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Spinella G, Boschetti GA, Bauckneht M, Raffa S, Marini C, Finotello A, Pane B, Pratesi G, Palombo D, Sambuceti G. Endovascular aortic repair impact on myocardial contractility: A prospective study. Eur J Clin Invest 2023; 53:e14011. [PMID: 37099603 DOI: 10.1111/eci.14011] [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: 02/11/2023] [Revised: 04/07/2023] [Accepted: 04/24/2023] [Indexed: 04/27/2023]
Abstract
BACKGROUND This study aimed to estimate if the altered sphygmic wave transmission may affect the left ventricular (LV) contractile function in patients undergoing endovascular aortic repair (EVAR). METHODS A prospective single-centre study was carried out on consecutive patients undergoing EVAR for abdominal aortic aneurysm. A preoperative and 6-month single photon emission computed tomography (SPECT) with arterial stiffness measurement were performed to evaluate variations in pressure wave curve and myocardial perfusion parameters. RESULTS From 2018 to 2020 a total of 16 patients were included in the study. Among the parameters evaluated, we found a measurable reduction of the reflected wave transit time from pre- to postoperative period, for both stress (115.13 ± 7.2 ms-111.1 ± 7.0 ms, p = .08) and rest SPECT acquisitions (115.3 ± 6.2 ms-112.2 ± 5.6 ms, p = .1). Unidirectional increase of both LV end-systolic volume (34 ± 9 mL-39 ± 8 mL, p = .02) and end-diastolic volume (85 ± 34 mL-89 ± 29 mL, p = .6) was also observed. Lastly, the ratio between the end-systolic pressure and the end-systolic volume (maximal systolic myocardial stiffness) decreased from 3.6 ± 1.5 mmHg/mL to 2.66 ± .74 mmHg/mL (p = .03). CONCLUSIONS Our data showed that EVAR induced an altered transmission of the sphygmic wave associated with an early LV contractile impairment.
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Affiliation(s)
- Giovanni Spinella
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gian Antonio Boschetti
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Matteo Bauckneht
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Stefano Raffa
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
| | - Cecilia Marini
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- CNR Institute of Molecular Bioimaging and Physiology (IBFM), Segrate, Italy
| | - Alice Finotello
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Bianca Pane
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Giovanni Pratesi
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Domenico Palombo
- Vascular and Endovascular Surgery Clinic, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Surgical Sciences and Integrated Diagnostics (DISC), University of Genoa, Genoa, Italy
| | - Gianmario Sambuceti
- Nuclear Medicine, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Health Sciences, University of Genoa, Genoa, Italy
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Yalçin F, Yalçin H, Küçükler N, Arslan S, Akkuş O, Kurtul A, Abraham MR. Basal Septal Hypertrophy as the Early Imaging Biomarker for Adaptive Phase of Remodeling Prior to Heart Failure. J Clin Med 2021; 11:75. [PMID: 35011816 PMCID: PMC8745483 DOI: 10.3390/jcm11010075] [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: 10/12/2021] [Revised: 11/01/2021] [Accepted: 11/15/2021] [Indexed: 01/19/2023] Open
Abstract
Hypertension plays a dominant role in the development of left ventricular (LV) remodeling and heart failure, in addition to being the main risk factor for coronary artery disease. In this review, we focus on the focal geometric and functional tissue aspects of the LV septal base, since basal septal hypertrophy (BSH), as the early imaging biomarker of LV remodeling due to hypertensive heart disease, is detected in cross-sectional clinic studies. In addition, the validation of BSH by animal studies using third generation microimaging and relevant clinical observations are also discussed in the report. Finally, an evaluation of both human and animal quantitative imaging studies and the importance of combined cardiac imaging methods and stress-induction in the separation of adaptive and maladaptive phases of the LV remodeling are pointed out. As a result, BSH, as the early imaging biomarker and quantitative follow-up of functional analysis in hypertension, could possibly contribute to early treatment in a timely fashion in the prevention of hypertensive disease progression to heart failure. A variety of stress stimuli in etiopathogenesis and the difficulty of diagnosing pure hemodynamic overload mediated BSH lead to an absence of the certain prevalence of this particular finding in the population.
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Affiliation(s)
- Fatih Yalçin
- Cardiology UCSF Health, Department of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA; (H.Y.); (M.R.A.)
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Hulya Yalçin
- Cardiology UCSF Health, Department of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA; (H.Y.); (M.R.A.)
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Nagehan Küçükler
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Serbay Arslan
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Oguz Akkuş
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Alparslan Kurtul
- Department of Cardiology, Mustafa Kemal University, Antakya 31100, Turkey; (N.K.); (S.A.); (O.A.); (A.K.)
| | - Maria Roselle Abraham
- Cardiology UCSF Health, Department of Medicine, University of California at San Francisco, San Francisco, CA 94143, USA; (H.Y.); (M.R.A.)
