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Srdanović I, Stefanović M, Milovančev A, Vulin A, Pantić T, Dabović D, Tadić S, Ilić A, Stojšić Milosavljević A, Bjelobrk M, Miljković T, Velicki L. Relevance of the TAS'/PASP Ratio as a Predictor of Outcomes in Patients with Heart Failure with a Reduced Ejection Fraction. Life (Basel) 2024; 14:863. [PMID: 39063617 PMCID: PMC11277606 DOI: 10.3390/life14070863] [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: 04/04/2024] [Revised: 06/30/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024] Open
Abstract
BACKGROUND There is evidence that right ventricular (RV) contractile function, especially its coupling with the pulmonary circulation, has an important prognostic value in patients with left ventricular dysfunction. AIMS This study aimed to identify the best echocardiographic parameters of RV function and pulmonary artery systolic pressure (PASP) alone or in the form of the index of right ventricular-pulmonary artery coupling (RV-PA coupling) to determine the best predictor of 1-year major adverse cardiovascular events (MACE), which were defined as cardiovascular death and cardiac decompensation in heart failure patients with reduced ejection fraction (HFrEF). METHODS AND RESULTS The study enrolled 191 HFrEF patients (mean age 62.28 ± 12.79 years, 74% males, mean left ventricular ejection fraction (LVEF) 25.53 ± 6.87%). All patients underwent clinical, laboratory, and transthoracic echocardiographic (TTE) evaluation, focusing on assessing RV function and non-invasive parameters of RV-PA coupling. RV function was evaluated using fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), and peak tricuspid annular systolic velocity (TAS'). PASP was estimated by peak tricuspid regurgitation velocity (TRVmax) and corrected by assumed right atrial pressure relative to the dimension and collapsibility of the inferior vena cava. The TAPSE/PASP and TAS'/PASP ratios were taken as an index of RV-PA coupling. During the follow-up (mean period of 340 ± 84 days), 58.1% of patients met the composite endpoint. The independent predictors of one-year outcome were shown to be advanced age, atrial fibrillation, indexed left atrial systolic volume (LAVI), LVEF, TAPSE/PASP, and TAS'/PASP. TAS'/PASP emerged as the strongest independent predictor of prognosis, with a hazard ratio (HR) of 0.67 (0.531-0.840), p < 0.001. Reconstructing the ROC curve 0.8 (0.723-0.859), p < 0.001, we obtained a threshold value of TAS'/PASP ≤ 0.19 (cm/s/mm Hg) (sensitivity 74.0, specificity 75.2). Patients with TAS'/RVSP ≤ 0.19 have a worse prognosis (Log Rank p < 0.001). CONCLUSIONS This study confirmed previously known independent predictors of adverse outcomes in patients with HfrEF-advanced age, atrial fibrillation, LAVI, and LVEF-but non-invasive parameters of RV-PA coupling TAPSE/PASP and TAS'/PASP improved risk stratification in patients with HFrEF. Variable TAS'/PASP has been shown to be the most powerful, independent predictor of one-year outcome.
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Affiliation(s)
- Ilija Srdanović
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Maja Stefanović
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Aleksandra Milovančev
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Aleksandra Vulin
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Teodora Pantić
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Dragana Dabović
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Snežana Tadić
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Aleksandra Ilić
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Anastazija Stojšić Milosavljević
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Marija Bjelobrk
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Tatjana Miljković
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
| | - Lazar Velicki
- Faculty of Medicine, University in Novi Sad, 21000 Novi Sad, Serbia; (I.S.); (A.M.); (A.V.); (D.D.); (S.T.); (A.I.); (A.S.M.); (M.B.); (T.M.); (L.V.)
- Institute for Cardiovascular Diseases of Vojvodina, 21204 Sremska Kamenica, Serbia;
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Sjúrðarson T, Kyhl K, Nordsborg NB, Kollslíð R, Andersen LJ, Krustrup P, Mohr M. 15 weeks of soccer training increases left ventricular mass and improves indices of left ventricular diastolic function in previously sedentary, mildly hypertensive, middle-aged women. Eur J Appl Physiol 2024; 124:1621-1629. [PMID: 38177568 PMCID: PMC11055800 DOI: 10.1007/s00421-023-05399-7] [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: 04/06/2023] [Accepted: 12/05/2023] [Indexed: 01/06/2024]
Abstract
PURPOSE To investigate the impact of soccer training on cardiac adaptations in mildly hypertensive middle-aged women. METHODS Hypertensive premenopausal women (n = 41; age (mean ± SD): 44 ± 7 years; height: 166 ± 6 cm; weight: 78.6 ± 11.6 kg; body fat: 43.3 ± 5.2%) were randomized to soccer training (SOC, n = 21) or control (CON, n = 20). SOC performed three weekly training sessions for 15 weeks, whereas CON had no training or lifestyle changes during the same period. Cardiac structure and function were assessed by echocardiography pre-intervention and post-intervention. RESULTS Soccer training increased (P = 0.001) left ventricular mass index by 10% [95% CI 4; 15], while no changes occurred in CON (time × group interaction, P = 0.005). In addition, only SOC demonstrated a within-group increase (P = 0.01) of 8% [95% CI 2; 14] in left ventricular septum diameter. For markers of right ventricular remodelling, a within-group increase (P = 0.02) occurred for tricuspid annulus plane systolic excursion of 8% [95% CI 1; 14] in SOC only. Left atrial diameter index increased (P < 0.001) by 6% [95% CI 3; 10] after SOC, while it was unaffected in CON (time × group interaction, P = 0.02). For makers of diastolic function, SOC demonstrated a within-group increase (P = 0.02) in the average early diastolic mitral annulus velocity of 10% [95% CI 2; 19]. In addition, a reduction (P < 0.001) in mitral valve A velocity of - 19% [95% CI - 29; - 10] was observed following soccer training, which manifested in increased (P < 0.001) mitral valve E/A ratio of 34% [95% CI 16; 53] in SOC. No within-group changes were apparent in CON. CONCLUSION In sedentary, mildly hypertensive, middle-aged women, 15 weeks of soccer training increases left ventricular mass and left atrial diameter and improves indices of left ventricular diastolic function.
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Affiliation(s)
- Tórur Sjúrðarson
- Centre of Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Kyhl
- Centre of Health Science, Department of Medicine, The Faroese National Hospital, Tórshavn, Faroe Islands
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Nikolai B Nordsborg
- Department of Nutrition, Exercise and Sports, University of Copenhagen, Copenhagen, Denmark
| | - Rudi Kollslíð
- Centre of Health Science, Department of Medicine, The Faroese National Hospital, Tórshavn, Faroe Islands
| | - Lars Juel Andersen
- Department of Cardiology, Zealand University Hospital, Roskilde, Denmark
| | - Peter Krustrup
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, 5250, Odense M, Denmark
- Danish Institute for Advanced Study (DIAS), University of Southern Denmark, Odense M, Denmark
- Sport and Health Sciences, College of Life and Environmental Sciences, University of Exeter, Exeter, UK
| | - Magni Mohr
- Centre of Health Science, Faculty of Health Sciences, University of the Faroe Islands, Tórshavn, Faroe Islands.
- Department of Sports Science and Clinical Biomechanics, SDU Sport and Health Sciences Cluster (SHSC), University of Southern Denmark, 5250, Odense M, Denmark.
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Lu NF, Niu HX, Liu AQ, Chen YL, Liu HN, Zhao PH, Shao J, Xi XM. Types of Septic Cardiomyopathy: Prognosis and Influencing Factors - A Clinical Study. Risk Manag Healthc Policy 2024; 17:1015-1025. [PMID: 38680475 PMCID: PMC11055516 DOI: 10.2147/rmhp.s452803] [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: 12/01/2023] [Accepted: 04/11/2024] [Indexed: 05/01/2024] Open
Abstract
Objective To explore the prognostic outcomes associated with different types of septic cardiomyopathy and analyze the factors that exert an influence on these outcomes. Methods The data collected within 24 hours of ICU admission included cardiac troponin I (cTnI), N-terminal pro-Brain Natriuretic Peptide (NT-proBNP); SOFA (sequential organ failure assessment) scores, and the proportion of vasopressor use. Based on echocardiographic outcomes, septic cardiomyopathy was categorized into left ventricular (LV) systolic dysfunction, LV diastolic dysfunction, and right ventricular (RV) systolic dysfunction. Differences between the mortality and survival groups, as well as between each cardiomyopathy subgroup and the non-cardiomyopathy group were compared, to explore the influencing factors of cardiomyopathy. Results A cohort of 184 patients were included in this study, with LV diastolic dysfunction having the highest incidence rate (43.5%). The mortality group had significantly higher SOFA scores, vasopressor use, and cTnI levels compared to the survival group; the survival group had better LV diastolic function than the mortality group (p < 0.05 for all). In contrast to the non-cardiomyopathy group, each subgroup within the cardiomyopathy category exhibited elevated levels of cTnI. The subgroup with left ventricular diastolic dysfunction demonstrated a higher prevalence of advanced age, hypertension, diabetes mellitus, coronary artery disease, and an increased mortality rate; the RV systolic dysfunction subgroup had higher SOFA scores and NT-proBNP levels, and a higher mortality rate (P < 0.05 for all); the LV systolic dysfunction subgroup had a similar mortality rate (P > 0.05). Conclusion Patients with advanced age, hypertension, diabetes mellitus, or coronary artery disease are more prone to develop LV diastolic dysfunction type of cardiomyopathy; cardiomyopathy subgroups had higher levels of cTnI. The RV systolic dysfunction cardiomyopathy subgroup had higher SOFA scores and NT-proBNP levels. The occurrence of RV systolic dysfunction in patients with sepsis significantly increased the mortality rate.
