular structure and function in hypertension.
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Affiliation(s)
- Enrico Agabiti-Rosei
- Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia,
| | - Maria Lorenza Muiesan
- Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia
| | - Massimo Salvetti
- Department of Medical and Surgical Sciences, University of Brescia, c/o 2a Medicina Spedali Civili di Brescia, Piazzale Spedali Civili 1, 25123 Brescia
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Graham-Brown MPM, March DS, Churchward DR, Young HML, Dungey M, Lloyd S, Brunskill NJ, Smith AC, McCann GP, Burton JO. Design and methods of CYCLE-HD: improving cardiovascular health in patients with end stage renal disease using a structured programme of exercise: a randomised control trial. BMC Nephrol 2016; 17:69. [PMID: 27391774 PMCID: PMC4938939 DOI: 10.1186/s12882-016-0294-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 06/14/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND There is emerging evidence that exercise training could positively impact several of the cardiovascular risk factors associated with sudden cardiac death amongst patients on haemodialysis. The primary aim of this study is to evaluate the effect of an intradialytic exercise programme on left ventricular mass. METHOD AND DESIGN Prospective, randomised cluster open-label blinded endpoint clinical trial in 130 patients with end stage renal disease on haemodialysis. Patients will be randomised 1:1 to either 1) minimum of 30 min continuous cycling thrice weekly during dialysis or 2) standard care. The primary outcome is change in left ventricular mass at 6 months, assessed by cardiac MRI (CMR). In order to detect a difference in LV mass of 15 g between groups at 80 % power, a sample size of 65 patients per group is required. Secondary outcome measures include abnormalities of cardiac rhythm, left ventricular volumes and ejection fraction, physical function measures, anthropometric measures, quality of life and markers of inflammation, with interim assessment for some measures at 3 months. DISCUSSION This study will test the hypothesis that an intradialytic programme of exercise leads to a regression in left ventricular mass, an important non-traditional cardiovascular risk factor in end stage renal disease. For the first time this will be assessed using CMR. We will also evaluate the efficacy, feasibility and safety of an intradialytic exercise programme using a number of secondary end-points. We anticipate that a positive outcome will lead to both an increased patient uptake into established intradialytic programmes and the development of new programmes nationally and internationally. TRIAL REGISTRATION NUMBER ISRCTN11299707 (registration date 5(th) March 2015).
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Affiliation(s)
- M P M Graham-Brown
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK.
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK.
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| | - D S March
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - D R Churchward
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - H M L Young
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - M Dungey
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - S Lloyd
- Robertson Centre for Biostatistics University of Glasgow, Glasgow, UK
| | - N J Brunskill
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - A C Smith
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
| | - G P McCann
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
| | - J O Burton
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- Department of Infection Immunity and Inflammation, School of Medicine and Biological Sciences, University of Leicester, Leicester, LE1 9HN, UK
- Department of Cardiovascular Sciences, University of Leicester and NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital Leicester, Leicester, UK
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Abstract
Dilated cardiomyopathy (DCM), characterized by chamber dilatation and myocardial systolic and diastolic dysfunction, is one of the most common heart diseases in dogs. The clinical diagnosis is based on findings on echocardiographic and Doppler examinations, with the active exclusion of other acquired or congenital heart diseases. However, the echocardiographic criteria for the diagnosis of DCM are not wholly specific for the disease, and histologic examination may be necessary for final diagnosis. Review of reports on histologic findings in dogs with clinically diagnosed DCM reveals two histologically distinct forms of DCM: 1) cardiomyopathy of Boxers and Doberman Pinschers, corresponding to the “fatty infiltration-degenerative” type and 2) the form seen in many giant, large-, and medium-sized breeds, including some Boxers and Doberman Pinschers, classified as the “attenuated wavy fiber” type of DCM. The histologic changes of the attenuated wavy fiber type of DCM may precede clinical and echocardiographic signs of heart disease, thus indicating an early stage of DCM.
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Affiliation(s)
- A Tidholm
- Albano Animal Hospital of Stockholm, Rinkbyvägen 23, S-182 36 Danderyd, Sweden.