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Yalçin F, Yalçin H, Abraham R, Abraham TP. Hemodynamic stress and microscopic remodeling. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2021; 11:200115. [PMID: 34806089 PMCID: PMC8586739 DOI: 10.1016/j.ijcrp.2021.200115] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 01/20/2023]
Abstract
BACKGROUD Heart responds to physiologic and pathologic conditions and sympathetic drive plays an important role. It has been documented that LV base is more dominantly affected by sympathetic drive compared to the other regions. LV base is more dominantly exposed to wall stress in the initial period of remodeling due to pressure-overload, since LV cavity is the largest at base. Basal septal hypertrophy (BSH) in cross-sectional data is associated with the early phase of hypertensive heart disease. BSH was confirmed by 3rd generation microscopic ultrasound in small animals. BSH as the closest location to increased afterload could be detected in variety of stress stimuli and result in a huge septal hypertrophy in advance cases possibly related to earlier exposure of hemodynamic stress to septal wall. CONCLUSION Effective geometric and functional evaluation of initial remodeling due to hemodynamic stress is important according to both human and animal data. These findings possibly contribute to early recognition of adaptive phase of hypertensive remodeling and more effective management in a timely fashion.
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Affiliation(s)
- Fatih Yalçin
- Corresponding author. Department of Medicine, University of California at San Francisco, Cardiology UCSF Health, 505 Parnassus Avenue, Rm M314AUCSF Box 0214, San Francisco, CA, 94117, USA.
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Elias SO, Ajayi RE. Effect of sympathetic autonomic stress from the cold pressor test on left ventricular function in young healthy adults. Physiol Rep 2020; 7:e13985. [PMID: 30659769 PMCID: PMC6339552 DOI: 10.14814/phy2.13985] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 12/23/2018] [Accepted: 12/28/2018] [Indexed: 01/02/2023] Open
Abstract
There is a dearth of studies investigating the effect of sympathetic activation on left ventricular function. This study aimed to investigate the effect of sympathetic autonomic stress on left ventricular function in young healthy adults. Fifty‐six normotensive healthy participants (age 23.55 ± 3.82 years) took part in the study after giving informed consent. After obtaining baseline measurements, heart rate (HR), blood pressure (BP), peripheral saturation of oxygen (SpO2) and left ventricular function (assessed by means of ejection fraction (EF) obtained by transthoracic 2‐D echocardiography) were determined before and following sympathetic activation using cold pressor test (CPT). Exposure to CPT led to significant increase (P < 0.0001) in HR (70.4 ± 10.7 bpm to 91.6 ± 14.8 bpm), SBP (118 ± 8 mmHg to 138 ± 14 mmHg) and DBP (71 ± 7 mmHg to 91 ± 11 mmHg). Participants’ EDV (101.1 ± 15.8 ml to 104.2 ± 19.3 mL), ESV (38.7 ± 9.1 mL to 40.3 ± 11.6 mL), SpO2 (99.5 ± 0.79% to 99.5 ± 0.77%) and EF (61.9 ± 5.9% to 60.9 ± 6.4%) were only slightly changed (P > 0.05). However, cardiac output (4.3 ± 0.9 L/min to 5.4 ± 1.4 L/min) and cardiac index (3.7 ± 0.8 L/min per m2 to 4.5 ± 1.4 L/min per m2) increased significantly (P < 0.0001). We conclude that sympathetic stress induced by cold pressor test has marginal effect on ejection fraction and fractional shortening while increasing cardiac output and cardiac index in young healthy adults.