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Affiliation(s)
- Nian-Fang Lu
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People’s Republic of China
| | - Hong-Xia Niu
- Department of Emergency, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People’s Republic of China
| | - An-Qi Liu
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People’s Republic of China
| | - Ya-Lei Chen
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People’s Republic of China
| | - Hu-Nan Liu
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People’s Republic of China
| | - Pei-Hong Zhao
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, People’s Republic of China
| | - Jun Shao
- Department of Critical Care Medicine, Subei People’s Hospital of Jiangsu Province, Yangzhou, People’s Republic of China
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Capital Medical University Fuxing Hospital, Beijing, People’s Republic of China
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Semino T, Rosa GM, Monacelli F, Pellicano R, Testino G, Porto I. Right ventricle: current knowledge of echocardiographic evaluation of this "forgotten" chamber. Minerva Med 2024; 115:45-60. [PMID: 36988493 DOI: 10.23736/s0026-4806.23.08575-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
In the past the right ventricle (RV) has been traditionally regarded as a simple conduit between the venous system and the pulmonary circulation and it has aroused little interest in both clinical and echocardiographic cardiologists to such an extent that it has been defined as the "forgotten chamber." Subsequently it was clearly shown that the right heart (RH) plays an important physiologic role in cardiac activity, and that congenital or acquired alterations in its structure and function have an important prognostic value. Aim of this review is to shed the light on the echocardiographic approach to this cardiac chamber. In this narrative review we critically explored the most recent literature on this topic using PubMed and Medline and examining the most recent guidelines on the echocardiographic approach to the RV. Echocardiographic approach to RV presents some technical difficulties, which stem from the position of the RV inside the thorax and around the LV and from its particular anatomy, which precludes geometric assumptions. However, RV may now be evaluated quantitatively and qualitatively in many ways, and some new methods can partially overcome some of the limits imposed by its complex anatomy, thereby yielding a quantitative evaluation. Furthermore, due to the wide range of pathologies which may involve the RV a disease-oriented approach should be considered in the echocardiographic investigation of right heart disease.
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Affiliation(s)
- Tommaso Semino
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
| | - Gian M Rosa
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy -
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Fiammetta Monacelli
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
- Clinic of Geriatric Diseases, Department of Internal Medicine (DIMI), University of Genoa, Genoa, Italy
| | | | - Gianni Testino
- Unit of Addiction and Hepatology, Alcohological Regional Center, IRCCS San Martino Polyclinic Hospital, Genoa, Italy
| | - Italo Porto
- Department of Internal Medicine (DIMI), Clinic of Cardiovascular Diseases, University of Genoa, Genoa, Italy
- IRCCS San Martino Polyclinic Hospital, Genoa, Italy
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Pawar SG, Khan N, Salam A, Joshi M, Saravanan PB, Pandey S. The association of Pulmonary Hypertension and right ventricular systolic function - updates in diagnosis and treatment. Dis Mon 2024; 70:101635. [PMID: 37734967 DOI: 10.1016/j.disamonth.2023.101635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
Right ventricular (RV) systolic function is an essential but neglected component in cardiac evaluation, and its importance to the contribution to overall cardiac function is undermined. It is not only sensitive to the effect of left heart valve disease but is also more sensitive to changes in pressure overload than the left ventricle. Pulmonary Hypertension is the common and well-recognized complication of RV systolic dysfunction. It is also the leading cause of pulmonary valve disease and right ventricular dysfunction. Patients with a high pulmonary artery pressure (PAP) and a low RV ejection fraction have a seven-fold higher risk of death than heart failure patients with a normal PAP and RV ejection fraction. Furthermore, it is an independent predictor of survival in these patients. In this review, we examine the association of right ventricular systolic function with Pulmonary Hypertension by focusing on various pathological and clinical manifestations while assessing their impact. We also explore new 2022 ESC/ERS guidelines for diagnosing and treating right ventricular dysfunction in Pulmonary Hypertension.
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Affiliation(s)
| | - Nida Khan
- Jinnah Sindh Medical University, Pakistan
| | - Ajal Salam
- Government Medical College Kottayam, Kottayam, Kerala, India
| | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
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Benes J, Kotrc M, Wohlfahrt P, Kroupova K, Tupy M, Kautzner J, Melenovsky V. Right ventricular global dysfunction score: a new concept of right ventricular function assessment in patients with heart failure with reduced ejection fraction (HFrEF). Front Cardiovasc Med 2023; 10:1194174. [PMID: 37600032 PMCID: PMC10436518 DOI: 10.3389/fcvm.2023.1194174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 07/05/2023] [Indexed: 08/22/2023] Open
Abstract
Background Right ventricular (RV) function is currently being evaluated solely according to the properties of RV myocardium. We have tested a concept that in patients with heart failure with reduced ejection fraction (HFrEF), RV assessment should integrate the information about both RV function as well as size. Methods A total of 836 stable patients with HFrEF (LVEF 23.6 ± 5.8%, 82.8% males, 68% NYHA III/IV) underwent echocardiographic evaluation and were prospectively followed for a median of 3.07 (IQRs 1.11; 4.89) years for the occurrence of death, urgent heart transplantation or implantation of mechanical circulatory support. Results RV size (measured as RV-basal diameter, RVD1) was significantly associated with an adverse outcome independent of RV dysfunction grade (p = 0.0002). The prognostic power of RVD1 was further improved by indexing to body surface area (RVD1i, p < 0.05 compared to non-indexed value). A novel parameter named RV global dysfunction score (RVGDs) was calculated as a product of RVD1i and the degree of RV dysfunction (1-4 for preserved RV function, mild, moderate and severe dysfunction, respectively). RVGDs showed a superior prognostic role compared to RV dysfunction grade alone (ΔAUC >0.03, p < 0.0001). In every subgroup of RVGDs (<20, 20-40, 40-60, >60), patients with milder degree of RV dysfunction but more dilated RV had similar outcome as those with more severe degree of RV dysfunction but smaller RV size (all p > 0.50), independent of tricuspid regurgitation severity and degree of pulmonary hypertension. Conclusion RV dilatation is a manifestation of RV dysfunction. The evaluation of RV performance should integrate the information about both RV size and function.
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Affiliation(s)
- Jan Benes
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Peter Wohlfahrt
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Katerina Kroupova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Marek Tupy
- Radiodiagnostic and Interventional Radiology Department, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic
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Lu NF, Shao J, Niu HX, Han WY, Chen YL, Liu AQ, Liu HN, Xi XM. Early Diastolic Peak Velocity of Mitral Valve Annulus and Right Ventricular Systolic Tricuspid Annular Velocity as Predictors in Assessing Prognosis of Patients with Sepsis. Risk Manag Healthc Policy 2023; 16:921-930. [PMID: 37223427 PMCID: PMC10200692 DOI: 10.2147/rmhp.s407929] [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: 02/09/2023] [Accepted: 04/28/2023] [Indexed: 05/25/2023] Open
Abstract
Objective To analyze the epidemiological data of patients with septic cardiomyopathy and investigate the relationship between ultrasonic parameters and prognosis of patients with sepsis. Methods In this study, we enrolled patients with sepsis who were treated at the Department of Critical Care Medicine in the Beijing Electric Power Hospital (No.1 Taipingqiao Xili, Fengtai District, Beijing) from January 2020 to June 2022. All patients received standardized treatment. Their general medical status and 28-day prognosis were recorded. Transthoracic echocardiography was performed within 24 hours after admission. We compared the ultrasound indexes between the mortality group and the survival group at the end of 28 days. We included parameters with significant difference in the logistic regression model to identify the independent risk factors for prognosis and evaluated their predictive value using receiver operating characteristic (ROC) curve. Results We included 100 patients with sepsis in this study; the mortality rate was 33% and the prevalence rate of septic cardiomyopathy was 49%. The peak e' velocity and right ventricular systolic tricuspid annulus velocity (RV-Sm) of the survival group were significantly higher than those of the mortality group (P < 0.05). Results of logistic regression analysis showed that the peak e' velocity and RV-Sm were independent risk factors for prognosis. The area under curve of the peak e' velocity and the RV-Sm was 0.657 and 0.668, respectively (P < 0.05). Conclusion The prevalence rate of septic cardiomyopathy in septic patients is high. In this study, we found that the peak e' velocity and right ventricular systolic tricuspid annulus velocity were important predictors of short-term prognosis.
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Affiliation(s)
- Nian-Fang Lu
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, 100073, People’s Republic of China
| | - Jun Shao
- Department of Critical Care Medicine, Subei People’s Hospital of Jiangsu Province, Yangzhou, Jiangsu, 225001, People’s Republic of China
| | - Hong-Xia Niu
- Department of Emergency, Capital medical university electric teaching hospital/Beijing Electric Power Hospital, Beijing, 100073, People’s Republic of China
| | - Wen-Yong Han
- Department of Anesthesiology, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, 100073, People’s Republic of China
| | - Ya-Lei Chen
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, 100073, People’s Republic of China
| | - An-Qi Liu
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, 100073, People’s Republic of China
| | - Hu-Nan Liu
- Department of Critical Care Medicine, Capital Medical University Electric Teaching Hospital/Beijing Electric Power Hospital, Beijing, 100073, People’s Republic of China
| | - Xiu-Ming Xi
- Department of Critical Care Medicine, Capital Medical University Fuxing Hospital, Beijing, People’s Republic of China
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Lane ES, Jevsikov J, Shun-Shin MJ, Dhutia N, Matoorian N, Cole GD, Francis DP, Zolgharni M. Automated multi-beat tissue Doppler echocardiography analysis using deep neural networks. Med Biol Eng Comput 2023; 61:911-926. [PMID: 36631666 DOI: 10.1007/s11517-022-02753-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 12/24/2022] [Indexed: 01/13/2023]
Abstract
Tissue Doppler imaging is an essential echocardiographic technique for the non-invasive assessment of myocardial blood velocity. Image acquisition and interpretation are performed by trained operators who visually localise landmarks representing Doppler peak velocities. Current clinical guidelines recommend averaging measurements over several heartbeats. However, this manual process is both time-consuming and disruptive to workflow. An automated system for accurate beat isolation and landmark identification would be highly desirable. A dataset of tissue Doppler images was annotated by three cardiologist experts, providing a gold standard and allowing for observer variability comparisons. Deep neural networks were trained for fully automated predictions on multiple heartbeats and tested on tissue Doppler strips of arbitrary length. Automated measurements of peak Doppler velocities show good Bland-Altman agreement (average standard deviation of 0.40 cm/s) with consensus expert values; less than the inter-observer variability (0.65 cm/s). Performance is akin to individual experts (standard deviation of 0.40 to 0.75 cm/s). Our approach allows for > 26 times as many heartbeats to be analysed, compared to a manual approach. The proposed automated models can accurately and reliably make measurements on tissue Doppler images spanning several heartbeats, with performance indistinguishable from that of human experts, but with significantly shorter processing time. HIGHLIGHTS: • Novel approach successfully identifies heartbeats from Tissue Doppler Images • Accurately measures peak velocities on several heartbeats • Framework is fast and can make predictions on arbitrary length images • Patient dataset and models made public for future benchmark studies.