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Zhu H, Zhang W, Zhong M, Zhang G, Zhang Y. Myocardial ultrasonic integrated backscatter analysis in patients with chronic atrial fibrillation. Int J Cardiovasc Imaging 2010; 26:861-5. [DOI: 10.1007/s10554-010-9637-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2009] [Accepted: 04/24/2010] [Indexed: 11/25/2022]
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Methods from the Theory of Random Heterogeneous Media for Quantifying Myocardial Morphology in Normal and Dilated Hearts. Ann Biomed Eng 2009; 38:308-18. [DOI: 10.1007/s10439-009-9848-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2009] [Accepted: 11/15/2009] [Indexed: 01/08/2023]
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Nishimura Y, Inoue T, Morooka T, Node K. Mechanical stretch and angiotensin II increase interleukin-13 production and interleukin-13 receptor alpha2 expression in rat neonatal cardiomyocytes. Circ J 2008; 72:647-53. [PMID: 18362439 DOI: 10.1253/circj.72.647] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The high affinity receptor for interleukin (IL)-13, IL-13 receptor alpha2 (IL-13Ralpha2), acts as a decoy receptor for IL-13, modulates fibrosis and has an anti-tumor effect. Recently, IL-13Ralpha2 has been considered as a therapeutic target for fibrosis and tumor growth. However, the mechanism of IL-13Ralpha2 expression in cardiomyocytes is unclear. METHODS AND RESULTS The mechanism of IL-13Ralpha2 expression was examined using cultured rat neonatal cardiomyocytes. Cyclical mechanical stretch induced IL-13Ralpha2 mRNA expression in rat cardiomyocytes. Treatment with angiotensin II, which plays a pivotal role in mechanical stretch-induced cardiomyocyte hypertrophy, upregulated IL-13Ralpha2 mRNA expression in rat cardiomyocytes. IL-13Ralpha2 mRNA expression was also upregulated through IL-13 treatment. Furthermore, mechanical stretch and angiotensin II treatment caused IL-13 secretion from rat cardiomyocytes, which was suppressed by angiotensin type1 receptor (AT1R) RNA interference. Upregulation of IL-13Ralpha2 mRNA expression through mechanical stretch, angiotensin II treatment and IL-13 treatment was inhibited by anti-IL-13Ralpha1 antibody and STAT6 depletion through RNA interference. Positive immunohistochemical staining for IL-13Ralpha2 was observed in the myocardium of endomyocardial biopsy specimens from the failing human heart, but not in autopsy specimens from control subjects. CONCLUSION IL-13 might act in an autocrine and paracrine fashion to upregulate IL-13Ralpha2 expression in cardiomyocytes.
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Affiliation(s)
- Yuki Nishimura
- Department of Cardiovascular and Renal Medicine, Saga University Faculty of Medicine, Saga, Japan
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Yildirim N, Saricam E, Ozbakir C, Bozboga S, Ocal A. Assessment of the relationship between functional capacity and right ventricular ultrasound tissue characterization by integrated backscatter in patients with isolated mitral stenosis. Int Heart J 2007; 48:87-96. [PMID: 17379982 DOI: 10.1536/ihj.48.87] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
AIM The aim of the present study was to investigate right ventricular (RV) myocardial textural properties in asymptomatic and symptomatic mitral stenosis (MS) patients with normal RV systolic function using integrated backscatter (IBS). METHODS The study included 40 patients with MS of moderate or severe degree. Patients were classified into 2 groups according to NYHA class (asymptomatic group, NYHA class I, symptomatic group, NYHA class II-III). RV pulsed-wave tissue Doppler imaging (TDI) and IBS analyses were performed in all patients. Isovolumic contraction time (IVCT), systolic wave velocity (S), isovolumic relaxation time (IVRT), early diastolic wave velocity (E), and late diastolic wave velocity (A) were measured by TDI. IBS amplitude (IB) and cyclic variation (CV) of the RV lateral wall in the parasternal long-axis view were measured by IBS. CV was calculated by subtracting systolic IB from diastolic IB. RESULTS IVRT (54.2 +/- 11.9 ms versus 86.2 +/- 16.2 ms, P < 0.001) and A wave amplitude (10.2 +/- 2.1 cm/s versus 13.6 +/- 1.8 cm/s, P < 0.05) were higher whereas E wave amplitude (11.7 +/- 1.6 cm/s and 10.3 +/- 1.5 cm/s, P < 0.05) and E/A ratio (1.3 +/- 0.3 versus 0.7 +/- 0.1, P < 0.001) were lower in group 2. Symptomatic patients had a lower CV value of RV (9.5 +/- 3.4 dB versus 6.7 +/- 1.9 dB, P = 0.004). There was a positive correlation between CV and E/A (r = 0.964, P < 0.001) CONCLUSION Symptomatic isolated MS patients had RV echo texture changes and diastolic dysfunction in comparison to asymptomatic ones with similar mitral valve areas in the presence of normal RV systolic function. In isolated MS, both pulsed-wave TDI and IBS may aid in the detection of RV diastolic pathology.