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Affiliation(s)
- Simiat O Elias
- Department of Physiology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Reina E Ajayi
- Department of Physiology, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
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Exercise hypertension should be recalled in basal septal hypertrophy as the early imaging biomarker in patients with stressed heart morphology. Blood Press Monit 2020; 25:118-119. [PMID: 32134796 DOI: 10.1097/mbp.0000000000000429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Yalçin F, Abraham TP, Garcia MJ. Current obstacles in management of hypertensive patients by performance-based care and importance of diagnostic tests. IJC HEART & VASCULATURE 2015; 9:73-74. [PMID: 28785712 PMCID: PMC5497330 DOI: 10.1016/j.ijcha.2015.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 10/26/2022]
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Yalçin F, Schindler T, Abraham TP. Hypertension should be ruled out in patients with hyperdynamic left ventricle on radionuclide myocardial perfusion imaging, diastolic dysfunction and dyspnea on exertion. IJC HEART & VASCULATURE 2015; 7:149-150. [PMID: 28785664 PMCID: PMC5497229 DOI: 10.1016/j.ijcha.2015.04.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 04/02/2015] [Indexed: 01/20/2023]
Affiliation(s)
- Fatih Yalçin
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, USA
| | - Thomas Schindler
- Johns Hopkins Medical Institutions, Department of Nuclear Medicine, Baltimore, MD, USA
| | - Theodore P Abraham
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, USA
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Yalçin F, Topaloglu C, Kuçukler N, Ofgeli M, Abraham TP. Could early septal involvement in the remodeling process be related to the advance hypertensive heart disease? IJC HEART & VASCULATURE 2015; 7:141-145. [PMID: 28785662 PMCID: PMC5497240 DOI: 10.1016/j.ijcha.2015.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 04/02/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Quantitative imaging analyses showed an earlier septal wall involvement in hypertension. We planned to determine the effect of hypertension on regional myocardial performance index (MPI) in a hypertensive patient population. METHODS We evaluated 119 hypertensive patients who were divided into gr. I: 57 patients without left ventricular hypertrophy (LVH), (53.1 ± 10 years), and gr. II: 62 patients with LVH (55.1 ± 9 years) using conventional and tissue doppler imaging. They were compared with gr. III, a sex-age-matched normal control group (37 subjects, 53.0 ± 10 years). RESULTS We detected basal septal and basal lateral contraction time (CT), isovolumetric CT and relaxation time (IVRT) and MPI. EF was 68 ± 5 % in gr. I, 69 ± 5 % in gr. II, 69 ± 4 % in gr. III. LV mass index was 122 ± 11 g/m2 in gr. I, 148 ± 13 g/m2 in gr. II and 118 ± 13 g/m2 in gr. III. Concentric LVH was detected in gr. II (relative wall thickness = 0.49 ± 0.8). LV septal and lateral MPI were abnormal in both hypertensive groups (p < 0.0001). Septal MPI was correlated moderately with septal wall thickness (r = 0.447, p < 0.001). CONCLUSIONS LV diastolic dysfunction becomes more severe in septal wall than lateral wall in hypertensive LVH. Septal myocardial performance is more dominantly affected by hypertension possibly due to earlier septal involvement in disease course. Septal MPI is correlated moderately with septal wall thickness.
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Affiliation(s)
- Fatih Yalçin
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, United States.,Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Caner Topaloglu
- Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Nagehan Kuçukler
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, United States.,Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Mehmet Ofgeli
- Mustafa Kemal University, Department of Cardiology, Antioch, Turkey
| | - Theodore P Abraham
- Johns Hopkins Medical Institutions, Division of Cardiology, Baltimore, MD, United States
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Ennezat PV, Le Jemtel TH, Logeart D, Maréchaux S. [Heart failure with preserved ejection fraction: a systemic disorder?]. Rev Med Interne 2012; 33:370-80. [PMID: 22424669 DOI: 10.1016/j.revmed.2012.02.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Revised: 01/30/2012] [Accepted: 02/14/2012] [Indexed: 11/18/2022]
Abstract
When the syndrome of heart failure (HF) is due to left ventricular (LV) systolic dysfunction the clinical manifestations and natural history of the syndrome depend primarily on the severity of LV systolic dysfunction. In contrast, when the syndrome is attributed to LV diastolic dysfunction multiple comorbidities are responsible for the clinical manifestations and the natural history of the syndrome. The present review underscores the multifactorial pathogenesis of the syndrome of HF associated with LV diastolic dysfunction that nowadays is more properly referred to as HF with preserved LV ejection fraction (HFpEF) than to diastolic HF. The prognosis is similarly poor whether HF is due to systolic dysfunction or associated with diastolic dysfunction. The cause of death that is commonly non-cardiovascular in HFpEF supports the pathogenic importance of comorbidities in this condition. Hypertension, chronic kidney disease (CKD), diabetes, obesity and sleep disorder breathing are among the most frequent comorbidities in HFpEF. These comorbidities account for the multiple clinical presentations of the syndrome of HFpEF. Limited functional capacity is in HFpEF largely related to the downward spiral between CKD mediated fluid accumulation and LV stiffness as well as altered ventricular-vascular coupling. The diagnosis of HFpEF currently relies on 2D-Doppler echocardiography findings of impaired LV relaxation and increased LV stiffness and to a lesser extent on biomarkers. Owing to both lack of stringent inclusion and exclusion enrollment criteria and mistaken therapeutic target, placebo-controlled randomized therapeutic trials have been so far negative in HFpEF.
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Affiliation(s)
- P-V Ennezat
- EA 2693, IFR 114, université de Lille Nord de France, 1, place de Verdun, 59045 Lille, France.
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