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Affiliation(s)
- Elisabeth S Lane
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK.
| | - Jevgeni Jevsikov
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK
| | | | - Niti Dhutia
- New York University Abu Dhabi, Saadiyat Island, Abu Dhabi, United Arab Emirates
| | - Nasser Matoorian
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK
| | - Graham D Cole
- National Heart and Lung Institute, Imperial College, London, UK
| | | | - Massoud Zolgharni
- School of Computing and Engineering, University of West London, St Mary's Rd, Ealing, London, W5 5RF, UK
- National Heart and Lung Institute, Imperial College, London, UK
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Kurtoğlu A, Kurtoğlu E, Konar N, Çar B, Eken Ö, Prieto-González P, Nobari H. Comparison of echocardiographic parameters of amputee football players with active football players and sedentary individuals. BMC Sports Sci Med Rehabil 2023; 15:41. [PMID: 36964618 PMCID: PMC10037385 DOI: 10.1186/s13102-023-00651-1] [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: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 03/26/2023]
Abstract
BACKGROUND The purpose of this study is to compare the echocardiographic (ECHO) parameters of amputee football players (AF) with those of athletes without a disability (football players) (FP), and sedentary individuals (SI). METHODS A total of 37 male participants (nAF = 12, nFP = 12, nSI = 13) were included in the study. All participants underwent a transthoracic echocardiographic examination. Aortic diameter in systole (ADs), aortic diameter in diastole (ADd), isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), left ventricular ejection fraction (LVEF), early (E) and late (A) wave velocities, myocardial systolic (S), early diastolic (E'), and late diastolic (A') myocardial rates, interventricular septal thickness (IVS), left ventricular end-diastolic diameter (LVDd) and left ventricular end-systole diameter (LVDs), left ventricular posterior wall thickness (LVPWd), left atrial diameter (LAD), and ascending aortic diameter (AAD) were measured. RESULTS LVDd, E' were lower in AF than in FP. In contrast, LVDs, LVPWd, and A wave were higher in AF than in FP. When AF and SI groups were compared, ADs, LVPWd, A wave, IVRT, and S wave were higher in AF than in SI. ANOVA test showed a statistically significant difference between groups in LVPWd, A-wave, and E' wave. TTE data indicate that some parameters in AF differ from those observed in healthy individuals. The smaller LVEED diameter and higher PWT were found in AF. CONCLUSIONS Although within normal limits, some ECHO parameters in the AF group differed from those without disability. Future studies should further investigate these differences using different and detailed measurement methods.
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Affiliation(s)
- Ahmet Kurtoğlu
- Department of Coaching, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balikesir, 10200, Turkey
| | - Ertuğrul Kurtoğlu
- Department of Cardiology, Faculty of Medicine, Malatya Turgut Ozal University, Malatya, 44000, Turkey
| | - Nurettin Konar
- Department of Physical Education and Sport Teaching, Faculty of Sport Science, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balıkesir, 10200, Turkey
| | - Bekir Çar
- Department of Physical Education and Sport Teaching, Faculty of Sport Science, Faculty of Sport Science, Bandirma Onyedi Eylul University, Balıkesir, 10200, Turkey
| | - Özgür Eken
- Department of Physical Education and Sport Teaching, Inonu University, Malatya, 44000, Turkey
| | - Pablo Prieto-González
- Health and Physical Education Department, Prince Sultan University, Riyadh, 11586, Saudi Arabia
| | - Hadi Nobari
- Department of Exercise Physiology, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, 56199-11367, Iran.
- Faculty of Sport Sciences, University of Extremadura, Cáceres, 10003, Spain.
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Naseem M, Alkassas A, Alaarag A. Tricuspid annular plane systolic excursion/pulmonary arterial systolic pressure ratio as a predictor of in-hospital mortality for acute heart failure. BMC Cardiovasc Disord 2022; 22:414. [PMID: 36115949 PMCID: PMC9482278 DOI: 10.1186/s12872-022-02857-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 09/12/2022] [Indexed: 11/19/2022] Open
Abstract
Background Right ventricular (RV) function is an important prognostic factor in heart failure. Patients with impaired right ventricular function have a poorer prognosis. The ratio between a tricuspid annular plane systolic excursion (TAPSE) and pulmonary artery systolic pressure (PASP) is a simple non-invasive parameter that has shown a good correlation with invasively estimated right ventricle (RV)-pulmonary artery (PA) coupling. The current study aimed to determine the value of the non-invasive evaluation of RV-PA coupling using the TAPSE/PASP ratio in predicting in-hospital mortality in patients with acute heart failure. Methods We included 200 patients with (heart failure and reduced ejection fraction) HFrEF presented by acute heart failure. Echocardiographic evaluation for left ventricle systolic and diastolic function was performed at the time of admission. RV functions were evaluated by calculating the following (TAPSE, PSAP, TAPSE/PASP ratio). Data were analyzed to find the predictors of in-hospital mortality.
Results The study cohort included two hundred consecutive patients who were hospitalized for a diagnosis of acute decompensation of chronic heart failure. The in-hospital mortality rate was 12%. TAPSE/PASP was an independent predictor for in-hospital mortality (odd ratio = 3.470; 95% confidence interval, 1.240–9.705, p-value = 0.018) and (odd ratio = 18.813; 95% confidence interval, 1.974–179.275, p-value = 0.011) in univariate and multivariable logistic regression analyses respectively. In ROC curve analysis, TAPSE/PASP with a cut-off value < 0.4 mm/mmHg had a sensitivity of 79.17, a specificity of 47.73, and an area under ROC curve = 0.666 for predicting in-hospital mortality. Conclusions The non-invasive TAPSE/PASP ratio could be an independent predictor of mortality in HErEF patients presenting with acute heart failure.
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Giustiniano E, Palma S, Meco M, Ripani U, Nisi F. Echocardiography in Prone Positioned Critically Ill Patients: A Wealth of Information from a Single View. Diagnostics (Basel) 2022; 12:diagnostics12061460. [PMID: 35741270 PMCID: PMC9221662 DOI: 10.3390/diagnostics12061460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Revised: 06/07/2022] [Accepted: 06/10/2022] [Indexed: 02/05/2023] Open
Abstract
In critically ill patients, standard transthoracic echocardiography (TTE) generally does not facilitate good image quality during mechanical ventilation. We propose a prone-TTE in prone positioned patients, which allows clinicians to obtain a complete apical four-chamber (A-4-C) view. A basic cardiac assessment can be performed in order to evaluate right ventricle function and left ventricle performance, even measuring objective parameters, i.e., tricuspid annular plane systolic excursion (TAPSE); pulmonary artery systolic pressure (PAP), from the tricuspid regurgitation peak Doppler velocity; RV end-diastolic diameter and its ratio to left ventricular end-diastolic diameter; the S’ wave peak velocity with tissue Doppler imaging; the ejection fraction (EF); the mitral annular plane systolic excursion (MAPSE); diastolic function evaluation by the mitral valve; and annular Doppler velocities. Furthermore, by tilting the probe, we can obtain the apical-five-chamber (A-5-C) view, which facilitates the analysis of blood flow at the level of the output tract of the left ventricle (LVOT) and then the estimation of stroke volume. Useful applications of this technique are hemodynamic assessment, titration of fluids, vasoactive drugs therapy, and evaluation of the impact of prone positioning on right ventricle performance and right pulmonary resistances. We believe that considerable information can be drawn from a single view and hope this may be helpful to emergency and critical care clinicians whenever invasive hemodynamic monitoring tools are not available or are simply inconvenient due to clinical reasons.
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Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
| | - Sergio Palma
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
| | - Massimo Meco
- Department of Anesthesia and Intensive Care, Humanitas Gavazzeni Clinics, Via Mauro Gavazzeni, 21, 24125 Bergamo, Italy;
| | - Umberto Ripani
- Division of Clinic Anaesthesia, Department of Emergency Hospital Riuniti, Conca Street 71, 60126 Ancona, Italy;
| | - Fulvio Nisi
- Department of Anesthesia, Intensive Care Unit and Pain Therapy, IRCCS Humanitas Clinical and Research Center, 20089 Milan, Italy; (E.G.); (S.P.)
- Correspondence: ; Tel.: +39-02-8224-4115; Fax: +39-02-8224-4190
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Liu QQ, Yang J, Lu D, Xu XQ, Jiang X, Wang H, Li JY, Guo F, Zhu YL, Zhao QH. Time-Velocity Integral of Left Ventricular Outflow Tract Predicts Worse Long-Term Survival in Pulmonary Arterial Hypertension. JACC. ASIA 2022; 2:235-243. [PMID: 36338398 PMCID: PMC9627844 DOI: 10.1016/j.jacasi.2022.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND The time-velocity integral of the left ventricular outflow tract (TVILVOT) has been demonstrated to correlate with heart failure hospitalization and mortality, but the association of TVILVOT with the severity and prognosis of pulmonary arterial hypertension (PAH) has not been evaluated. OBJECTIVES The aim of this study was to investigate the predictive value of baseline TVILVOT in PAH. METHODS A total of 225 consecutive patients with a diagnosis of incident PAH were prospectively studied and echocardiology-derived TVILVOT was measured at enrollment followed by right heart catheterization examination within 48 hours. Cox proportional hazards analysis was performed to assess the association between baseline variables and mortality. RESULTS During a median follow-up period of 33.8 months, 44 patients died of cardiovascular events. Baseline TVILVOT was significantly lower in the nonsurvivors compared with the survivors (P < 0.001). Baseline TVILVOT was positively correlated with stroke volume obtained by right heart catheterization (r = 0.709; P < 0.001), and inversely correlated with N-terminal pro-B-type natriuretic peptide (r = -0.533; P < 0.001), pulmonary vascular resistance (r = -0.423; P < 0.001). Multivariate analysis showed that baseline TVILVOT (hazard ratio: 0.856; 95% CI: 0.780-0.941; P = 0.001) was an independent predictor of cardiovascular mortality in PAH. Patients with a baseline TVILVOT <17.1 cm (median value) had a significantly worse survival than those with a baseline TVILVOT ≥17.1 cm (P < 0.001). CONCLUSIONS The findings of this study suggest that noninvasive TVILVOT provides a practical method to assess the severity and predict long-term outcome of PAH.