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Affiliation(s)
- Nesligül Yildirim
- Department of Cardiology, Faculty of Medicine, Zonguldak Karaelmas University, Kozlu, Zonguldak, Turkey
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Salvetti M, Muiesan ML, Paini A, Monteduro C, Bonzi B, Galbassini G, Belotti E, Movilli E, Cancarini G, Agabiti-Rosei E. Myocardial ultrasound tissue characterization in patients with chronic renal failure. J Am Soc Nephrol 2007; 18:1953-8. [PMID: 17442790 DOI: 10.1681/asn.2006050462] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The objective of this study was to detect ultrastructural changes in myocardium related to collagen content by ultrasound tissue characterization in patients with chronic kidney disease (CKD) and in uncomplicated hypertensive control subjects. In 25 hemodialysis (HD) patients, in 25 patients with moderate to severe chronic renal failure (CRF), and in 10 patients with essential hypertension (EH) and normal renal function matched for age, BP, and left ventricular mass index, left ventricular anatomy and function were evaluated by conventional echocardiography, and integrated backscatter signal (IBS) was analyzed by acoustic densitometry. IBS mean reflectivity increased from 48% in patients with EH to 56% in patients with CRF to 62% in HD patients (ANOVA P < 0.01). IBS mean cyclic variation was progressively increased from 4.35 +/- 1.2 dB in HD patients to 5.27 +/- 0.90 in patients with CRF to 6.50 +/- 1.6 dB in patients with EH (ANOVA P < 0.01). At multivariate analysis, IBS mean reflectivity was positively related to age and serum creatinine (beta 0.351, P = 0.036; and beta = 0.408, P = 0.016, respectively). IBS mean cyclic variation was inversely related to age and serum creatinine (beta = -0.274, P = 0.025; and beta = -0.262, P = 0.025, respectively) and positively related to left ventricular midwall fractional shortening and transmitral E/A ratio (beta = 0.269, P < 0.05; and beta = 0.314, P < 0.001, respectively). The data support the hypothesis that interstitial collagen deposition may appear early in the course of CKD and suggest that acoustic densitometry may represent a useful tool for the assessment of myocardial tissue changes in patients with CKD.
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Affiliation(s)
- Massimo Salvetti
- Department of Medical and Surgical Sciences, University of Brescia, c/o Spedali Civili, 2a Medicina, Brescia 25100, Italy.
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Mizuno R, Fujimoto S, Saito Y, Nakamura S. Non-invasive quantitation of myocardial fibrosis using combined tissue harmonic imaging and integrated backscatter analysis in dilated cardiomyopathy. Cardiology 2006; 108:11-7. [PMID: 16960443 DOI: 10.1159/000095595] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2006] [Accepted: 06/26/2006] [Indexed: 11/19/2022]
Abstract
BACKGROUND Echocardiographic modalities have challenged the myocardial tissue characterization, but this reliability has not reached to the clinical use. This study investigated whether combined tissue harmonic imaging (THI) and integrated backscatter analysis (IB) provide the reliable and quantitative information about myocardial fibrosis in idiopathic dilated cardiomyopathy (DCM) in comparison with myocardial biopsy findings. METHODS We studied 56 patients with DCM. All patients underwent left ventricular endomyocardial biopsy and IB with fundamental imaging (FI) and THI. RESULTS In patients with good echocardiographic image quality, excellent correlations between the percentage of area occupied by myocardial fibrosis (% fibrosis) and the mean of integrated backscatter during a cardiac cycle (m-IB) measured with FI or THI were seen, and the correlation was closer with THI compared with FI. While in patients with poor image quality the correlation between m-IB and % fibrosis was only modest with FI, but the correlation was excellent with THI. Four cut-off values of m-IB with THI obtained from receiver operating characteristic curve discriminated between % fibrosis of more and less than 25, 30, 35, and 40% with high sensitivity and specificity. Multivariate analysis revealed that m-IB with THI was an independent predictor for discrimination of the severity of myocardial fibrosis. CONCLUSION Combined IB and THI are a clinically applicable method and may be an alternative to myocardial biopsy in evaluating quantitatively myocardial fibrosis in DCM.