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Key Words
- 6MWD, 6-minute walk distance
- BSA, body surface area
- CI, cardiac index
- CMR, cardiac magnetic resonance imaging
- CO, cardiac output
- HR, hazard ratio
- LV, left ventricular
- LVOT, left ventricular outflow tract
- NT-proBNP, N-terminal pro–B-type natriuretic peptide
- PAH, pulmonary arterial hypertension
- PVR, pulmonary vascular resistance
- RHC, right heart catheterization
- RV, right ventricular
- STr, peak systolic tricuspid annular velocity of tissue Doppler
- SVRHC, stroke volume obtained by right heart catheterization
- TAPSE, tricuspid annular plane systolic excursion
- TTE, transthoracic echocardiography
- TVI, time-velocity integral
- TVILVOT, time-velocity integral of left ventricular outflow tract
- WHO-FC, World Health Organization functional class
- left ventricular outflow tract
- pulmonary arterial hypertension
- survival
- time-velocity integral
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Affiliation(s)
- Qian-Qian Liu
- Department of Echocardiography, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing Yang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dan Lu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi-Qi Xu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xin Jiang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hui Wang
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jing-Yi Li
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fan Guo
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yan-Lin Zhu
- Department of Cardiology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qin-Hua Zhao
- Department of Pulmonary Circulation, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Sisinni A, Munafò A, Pivato CA, Adamo M, Taramasso M, Scotti A, Parlati AL, Italia L, Voci D, Buzzatti N, Denti P, Ancona F, Marengo A, Sala A, Bodega F, Ruffo MM, Curello S, Castiglioni A, Montorfano M, de Bonis M, Alfieri O, Agricola E, Colombo A, Maisano F, Metra M, Margonato A, Godino C. Effect of Chronic Kidney Disease on 5-Year Outcome in Patients With Heart Failure and Secondary Mitral Regurgitation Undergoing Percutaneous MitraClip Insertion. Am J Cardiol 2022; 171:105-114. [PMID: 35317926 DOI: 10.1016/j.amjcard.2022.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 01/20/2022] [Accepted: 01/26/2022] [Indexed: 11/01/2022]
Abstract
Chronic kidney disease (CKD) is strongly related to outcomes in cardiovascular diseases. Limited data are available regarding the independent prognostic role of CKD after transcatheter mitral valve repair with MitraClip. We sought to evaluate the real impact of CKD in a large series of patients with heart failure (HF) and secondary mitral regurgitation (SMR) who underwent MitraClip treatment. The study included 565 patients with severe SMR from a multicenter international registry. Patients were stratified into 3 groups according to estimated glomerular filtration rate (eGFR) assessment before MitraClip implantation: normal eGFR (≥60 ml/min/1.73 m2) (n = 196), mild-to-moderate CKD (30 to 59 ml/min/1.73 m2) (n = 267), and severe CKD (<30 ml/min/1.73 m2) (n = 102). The primary end point was a composite of overall death and the first rehospitalization for HF, the secondary end points were overall death, cardiac death, and first rehospitalization for HF. CKD was present in about 2/3 of patients. At 5-year Kaplan-Meier analysis, primary clinical end point occurred in 60% of patients with normal eGFR, compared with 73% cases in patients with mild-to-moderate CKD and 91% in patients with severe CKD (p <0.001). Long-term overall death rate significantly decreased with increasing eGFR, and cardiac death and rehospitalization for HF rates. Multivariate Cox regression analysis identified severe CKD as the strongest independent predictor of adverse outcome (hazard ratio 2.136, 95% confidence interval 1.164 to 3.918, p = 0.014). In conclusion, CKD affected about 2/3 of patients who underwent MitraClip treatment for severe SMR, and it was a strong and independent predictor of 5-year adverse outcomes.
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Araújo CGD, Resende MBS, Tupinambás JT, Dias RCTM, Barros FC, Vasconcelos MCM, Januário JN, Ribeiro ALP, Nunes MCP. Testes Ergométricos em Pacientes com Anemia Falciforme: Segurança, Viabilidade e Possíveis Implicações no Prognóstico. Arq Bras Cardiol 2022; 118:565-575. [PMID: 35319606 PMCID: PMC8959037 DOI: 10.36660/abc.20200437] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 03/24/2021] [Indexed: 01/20/2023] Open
Abstract
Fundamento Pacientes com anemia falciforme (AF) têm risco aumentado de complicações cardiovasculares. O teste ergométrico é usado como marcador de prognóstico em uma série de doenças cardiovasculares. Entretanto, há uma escassez de evidências sobre exercícios em pacientes com AF, especialmente em relação à sua segurança, viabilidade e possível função prognóstica. Objetivos Usamos o teste em esteira máximo para determinar a segurança e a viabilidade do teste ergométrico em pacientes com AF. Além disso, os fatores associados à duração do exercício, bem como o impacto das alterações causadas pelo exercício em resultados clínicos, também foram avaliados. Métodos 113 pacientes com AF que passaram pelo teste ergométrico e por uma avaliação cardiovascular abrangente incluindo um ecocardiograma e os níveis do peptídeo natriurético do tipo B (BNP). O desfecho de longo prazo foi uma combinação de eventos incluindo morte, crises álgicas graves, síndrome torácica aguda ou internações hospitalares por outras complicações associadas â doença falciforme. A análise de regressão de Cox foi realizada para identificar as variáveis associadas ao resultado. Um p valor <0,05 foi considerado estatisticamente significativo. Resultados A média de idade foi de 36 ± 12 anos (intervalo, 18-65 anos), e 62 pacientes eram do sexo feminino (52%). A presença de alterações isquêmicas ao esforço e resposta pressórica anormal ao exercício foram detectadas em 17% e 9 % da´população estudada respectivamente. Dois pacientes apresentaram crise álgica com necessidade de internação hospitalar no período de 48 horas da realização do exame. Fatores associados à duração do exercício foram idade, sexo, velocidade máxima de regurgitação tricúspide (RT), e relação E/e’, após a padronização quanto aos marcadores da gravidade da doença. Durante o período médio de acompanhamento de 10,1 meses (variando de 1,2 a 26), 27 pacientes (23%) apresentaram desfechos clínicos adversos. Preditores independentes de eventos adversos foram a concentração de hemoglobina, velocidade do fluxo transmitral tardio (onda A), e a resposta da PA ao exercício. Conclusões A realização de testes ergométricos em pacientes com AF, clinicamente estáveis, é viável. A duração do exercício estava associada à função diastólica e a pressão arterial pulmonar. A resposta anormal da PA foi um preditor independente de eventos adversos.
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Ji M, Wu W, He L, Gao L, Zhang Y, Lin Y, Qian M, Wang J, Zhang L, Xie M, Li Y. Right Ventricular Longitudinal Strain in Patients with Heart Failure. Diagnostics (Basel) 2022; 12:diagnostics12020445. [PMID: 35204536 PMCID: PMC8871506 DOI: 10.3390/diagnostics12020445] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 02/03/2022] [Accepted: 02/04/2022] [Indexed: 11/16/2022] Open
Abstract
Patients with heart failure (HF) have high morbidity and mortality. Accurate assessment of right ventricular (RV) function has important prognostic significance in patients with HF. However, conventional echocardiographic parameters of RV function have limitations in RV assessments due to the complex geometry of right ventricle. In recent years, speckle tracking echocardiography (STE) has been developed as promising imaging technique to accurately evaluate RV function. RV longitudinal strain (RVLS) using STE, as a sensitive index for RV function evaluation, displays the powerfully prognostic value in patients with HF. Therefore, the aim of the present review was to summarize the utility of RVLS in patients with HF.
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Affiliation(s)
- Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Wenqian Wu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lin He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yanting Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingzhu Qian
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Jing Wang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Shenzhen Huazhong University of Science and Technology Research Institute, Shenzhen 518057, China
- Tongji Medical College and Wuhan National Laboratory for Optoelectronics, Huazhong University of Science and Technology, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (M.J.); (W.W.); (L.H.); (L.G.); (Y.Z.); (Y.L.); (M.Q.); (J.W.); (L.Z.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
- Correspondence: (M.X.); (Y.L.); Tel.: +86-27-8572-6430 (M.X.); +86-27-8572-6386 (Y.L.); Fax: +86-27-8572-6386 (M.X.); +86-27-8572-6386 (Y.L.)
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Kulagina TY, Sandrikov VA, Van EY, Zyabirova RZ, Petrova YN. Evaluation of right and left ventricular function in patients with ischemic heart disease complicated by mitral insufficiency. KARDIOLOGIIA 2022; 62:46-56. [PMID: 35168533 DOI: 10.18087/cardio.2022.1.n1695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/16/2021] [Indexed: 01/10/2023]
Abstract
Aim To evaluate the right and left ventricular function and their interaction in patients with ischemic heart disease (IHD) complicated with mitral valve insufficiency (MVI) according to data of echocardiography (EchoCG) with the strain in gray scale, vector and diagram analyses.Material and methods The study included 118 patients evaluated with EchoCG at the preoperative stage of treatment; 71 of these patients had ischemic MVI (group 1) and 47 patients had uncomplicated IHD (group 2 or comparison group). Mean age of patients was 64±10 years. All patients underwent a surgery in an appropriate volume for myocardial revascularization supplemented with mitral valve plasty or replacement in patients with MVI. Standard EchoCG parameters and data obtained by postprocessing the EchoCG gray-scale images using the strain in gray scale, vector and diagram analyses were evaluated.Results In patients with complicated IHD, both global and local left ventricular (LV) systolic function and the right ventricular (RV) fractional area change (FAC) were significantly decreased. At the same time, there were no significant differences in the tricuspid annular plane systolic excursion (TAPSE) measured in M-mode and in the tricuspid annular systolic wave velocity (VSta), which also characterize the RV systolic function. The global longitudinal strain, the velocities of LV volume change and RV area change, and the long axis change velocity were informative for the right and left chambers, whereas the velocities of LV volume and RV area changes better detected RV disorders. The Pearson's correlation analysis used to identify the most significant parameters of interventricular interaction showed the presence of a strong inverse correlation, in the group of MVI patients, between the RV FAC and the degree of LV diastolic dysfunction (Е / e') - r= -0,62; p=0.000, as well аs the degree of MVI (vena contracta) - r= -0.58; p=0.001. In the comparison group of IHD patients without MVI, the correlation of RV FAC with E / e' was absent (r=0.28; p=0.192). The volume change velocity (dVol / dt) moderately correlated with the RV end-systolic and end-diastolic area in IHD patients but not in IHD patients with MVI. The RV area change velocity (dS / dt) evaluated during systole and diastole moderately significantly correlated with the LV end-diastolic volume.Conclusion Additional overload of left heart chambers in ischemic MVI is a factor that influences the development of the systemic and pulmonary circuit disorders. Recording and evaluation of global longitudinal strain, LV volume change velocity, and long axis change velocity with simultaneous recording of the segmental myocardial displacement velocity serve as highly informative criteria for disorders of LV and RV function. The vector analysis allows quantitative estimation of the local segmental myocardial function. Decreased velocities of the free RV wall segmental displacements during systole and diastole are characteristic of systolic and diastolic dysfunction in patients with IHD complicated with mitral regurgitation.