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Affiliation(s)
- Reiko Mizuno
- Department of General Medicine, Nara Medical University, Kashihara, Japan
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Ohtsuka T, Inoue K, Hara Y, Morioka N, Ohshima K, Suzuki J, Ogimoto A, Shigematsu Y, Higaki J. Serum markers of angiogenesis and myocardial ultrasonic tissue characterization in patients with dilated cardiomyopathy. Eur J Heart Fail 2005; 7:689-95. [PMID: 15921813 DOI: 10.1016/j.ejheart.2004.09.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2004] [Revised: 07/13/2004] [Accepted: 09/20/2004] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND AND AIMS It has been proven that a disturbance in angiogenesis contributes to the progression of myocardial interstitial fibrosis in idiopathic dilated cardiomyopathy (DCM). This study was designed to evaluate the relationship between serum activity of angiogenic factors and myocardial ultrasonic tissue characterization in patients with DCM. METHODS AND RESULTS We studied 30 patients with DCM and 15 healthy control subjects. Serum levels of vascular endothelial growth factor (VEGF), interleukin (IL)-4 and IL-13 were measured using enzyme-linked immunosorbent assay. We determined calibrated myocardial integrated backscatter (IB) as the value of myocardial interstitial fibrosis using ultrasonic tissue characterization and also quantified the magnitude of cyclic variations in IB (CV-IB). Serum levels of VEGF and IL-13 were significantly higher in patients with DCM than in control subjects (both P<0.05). Calibrated IB was significantly higher and CV-IB was markedly lower in patients with DCM than in control subjects (both P<0.01). In patients with DCM, the levels of IL-13 significantly correlated with calibrated IB (r=0.520, P=0.018). In addition, there was a significant negative correlation between levels of VEGF and CV-IB (r=-0.611, P=0.007). CONCLUSION The increase in serum VEGF and IL-13 may be closely related to alterations in myocardial texture in DCM.
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Affiliation(s)
- Tomoaki Ohtsuka
- The Second Department of Internal Medicine, Ehime University School of Medicine, Shigenobu, Onsen-gun, Ehime 791-0295, Japan.
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Beaver TA, Jansujwicz A, Arbuckle BE, D'Sa A, Palac RT. Integrated backscatter during harmonic and fundamental frequency imaging--effect of depth, mechanical index, and tissue anisotropy: implications for myocardial tissue characterization. Echocardiography 2003; 20:337-43. [PMID: 12848877 DOI: 10.1046/j.1540-8175.2003.03039.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To explore the potential advantages of tissue harmonic imaging (THI) versus fundamental frequency imaging (FFI) when applied to tissue characterization. METHODS A Philips Medical Systems Sonos 5500 echocardiograph equipped with a broadband transducer (S4) and an on-line quantitative analysis software package (Acoustic Densitometry) was used for imaging. The effect of mechanical index (MI), imaging depth, and anisotropy on relative backscatter amplitude was evaluated. RESULTS This study demonstrated that imaging with tissue harmonics generated relatively greater backscatter values at clinically relevant imaging depths and instrument settings referenced to FFI. This effect was dependent on MI setting. A direct relationship between backscatter amplitude and MI was demonstrated. Additionally, tissue anisotropy had similar effects on integrated backscatter amplitude during both THI and FFI. However, relative backscatter values at each fiber orientation are greater during THI at similar instrument settings when referenced to FFI. CONCLUSION Tissue harmonic imaging may offer advantages over FFI for myocardial tissue characterization.
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Affiliation(s)
- Timothy A Beaver
- Echocardiography Laboratory, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
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Dağdeviren B, Akdemir O, Eren M, Bolca O, Oğuz E, Gürlertop Y, Tezel T. Prognostic implication of myocardial texture analysis in idiopathic dilated cardiomyopathy. Eur J Heart Fail 2002; 4:41-8. [PMID: 11812664 DOI: 10.1016/s1388-9842(01)00205-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND AIM Abnormal myocardial acoustic properties have been reported in patients with idiopathic dilated cardiomyopathy (IDC). The aim of this study was to investigate the relationship between quantitative ultrasonic textural alterations of myocardium and clinical outcome in IDC. METHODS Baseline clinical and echocardiographic variables were obtained from 28 patients with IDC. By using a videodensitometric approach, quantitative myocardial texture analysis was performed on images obtained from septum and posterior wall (PW). Cyclic variation (CV) index of mean gray level (MGL) was calculated according to the formula: (MGLdiast-MGLsyst)/MGLdiastx100. All patients were followed for an average of 11+/-5 months for the occurrence of cardiac death or repeated hospitalization due to worsening of heart failure. RESULTS During follow-up, 10 patients experienced cardiac events (6 cardiac deaths and 4 heart failure events). The CV indexes of both septum and PW were significantly lower in patients with cardiac events than those of event free patients (6.8+/-9.6% vs. 13.6+/-8.2%, P<0.05 and 5.3+/-6.4% vs.15.7+/-7.2% P<0.001, respectively). Univariate analysis defined the following variables as predictors of outcome: PW-CV index (chi2=13.0, P=0.0003), transmitral E/A ratio (chi2=12.5, P=0.0004), symptom status (chi2=8.7, P=0.003), and septum-CV index (chi2=4.7, P=0.03). Multivariate stepwise regression analysis showed that the PW-CV index (chi2=7.5, P=0.006) and E/A ratio (chi2=6.5, P=0.01) were the independent predictors of outcome. The event-free survival rate of patients with PW-CV index <11% was significantly lower than those with an index > or = 11 (35.7% vs. 92.8%, P=0,001). CONCLUSION The assessment of severely depressed CV index provides valuable prognostic information in patients with IDC.
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Affiliation(s)
- Bahadir Dağdeviren
- Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology Clinic, Istanbul, Turkey.
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Dagdeviren B, Akdemir O, Bolca O, Eren M, Gürlertop Y, Tezel T. Myocardial texture analysis in idiopathic dilated cardiomyopathy: prediction of contractile reserve on dobutamine echocardiography. J Am Soc Echocardiogr 2002; 15:36-42. [PMID: 11781552 DOI: 10.1067/mje.2002.115618] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Conventional resting echocardiography is not able to predict contractile reserve (CR) of patients with idiopathic dilated cardiomyopathy. The aim of this study was to investigate whether the videodensitometric myocardial texture analysis could predict the CR of these patients. Myocardial texture analysis was performed on echocardiographic digitized images of 27 patients with IDC through a calibrated 256 gray level digitization system. Cyclic variation (CV) index of myocardial mean gray level (MGL) was calculated according to the formula: (MGL(diast) - MGL(syst))/ MGL(diast) x 100. CR was defined as the %-change of ejection fraction by 10 microg/kg per minute dobutamine infusion. A clinical follow-up was also performed for all patients for an average of 8 +/- 3 months. CR ranged from -1.8% to 50.3%. CV index of both septum and posterior wall (PW) was the single parameter significantly correlated to CR (r = 0.69 and r = 0.77, respectively, P <.0001 for both). The mean resting CV index of septum and PW were significantly lower in patients with CR less than 17%-median value of all subjects-(5.7 +/- 5.6 vs 16.9 +/- 7.9 and 5.4 +/- 5.9 vs 16.1 +/- 6.4, respectively, P <.0001 for both). A CV index of 10% for both septum and PW yielded a sensitivity of 77% and 84%, and a specificity of 84% and 84% for predicting diminished CR, respectively. The event-free survival rate was significantly lower in patients with CR less than 17% (61.5% vs 92.8%, P <.05). The CV index of both septum and PW were also significantly lower in patients with cardiac events (13.6 +/- 8 vs 4.3 +/- 6, P <.05 and 14.7 +/- 7 vs 4.1 +/- 7, P <.01, respectively). Ultrasonic myocardial texture analysis in idiopathic dilated cardiomyopathy has a high ability to discriminate the patients with and without preserved CR, and patients with unfavorable outcome as well.
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Affiliation(s)
- Bahadir Dagdeviren
- Siyami Ersek Thoracic and Cardiovascular Surgery Center, Cardiology Clinic, Istanbul, Turkey.
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Tidholm A, Häggström J, Borgarelli M, Tarducci A. Canine idiopathic dilated cardiomyopathy. Part I: Aetiology, clinical characteristics, epidemiology and pathology. Vet J 2001; 162:92-107. [PMID: 11531394 DOI: 10.1053/tvjl.2001.0571] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Dilated cardiomyopathy (DCM), characterized by chamber dilatation and myocardial systolic and diastolic dysfunction, is one of the most common heart diseases in dogs. The aetiology of the myocardial hypokineis is seldom known in the individual case of DCM, although several theories concerning genetic, nutritional, metabolic, inflammatory, infectious, or drug- or toxin-induced myocardial disease have been discussed. DCM is often referred to as being breed-specific for Boxers, Doberman Pinschers, English Cocker Spaniels and other breeds. Review of reports on histopathologic findings in canine DCM reveals two histologically distinct forms of DCM; (1) cardiomyopathy of boxers and of Doberman pinschers, corresponding to the "fatty infiltration-degenerative" type, and (2) the form seen in many giant, large- and medium-sized breeds, including some boxers and Doberman pinschers, which can be classified as the "attenuated wavy fiber" type of DCM. The classification of canine idiopathic DCM according to histologic findigns seems superior to classification suggesting breed-specific syndromes, as some breeds (i.e. boxers and Doberman pinschers) may be affected by both diseases. However, ante mortem aetiological diagnosis of DCM is difficult. DCM carries a poor prognosis in dogs, and few prognostic indicators have been identified.
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Affiliation(s)
- A Tidholm
- Albano Animal Hospital of Stockholm, Rinkebyvägen 23, S-182 36 Danderyd, Sweden.
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