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Affiliation(s)
- T Yu Kulagina
- Scientific Institution "Petrovsky national research centre of surgery", Moscow
| | - V A Sandrikov
- Scientific Institution "Petrovsky national research centre of surgery", Moscow
| | - E Yu Van
- Scientific Institution "Petrovsky national research centre of surgery", Moscow
| | - R Z Zyabirova
- Scientific Institution "Petrovsky national research centre of surgery", Moscow
| | - Yu N Petrova
- Scientific Institution "Petrovsky national research centre of surgery", Moscow
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Mohsin M, Farooq MU, Akhtar W, Mustafa W, Rehman TU, Malik J, Zahid T. Echocardiography in a critical care unit: A contemporary review. Expert Rev Cardiovasc Ther 2022; 20:55-63. [PMID: 35098852 DOI: 10.1080/14779072.2022.2036124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Echocardiography is a rapid, noninvasive, and complete cardiac assessment tool for patients with hemodynamic instability. This review provides an overview of the evidence for current practices in critical care units (CCUs), incorporating the use of echocardiography in different etiologies of shock. AREAS COVERED : Relevant articles were extracted after searching on databases by two reviewers and incorporated in this review in a narrative style. EXPERT OPINION : In an acute scenario, a basic echocardiographic study yields prompt diagnosis, allowing for the initiation of treatment. The most common pathologies in shocked patients are identified promptly using two-dimensional (2D) and M-mode echocardiography. A more comprehensive assessment can follow after patients have been stabilized. There are four types of shock: (i) cardiogenic shock, (ii) hypovolemic shock, (iii) obstructive shock, and (iv) septic shock. All of them can be readily identified by echocardiography. As echocardiography is increasingly being used in an intensive care setting, its applications and evidence base should be expanded by randomized controlled trials to demonstrate patient outcomes in critical care.
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Affiliation(s)
- Muhammad Mohsin
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Muhammad Umar Farooq
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Waheed Akhtar
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, 13190, Pakistan
| | - Waqar Mustafa
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, 13190, Pakistan
| | - Tanzeel Ur Rehman
- Department of Cardiology, Benazir Bhutto Hospital, Rawalpindi, 46000, Pakistan
| | - Jahanzeb Malik
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, 46000, Pakistan
| | - Taimoor Zahid
- Department of Medicine, Warwick Hospital, Warwickshire, United Kingdom
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18
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Poupore NS, Gudipudi R, Nguyen SA, Pecha PP, Pecha TJ, Carroll WW. Tissue Doppler echocardiography in children with OSA before and after tonsillectomy and adenoidectomy: A systematic review and meta-analysis. Int J Pediatr Otorhinolaryngol 2022; 152:111002. [PMID: 34894539 DOI: 10.1016/j.ijporl.2021.111002] [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: 09/23/2021] [Revised: 11/09/2021] [Accepted: 12/04/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND When to order an echocardiogram in children with obstructive sleep apnea (OSA) is debated. Studies evaluating the utility of pre-operative standard echocardiography are inconsistent. Tissue Doppler imaging (TDI) is an additional technique that quantifies the velocity of myocardial motion to assess cardiac function. The utility of TDI in pediatric OSA remains unclear. METHODS A systematic review and meta-analysis were performed in accordance with PRISMA guidelines using PubMed, Scopus, CINAHL, and Cochrane Library databases. Studies of echocardiographic findings using TDI in children with polysomnogram confirmed OSA before and after tonsillectomy and adenoidectomy (T&A) were included. 1,423 studies were screened, and 4 studies met inclusion criteria. Meta-analysis of echocardiographic findings was performed. RESULTS Data from 560 children were analyzed. Study groups included pre- and post-T&A children with OSA and non OSA controls. Pre-T&A S' wave at the tricuspid annulus (S' RV) was decreased with a mean difference of -1.04 [95% CI -1.57, -0.52, p < 0.001] and E'/A' ratio at the mitral annulus (E'/A' LV) was decreased with a mean difference of -0.74 [95% CI -0.85, -0.64, p < 0.001] when compared to controls. These variables were not statistically different when comparing post-T&A to controls. CONCLUSIONS TDI appears to successfully detect subclinical changes in cardiac function in children with OSA. However, echocardiography parameters of post-T&A and non OSA control children were similar. Further prospective studies stratified by OSA severity are needed with both TDI and standard echocardiography to define the utility of pre-operative cardiac imaging.
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Affiliation(s)
- Nicolas S Poupore
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; University of South Carolina School of Medicine Greenville, 607 Grove Road, Greenville, SC, 29605, USA.
| | - Rachana Gudipudi
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA; Case Western Reserve University School of Medicine, 9501 Euclid Ave, Cleveland, OH, 44106, USA
| | - Shaun A Nguyen
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Phayvanh P Pecha
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
| | - Travis J Pecha
- Medical University of South Carolina, Department of Anesthesia and Perioperative Medicine, 167 Ashley Avenue, MSC912, Charleston, SC, 29425, USA
| | - William W Carroll
- Medical University of South Carolina, Department of Otolaryngology - Head and Neck Surgery, 135 Rutledge Avenue, MSC550, Charleston, SC, 29425, USA
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Stanley A, Athanasuleas C, Nanda N. Paradoxical Septal Motion after Uncomplicated Cardiac Surgery: A Consequence of Altered Regional Right Ventricular Contractile Patterns. Curr Cardiol Rev 2022; 18:e060122200068. [PMID: 34994332 PMCID: PMC9893138 DOI: 10.2174/1573403x18666220106115117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 11/18/2021] [Accepted: 11/24/2021] [Indexed: 11/22/2022] Open
Abstract
Paroxysmal interventricular septal motion (PSM) is the movement of the septum toward the right ventricle (RV) during cardiac systole. It occurs frequently after uncomplicated cardiac surgery (CS), including coronary bypass (on-pump and off-pump), valve repair or replacement, and with all types of incisions (sternotomy or mini-thoracotomy). It sometimes resolves quickly but may persist for months or become permanent. Global RV systolic function, stroke volume and ejection fraction remain normal after uncomplicated CS, but regional contractile patterns are altered. There is a decrease in longitudinal shortening but an increase in transverse shortening in the endocardial and epicardial right ventricular muscle fibers, respectively. PSM is a secondary event as there is no loss of septal perfusion or thickening. The increased RV transverse shortening (free wall to septal fibers) may modify septal movement resulting in PSM that compensates for the reduced RV longitudinal shortening, thus preserving normal global right ventricular function.
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Affiliation(s)
- Alfred Stanley
- Cardiovascular Associates of the Southeast, Birmingham AL and Kemp-Carraway Heart Institute, Birmingham AL, USA
| | - Constantine Athanasuleas
- Department of Surgery, Section of Cardiothoracic Surgery, University of Alabama at Birmingham, Birmingham, AL and Kemp-Carraway Heart Institute, Birmingham AL, USA
| | - Navin Nanda
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Birmingham AL, USA
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20
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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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21
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Differences in clinical and echocardiographic variables and mortality predictors among older patients with pulmonary embolism. Aging Clin Exp Res 2021; 33:2223-2230. [PMID: 33999379 DOI: 10.1007/s40520-021-01882-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND An increase in short-term mortality can be found among older patients with hemodynamically stable acute pulmonary embolism (APE) who have signs of right ventricular (RV) dysfunction. AIMS This study was designed to assess whether any difference exists among clinical, laboratory, electrocardiography and echocardiography parameters between older and younger patients diagnosed with APE. METHODS The study sample included a total of 635 patients with confirmed APE who were divided into two groups of older (65 years and older) and younger (younger than 65 years) individuals. Comparisons were performed between these groups in terms of clinical, predisposing factors and laboratory, electrocardiographic and echocardiographic parameters. RESULTS Analyses of 295 (46.4%) older and 340 (53.6%) younger patients diagnosed with APE were performed. Female sex, Pulmonary Embolism Severity Index score and baseline creatinine levels were higher in the older group. Also, the frequency of atrial fibrillation, RV outflow tract parasternal long-axis proximal diameter, RV end-diastolic diameter (RV-EDD) basal (apical four-chamber) and RV systolic pressure were significantly greater in older patients with APE. A total of 30 (4.7%) deaths were observed during the in-hospital period [21 (7.1%) older vs 9 (2.6%) younger patients; p < 0.01]. In the multivariate logistic regression analysis, age, white blood cell count (WBC), left ventricular ejection fraction (LVEF), RV-EDD basal and tricuspid annular plane systolic excursion (TAPSE) of less than 16 mm were found to be independently associated with in-hospital mortality. CONCLUSION Older patients might experience greater rates of RV dilatation, RV dysfunction and atrial fibrillation during APE. In addition to age; elevated WBC, low LVEF, increased RV-EDD basal and TAPSE of less than 16 mm were independent predictors of mortality among study population.
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22
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The Impact of Septoplasty on Cardiopulmonary Functions in Patients With Nasal Septal Deviation: A Prospective Comprehensive Analysis of Echocardiographic Outcome and Serum N-Terminal Pro BNP Levels. J Craniofac Surg 2021; 33:35-40. [PMID: 34267121 DOI: 10.1097/scs.0000000000007801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ABSTRACT This study was designed to evaluate the impact of septoplasty on cardiopulmonary functions in patients with nasal septal deviation (NSD). A total of 30 consecutive adult patients (mean [standard deviation] age: 33.7 [10.9] years, 56.7% were males) who underwent septoplasty due NSD were included. Visual analog scale scores, nose obstruction symptom evaluation scale scores, serum N-terminal Pro BNP levels, and cardiologic examination findings on electrocardiogram, transthoracic echocardiography, and exercise treadmill testing were evaluated both 7 days before and 3-months after septoplasty operation. A significant decrease was noted in mean (standard deviation) visual analog scale scores (8.27 [0.83] versus 1.87 [0.73], P < 0.001), and nose obstruction symptom evaluation scores (83.7 [4.9] versus 12.7 [(5.4], P < 0.001) from preoperative to postoperative period, while maximum effort capacity was improved significantly (11.8 [1.9] versus 13.1 [2.1], P = 0.010) after septoplasty. Echocardiography findings at 3rd postoperative month revealed significant decrease in pulmonary artery systolic pressure (22.2 [3.2] versus 19.0 [3.6], P = 0.001), whereas significant increase in trans-mitral early diastolic rapid filling (E wave, 0.82 [0.14] versus 0.87 [0.13], P = 0.011), peak systolic velocity (S, 0.11 [0.02] versus 0.12 [0.02], P = 0.002), tricuspid annular plane systolic excursion (22.6 [3.2] versus 24.9 [2.9], P = 0.002), and right ventricle stroke volume (0.14 [(0.02] versus 0.15 [0.02], P = 0.013). In conclusion, our findings indicate favorable outcome of septoplasty in NSD patients not only in terms of improved nasal airflow but also cardiopulmonary functions, particularly the exercise capacity, pulmonary artery pressure, and right ventricular systolic functions. In this regard, our findings emphasize the important role of treating NSD patients without delay, given the likelihood of septoplasty to reverse the changes in the pulmonary artery system and to prevent onset of permanent cardiopulmonary dysfunction via amelioration of chronic obstruction of the upper respiratory tract.
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Bech-Hanssen O, Astengo M, Fredholm M, Bergh N, Hjalmarsson C, Polte CL, Ricksten SE, Bollano E. Grading right ventricular dysfunction in left ventricular disease using echocardiography: a proof of concept using a novel multiparameter strategy. ESC Heart Fail 2021; 8:3223-3236. [PMID: 34034360 PMCID: PMC8318504 DOI: 10.1002/ehf2.13448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/19/2021] [Accepted: 05/16/2021] [Indexed: 01/18/2023] Open
Abstract
Aims Grading right ventricular dysfunction (RVD) in patients with left ventricular (LV) disease has earned little attention. In the present study, we established an echocardiographic RVD score and investigated how increments of the score correspond to RVD at right heart catheterization. Methods and results We included 95 patients with LV disease consecutively referred for heart transplant or heart failure work‐up with catheterization and echocardiography within 48 h. The RVD score (5 points) included well‐known characteristics of the development from compensated to decompensated right ventricular (RV) function: pulmonary hypertension, reduced RV strain, RV area dilatation, moderate/severe tricuspid regurgitation, and increased right atrial pressure (RAP) by echocardiography. Comparing three groups with increments of RVD score [1 (mild), 2–3 (moderate), and 4–5 (severe)] showed more advanced RVD with increasing RV end‐diastolic pressure (P < 0.001) and signs of uncoupling to load (reduced ratio between RV and pulmonary artery elastance, P < 0.001) and more spherical RV shape (RV area/length, P < 0.001). Receiver operating characteristic curve analysis for detection of severe RV (RAP ≥ 10 mmHg) showed for the RVD score an area under the curve of 0.88 compared with 0.69, 0.68, and 0.64 for RV strain, tricuspid annular plane systolic excursion, and fractional area change, respectively. A patient with RVD score ≥ 4 had a 6.7‐fold increase in likelihood of severe RVD, and no patient with RVD score ≤ 1 had severe RVD. Conclusions In this proof of concept study, a novel RVD score outperformed the widely used longitudinal parameters regarding grading of RVD severity, with a potential role for refined diagnosis, follow‐up, and prognosis assessment in heart failure patients.
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Affiliation(s)
- Odd Bech-Hanssen
- Departments of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Marco Astengo
- Departments of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Martin Fredholm
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Niklas Bergh
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Clara Hjalmarsson
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christian Lars Polte
- Departments of Clinical Physiology, Institute of Medicine at the Sahlgrenska Academy, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Anaesthesiology and Intensive Care Medicine, Gothenburg, Sweden
| | - Entela Bollano
- Institution of Medicine, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Alerhand S, Sundaram T, Gottlieb M. What are the echocardiographic findings of acute right ventricular strain that suggest pulmonary embolism? Anaesth Crit Care Pain Med 2021; 40:100852. [PMID: 33781986 DOI: 10.1016/j.accpm.2021.100852] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 12/24/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Pulmonary embolism (PE) is a potentially fatal disease encountered in the hospital setting. Prompt diagnosis and management can improve outcomes and survival. Unfortunately, a PE may be difficult to diagnose in a timely manner. Point-of-care ultrasound (POCUS) can assist in the evaluation for suspected PE by assessing for acute right ventricular strain. Physicians should thus be aware of these echocardiographic findings. OBJECTIVE This manuscript will review ten echocardiographic findings of right ventricular strain that may suggest a diagnosis of PE. It will provide a description of each finding along with the associated pathophysiology. It will also summarize the literature for the diagnostic utility of echocardiography for this indication, while providing reference parameters where applicable. Along with labeled images and video clips, the review will then illustrate how to evaluate for each of the ten findings, while offering pearls and pitfalls in this bedside evaluation. DISCUSSION The ten echocardiographic findings of right ventricular strain are: increased right ventricle: left ventricle size ratio, abnormal septal motion, McConnell's sign, tricuspid regurgitation, elevated pulmonary artery systolic pressure, decreased tricuspid annular plane systolic excursion, decreased S', pulmonary artery mid-systolic notching, 60/60 sign, and speckle tracking demonstrating decreased right ventricular free wall strain. CONCLUSIONS Physicians must recognize and understand the echocardiographic findings and associated pathophysiology of right ventricular strain. In the proper clinical context, these findings can point toward a diagnosis of PE and thereby lead to earlier initiation of directed management.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Tina Sundaram
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Kellogg Suite 108, Chicago, IL 60612, USA
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, 1750 W. Harrison Street, Kellogg Suite 108, Chicago, IL 60612, USA
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25
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Godino C, Sisinni A, Pivato CA, Adamo M, Taramasso M, Parlati A, Italia L, Voci D, Scotti A, Munafò A, Buzzatti N, Denti P, Ancona F, Fiore G, Sala A, Vergara P, Bodega F, Ruffo MM, Curello S, Castiglioni A, De Bonis M, Alfieri O, Agricola E, Maisano F, Metra M, Colombo A, Margonato A. Prognostic Value of Pre-operative Atrial Fibrillation in Patients With Secondary Mitral Regurgitation Undergoing MitraClip Implantation. Am J Cardiol 2021; 143:51-59. [PMID: 33359201 DOI: 10.1016/j.amjcard.2020.12.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/06/2020] [Accepted: 12/08/2020] [Indexed: 12/30/2022]
Abstract
Limited data are available regarding the independent prognostic role of preoperative atrial fibrillation (AF) after transcatheter mitral valve repair with MitraClip. We sought to evaluate the impact of preoperative AF in patients with heart failure (HF) and concomitant secondary mitral regurgitation (MR) after MitraClip treatment. The study included 605 patients with significant secondary MR from a multicenter international registry. Patients were stratified into 2 groups according to the presence or absence of preoperative AF. Primary end point was 5-year overall death, secondary end points were 5-year cardiac death and first re-hospitalization for HF. To account for baseline differences, patients were propensity score matched 1:1. The overall prevalence of preoperative AF was 44%. At 5-year Kaplan-Meier analysis, compared with patients without AF, those with AF had significantly more adverse events in term of overall death (67% vs 43%; HR 1.84, log-rank p <0.001) and cardiac death (56% vs 29%; HR 2.11, log-rank p <0.001) and re-hospitalization for HF (63% vs 52%; HR 1.33, log-rank p = 0.048). Multivariate analysis identified AF as independent predictor of worse outcome in term of primary end point (HR 1.729, 95% C.I. 1.060 to 2.821; p = 0.028). After propensity score matching, patients with AF had higher rates of death and cardiac mortality but similar rates of re-hospitalization for HF. In conclusion, in patients with HF undergoing MitraClip treatment for secondary MR, preoperative AF is common and an unfavourable predictor of 5-year death and cardiac death. However, AF did not affect the frequency of re-hospitalization for HF.
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Affiliation(s)
- Cosmo Godino
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy..
| | - Antonio Sisinni
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Carlo Andrea Pivato
- Humanitas Clinical and Research Center IRCCS - Rozzano, Milan, Italy.; Department of Biomedical Sciences - Pieve Emanuele, Humanitas University, Milan, Italy
| | - Marianna Adamo
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | - Antonio Parlati
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Leonardo Italia
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | - Davide Voci
- Division of Cardiac Surgery, University Hospital Zürich, Switzerland
| | - Andrea Scotti
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, University of Padua Medical School, Padua, Italy
| | - Andrea Munafò
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Nicola Buzzatti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Paolo Denti
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Ancona
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Giorgio Fiore
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Alessandra Sala
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Pasquale Vergara
- Arrhythmias and Cardiac Electrophysiology, Ospedale San Raffaele, Milan, Italy
| | - Francesca Bodega
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | | | - Salvatore Curello
- Cardiac Catheterization Laboratory, Cardiothoracic Department, Spedali Civili, Brescia, Italy
| | | | - Michele De Bonis
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Ottavio Alfieri
- Department of Cardiac Surgery, San Raffaele Scientific Institute, Milan, Italy
| | - Eustachio Agricola
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Maisano
- Division of Cardiac Surgery, University Hospital Zürich, Switzerland
| | - Marco Metra
- Cardiology Unit, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health University, Cardiothoracic Department, Spedali Civili of Brescia, Brescia, Italy
| | - Antonio Colombo
- Cardiology Unit, GVM Care & Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Alberto Margonato
- Cardiovascular Department, San Raffaele Scientific Institute, Milan, Italy
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Billig S, Zayat R, Ebeling A, Steffen H, Nix C, Hatam N, Schnöring H, Derwall M. Transesophageal echocardiography in swine: evaluation of left and right ventricular structure, function and myocardial work. Int J Cardiovasc Imaging 2021; 37:835-846. [PMID: 33048268 PMCID: PMC7969559 DOI: 10.1007/s10554-020-02053-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 09/29/2020] [Indexed: 02/07/2023]
Abstract
This study aimed to determine standard left (LV) and right ventricular (RV) transesophageal echocardiographic (TEE) measurements in swine. Additionally, global myocardial work index (GWI) was estimated using pressure-strain loops (PSL). A comprehensive TEE examination was conducted in ten anesthetized, intubated and mechanically ventilated healthy female German landrace swine, weighing 44 to 57 kg. For GWI calculation, we performed LV and RV segmental strain analysis and used invasively measured LV and RV pressure to obtain PSL. The GWI and further myocardial work indices were calculated from the area of the PSL using commercially available software. Furthermore, hemodynamic measurements were obtained using indwelling catheters. We obtained complete standardized baseline values for left and right ventricular dimensions and function. Biplane LV ejection fraction was 63 ± 7 % and the LV end-diastolic volume was 70.5 ± 5.9 ml. Tissue Doppler estimated peak tricuspid annular systolic velocity was 13.1 ± 1.8 cm/s. The Doppler estimated LV and RV stroke volume index were 75.6 ± 7.2 ml/m2 and 76.7 ± 7.8 ml/m2 respectively. Pulsed wave Doppler derived cardiac output correlated well with cardiac output estimated using the thermodilution method (7.0 ± 1.2 l/min vs. 7.0 ± 1.1 l/min, r = 0.812, p = 0.004). The LV global longitudinal strain was -21.3 ± 3.9 % and the RV global longitudinal strain was -15.4 ± 2.5 %. LV GWI was 1885(1281-2121) mmHg*% and 297 ± 62 mmHg*% for the RV. LV global myocardial work efficiency was 82.6 ± 4 % and 83(72-88) % for the RV. TEE offers sufficient morphological, functional and hemodynamic assessment of the heart in swine. Myocardial contractility and mechanics can be reliably evaluated with the non-invasive GWI derived from echocardiography without additional invasive measures.
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Affiliation(s)
- Sebastian Billig
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Rashad Zayat
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Andreas Ebeling
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Henning Steffen
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Christoph Nix
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
- Abiomed Europe GmbH, Neuenhofer Weg 3, Aachen, 52074, Germany
| | - Nima Hatam
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Heike Schnöring
- University Hospital RWTH Aachen, Department of Thoracic and Cardiovascular Surgery, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany
| | - Matthias Derwall
- University Hospital RWTH Aachen, Department of Anesthesiology, Medical Faculty, RWTH Aachen University, Pauwelsstr. 30, Aachen, 52074, Germany.
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Guliyeva A, Cakir E, Yazan H, AlShadfan L, Sharifov R, Temur HO, Karaarslan U, Yozgat CY, Erenberk U, Yakut K, Yozgat Y. Assessment of Right Heart Functions in Children with Mild Cystic Fibrosis. KLINISCHE PADIATRIE 2021; 233:231-236. [PMID: 33601431 DOI: 10.1055/a-1341-1698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Cystic fibrosis (CF) is a multisystemic disease that prevalently involves the lungs. Hypoxemia occurs due to the existing of progressive damage to the pulmonary parenchyma and pulmonary vessels. The condition may cause systolic and diastolic dysfunction to the right ventricle due to the effects of high pulmonary artery systolic pressure (PASP). The study aimed to determine echocardiographic alterations in PASP, right ventricle (RV) anatomy, and functions in mild CF children. MATERIALS AND METHODS RV anatomy, systolic, and diastolic functions were evaluated with conventional echocardiographic measurements. Estimated PASP was used measured with new echocardiographic modalities, including pulmonary artery acceleration time (PAAT), right ventricular ejection time (RVET), and their ratio (PAAT/RVET). The obtained echocardiographic data were statistically compared between the patient group and the control group. RESULTS The study consisted of 30 pediatric patients with mild CF and 30 healthy children with similar demographics. In patient group, conventional parameters disclosed differences in RV anatomy, both systolic and diastolic functions of RV compared with the healthy group. We did not compare the patient group with published standard data because of the wide range variability. However, new echocardiographic parameters showed notable increase in pulmonary artery pressure compared with values of control group and published standard data (p<0.001). CONCLUSION Elevated PASP, RV failure, and Cor pulmonale usually begin early in children with mild CF. In addition to routine echocardiographic measurements to evaluate RV, we recommend the use of new echocardiographic modalities for routine examinations and in the follow up of children with mild CF.
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Affiliation(s)
- Aynur Guliyeva
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Erkan Cakir
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Hakan Yazan
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | - Lina AlShadfan
- Pediatric Pulmonology, Bezmialem Vakif University, Istanbul, Turkey
| | | | | | - Utku Karaarslan
- Pediatric Intensive Care Unit, Dr Behcet Uz Child Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | | | - Ufuk Erenberk
- Pediatrics, Bezmialem Vakif University, Istanbul, Turkey
| | - Kahraman Yakut
- Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
| | - Yilmaz Yozgat
- Pediatric Cardiology, Bezmialem Vakif University, Istanbul, Turkey
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Amr NH, Mahmoud RAA, Youssef O, Toaima NN, Elsedfy H. Effect of long-term glucocorticoid therapy on cardiac functions in children with congenital adrenal hyperplasia. Clin Endocrinol (Oxf) 2021; 94:210-218. [PMID: 32946608 DOI: 10.1111/cen.14333] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 08/26/2020] [Accepted: 09/02/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Glucocorticoids play an important role in cardiac physiology. Chronic exposure and higher doses may cause adverse effects on the myocardium, especially in young patients receiving long-term therapy. OBJECTIVE To assess cardiac function in children with congenital adrenal hyperplasia (CAH) and its relation to glucocorticoid dose and therapy duration. METHODS Forty-seven patients with CAH due to 21-hydroxylase deficiency were compared to 47 controls. Patients were subdivided according to treatment duration (Group A: less than 6 years, Group B: more than 6 years). Mean daily glucocorticoid and cumulative glucocorticoid doses were calculated. Echocardiography was performed for patients and controls to evaluate cardiac functions, chamber dimensions and tissue Doppler valvular status. RESULTS Compared to controls, patients had cardiac chamber hypertrophy reflected by higher M-mode dimensions. Patients had lower fractional shortening, defective ventricular relaxation, lower average mitral and tricuspid e´/a´ ratios (e´ early diastolic, a´ late diastolic) as well as s´ (systolic) velocities, higher average mitral E/e ratio and higher left ventricle TDI Tei index (P < .05). Group B had lower average mitral e´/a´ and tricuspid s´ velocities, and higher average mitral E/e ratio (P < .05). Cumulative glucocorticoid dose significantly correlated with different echocardiographic parameters. CONCLUSION Long-term glucocorticoid therapy even within the recommended therapeutic range adversely affects cardiac functions in children with 21-hydroxylase deficiency.
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Affiliation(s)
| | | | - Omneyia Youssef
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
| | | | - Heba Elsedfy
- Department of Pediatrics, Ain Shams University, Cairo, Egypt
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29
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Benes J, Kotrc M, Jarolim P, Hoskova L, Hegarova M, Dorazilova Z, Podzimkova M, Binova J, Lukasova M, Malek I, Franekova J, Jabor A, Kautzner J, Melenovsky V. The effect of three major co-morbidities on quality of life and outcome of patients with heart failure with reduced ejection fraction. ESC Heart Fail 2021; 8:1417-1426. [PMID: 33512782 PMCID: PMC8006738 DOI: 10.1002/ehf2.13227] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 12/28/2020] [Accepted: 01/13/2021] [Indexed: 12/18/2022] Open
Abstract
Aims Diabetes mellitus, chronic obstructive pulmonary disease, and chronic kidney disease are prevalent in patients with heart failure with reduced ejection fraction (HFrEF). We have analysed the impact of co‐morbidities on quality of life (QoL) and outcome. Methods and results A total of 397 patients (58.8 ± 11.0 years, 73.6% with New York Heart Association functional class ≥3) with stable advanced HFrEF were followed for a median of 1106 (inter‐quartile range 379–2606) days, and 68% of patients (270 patients) experienced an adverse outcome (death, urgent heart transplantation, and implantation of mechanical circulatory support). Chronic obstructive pulmonary disease was present in 16.4%, diabetes mellitus in 44.3%, and chronic kidney disease in 34.5% of patients; 33.5% of patients had none, 40.0% had one, 21.9% had two, and 3.8% of patient had three co‐morbidities. Patients with more co‐morbidities reported similar QoL (assessed by Minnesota Living with Heart Failure Questionnaire, 45.46 ± 22.21/49.07 ± 21.69/47.52 ± 23.54/46.77 ± 23.60 in patients with zero to three co‐morbidities, P for trend = 0.51). Multivariable regression analysis revealed that furosemide daily dose, systolic blood pressure, New York Heart Association functional class, and body mass index, but not the number of co‐morbidities, were significantly (P < 0.05) associated with QoL. Increasing co‐morbidity burden was associated with worse survival (P < 0.0001), lower degree of angiotensin‐converting enzyme inhibitor/angiotensin receptor blocker treatment (P = 0.001), and increasing levels of BNP (mean of 685, 912, 1053, and 985 ng/L for patients with zero to three co‐morbidities, P for trend = 0.008) and cardiac troponin (sm‐cTnI, P for trend = 0.0496), which remained significant (P < 0.05) after the adjustment for left ventricular ejection fraction, left ventricular end‐diastolic diameter, right ventricular dysfunction grade, body mass index, and estimated glomerular filtration rate. Conclusions In stable advanced HFrEF patients, co‐morbidities are not associated with impaired QoL, but negatively affect the prognosis both directly and indirectly through lower level of HF pharmacotherapy and increased myocardial stress and injury.
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Affiliation(s)
- Jan Benes
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic.,Department of Internal Medicine, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Martin Kotrc
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Petr Jarolim
- 3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lenka Hoskova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marketa Hegarova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Zora Dorazilova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Mariana Podzimkova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Jana Binova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Marianna Lukasova
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Ivan Malek
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Janka Franekova
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Antonin Jabor
- Department of Laboratory Methods, Institute for Clinical and Experimental Medicine-IKEM, Prague, Czech Republic.,3rd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Josef Kautzner
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
| | - Vojtech Melenovsky
- Department of Cardiology, Institute for Clinical and Experimental Medicine-IKEM, Vídeňská 1958/9, Prague 4, 140 21, Czech Republic
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30
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Sareen S, Maheshwari D, Mahla H, Sharma S. Immediate and short-term outcomes of percutaneous transvenous mitral commissurotomy on global and regional right ventricular strain by speckle-tracking echocardiography. INTERNATIONAL JOURNAL OF THE CARDIOVASCULAR ACADEMY 2021. [DOI: 10.4103/ijca.ijca_5_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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31
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Agasthi P, Chao CJ, Siegel RJ, Pujari SH, Mookadam F, Venepally NR, Wang P, Ashraf H, Marcotte F, Brown L, Semkiv OI, Fath AR, Allam MNA, Jokerst CE, Arsanjani R. Comparison of echocardiographic parameters with cardiac magnetic resonance imaging in the assessment of right ventricular function. Echocardiography 2020; 37:1792-1802. [PMID: 33012034 DOI: 10.1111/echo.14877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The right ventricle (RV) strain measured by speckle tracking (RVS) is an echocardiographic parameter used to assess RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE) and Doppler tissue imaging-derived peak systolic velocity (S') in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). METHODS We enrolled consecutive patients who underwent cardiac MRI between Jan 2012 and Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, S', and FAC% were tested for accuracy to identify impaired RV EF (EF < 45% & <30%) using receiver operator curves. RESULTS The study cohort included 500 patients with mean age 55 years ± 18 and peak tricuspid regurgitation velocity 2.7 ± 1.4 m/s. The area under ROC for RVS was 0.69 (95% CI 0.63-0.75) and 0.78 (95% CI 0.70-0.88) to predict RVEF < 45% & RVEF < 30%, respectively. The RV FAC% had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. CONCLUSION Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Robert J Siegel
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nithin R Venepally
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Panwen Wang
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Oksana I Semkiv
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Ayman R Fath
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Mohamed N A Allam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
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Şafak Ö, Gürsoy O, Emren V, Demir E, Yıldırım T, Argan O, Şimşek EÇ, Aytemiz F, Özdemir E, Bayar N, Erkal Z, Çelik O, Akhan O, Dönmez C, Kemaloğlu Öz T, Akyel S, Oktay Ergene A, Özkan M. Echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population: ECHO-DOP-TR Trial. Echocardiography 2020; 37:1374-1381. [PMID: 32815581 DOI: 10.1111/echo.14827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/29/2020] [Accepted: 07/29/2020] [Indexed: 11/26/2022] Open
Abstract
AIM Doppler echocardiography has become the standard imaging modality for diastolic function and provides pathophysiological insight into systolic and diastolic heart failure. In this study, we aimed to obtain normal echocardiographic Doppler parameters of healthy Turkish population. METHODS Among 31 collaborating institutions from all regions of Turkey, 1154 healthy volunteers were enrolled in this study. Predefined protocols were used for all participants during echocardiographic examination and The American Society of Echocardiography and European Association of Cardiovascular Imaging recommendations were used for echocardiographic Doppler measurements. RESULTS A total of 967 healthy participants were enrolled in this study after applying exclusion criteria. Echocardiographic examination was obtained from all subjects following predefined protocols. Mitral E wave velocity and E/A ratio were higher in females and decreased progressively in advancing ages. E wave deceleration time and A wave velocity were increased with aging. Assessment of tissue Doppler velocities showed that left ventricular lateral e', septal e', and septal s' were higher in younger subjects and in females. E/e' ratio was increased progressively with advancing decades. Right ventricular e' and s' were decreased but a' was increased with increasing age. Septal e' lower than 8 cm/s was 1.9% in the fifth decade and 13.7% in ages older than 50 years. The E/e' ratio greater than 15 (and also 13) was not found. CONCLUSION This study, for the first time, provides echocardiographic reference ranges for normal cardiac Doppler data in healthy Turkish population which will be useful in routine clinical practice as well as in future clinical trials.
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Affiliation(s)
- Özgen Şafak
- Department of Cardiology, Faculty of Medicine, Balıkesir University Hospital, Balıkesir, Turkey
| | - Ozan Gürsoy
- Department of Cardiology, Faculty of Medicine, İzmir Katip Çelebi University Hospital, İzmir, Turkey
| | - Volkan Emren
- Department of Cardiology, Faculty of Medicine, İzmir Katip Çelebi University Hospital, İzmir, Turkey
| | - Emre Demir
- Department of Cardiology, Faculty of Medicine, Ege University Hospital, İzmir, Turkey
| | - Tarık Yıldırım
- Department of Cardiology, Faculty of Medicine, Balıkesir University Hospital, Balıkesir, Turkey
| | - Onur Argan
- Department of Cardiology, Faculty of Medicine, Balıkesir University Hospital, Balıkesir, Turkey
| | | | - Fatih Aytemiz
- Department of Cardiology, Manisa State Hospital, Manisa, Turkey
| | - Emre Özdemir
- Department of Cardiology, Faculty of Medicine, İzmir Katip Çelebi University Hospital, İzmir, Turkey
| | - Nermin Bayar
- Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Zehra Erkal
- Department of Cardiology, Antalya Training and Research Hospital, Antalya, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Faculty of Medicine, Hitit University Hospital, Çorum, Turkey
| | - Onur Akhan
- Department of Cardiology, Bilecik State Hospital, Bilecik, Turkey
| | - Cevdet Dönmez
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | | | - Serdar Akyel
- Department of Cardiology, Faculty of Medicine, Kastamonu University Hospital, Kastamonu, Turkey
| | - Asim Oktay Ergene
- Department of Cardiology, Faculty of Medicine, Dokuz Eylül University Hospital, İzmir, Turkey
| | - Mehmet Özkan
- Department of Cardiology, Kartal Koşuyolu Yüksek İhtisas Training and Research Hospital, İstanbul, Turkey
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Cazalbou S, Chong Fah Shen V, Petermann A, Eyharts D, Fournier P, Cariou E, Lavie-Badie Y, Hennig A, Roncalli J, Rousseau H, Carrié D, Galinier M, Berry I, Lairez O. What is the most useful imaging parameter to explore the prognostic value of the right ventricular function at the time of multimodality cardiovascular imaging? Echocardiography 2020; 37:1233-1242. [PMID: 32686860 DOI: 10.1111/echo.14686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 12/28/2019] [Accepted: 04/21/2020] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Right ventricular (RV) function is a powerful independent predictor of adverse heart failure outcomes. The aim of this study was to compare the predictive value of main RV systolic imaging parameters for outcome. METHODS Seventy-nine patients underwent comprehensive cardiovascular imaging modalities including transthoracic echocardiography, cardiac magnetic resonance (CMR) imaging, and tomographic equilibrium radionuclide ventriculography (ERV) for the assessment of RV function. The composite primary endpoint (CPE) was defined by the occurrence of death, heart transplantation, implantation of a left ventricular assist device, or new-onset acute heart failure. RESULTS During a mean follow-up of 13 ± 9 months, 15 (19%) patients reached the CPE. The areas under the receiver operator characteristic curves for the prediction of the CPE were 0.922 (P < .001), 0.913 (P < .001), 0.906 (P < .001), 0.849 (P = .002), 0.837 (P = .003), 0.799 (P = .009), 0.792 (P = .011), 0.753 (P = .026), 0.720 (P = .053), and 0.608 (P = .346) for integral systolic S' wave tricuspid annular velocity, RV free wall longitudinal strain (RVFWLS), RV fractional area change, tricuspid annular plane systolic excursion, RV ejection fraction (RVEF) by CMR using the 4-chamber slices, peak systolic S' wave tricuspid annular velocity, RVEF by CMR using short-axis slices, RVEF by ERV, RV myocardial performance index, and RV myocardial acceleration during isovolumic contraction, respectively. CONCLUSION Echocardiographic parameters, and particularly integral systolic S' wave tricuspid annular velocity and RVFWLS, have the best prognostic performance.
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Affiliation(s)
- Stéphanie Cazalbou
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Vanessa Chong Fah Shen
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Antoine Petermann
- Cardiac Imaging Center, Toulouse University Hospital, France.,Department of Radiology, University Hospital of Rangueil, Toulouse, France
| | - Damien Eyharts
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Pauline Fournier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Eve Cariou
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Yoan Lavie-Badie
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France
| | - Alexia Hennig
- Cardiac Imaging Center, Toulouse University Hospital, France.,Department of Radiology, University Hospital of Rangueil, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Jérôme Roncalli
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Hervé Rousseau
- Cardiac Imaging Center, Toulouse University Hospital, France.,Department of Radiology, University Hospital of Rangueil, Toulouse, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Didier Carrié
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Purpan, University Paul Sabatier, Toulouse, France
| | - Michel Galinier
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France
| | - Isabelle Berry
- Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France.,Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
| | - Olivier Lairez
- Department of Cardiology, University Hospital of Rangueil, Toulouse, France.,Cardiac Imaging Center, Toulouse University Hospital, France.,Medical School of Rangueil, University Paul Sabatier, Toulouse, France.,Department of Nuclear Medicine, University Hospital of Rangueil, Toulouse, France
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Effect of kidney transplantation on right ventricular function, assessment by 2- dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2020; 18:16. [PMID: 32456642 PMCID: PMC7251705 DOI: 10.1186/s12947-020-00200-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Advanced chronic kidney disease often results in adverse cardiovascular outcomes and is the leading cause of mortality in patients with end stage renal diseases (ESRD). There is much information about the effect of chronic kidney diseases (CKD) on the left ventricle (LV) chamber, but the right ventricle (RV) as a neglected chamber had not been evaluated precisely, in spite of its importance. Objectives The aim of this study was to evaluate the impact of successful kidney transplants on the RV systolic and diastolic function using the advanced method of 2D speckle tracking echocardiography and comparison with the conventional methods. Method The study included 48 patients with CKD who were eligible for kidney transplantation and underwent successful kidney transplantations. Right ventricular indices were evaluated, while RV function was focused by conventional methods and 2D speckle tracking echocardiography before the successful kidney transplant and 1 week, 1 month, and 3 months after the successful kidney transplant. Results The results of the study showed that RV global longitudinal strain and RV free wall longitudinal strain improved over the time (P = 0.024, P < 0.001 respectively). It also represented that kidney transplantation did not have significant effect on the RV mid cavity diameter, tissue velocity, Myocardial performance index, RV longitudinal diameter, and Tricuspid annular plane systolic excursion indices, but for other indices this effect was significant. On the differences between the mean slope of regression line of the GLS variable in hypertensive subjects (1.0 ± 0.2) and non-hypertensive subjects (0.36 ± 0.32), an independent t-test showed that between the two groups in terms of the improvement of RVGLS, there was a significant statistical difference (P = 0.0067). Conclusion Most of the ESRD patients had subtle RV dysfunction which could be better detected by recent echocardiography methods than conventional methods. Moreover, kidney transplantation led to considerable improvements in RV function in this population.
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Antohi EL, Chioncel O. Understanding cardiac systolic performance beyond left ventricular ejection fraction. EXPLORATION OF MEDICINE 2020. [DOI: 10.37349/emed.2020.00006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Left ventricular ejection fraction is the critical parameter used for heart failure classification, decision making and assessing prognosis. It is defined as a volumetric ratio and is essentially a composite of arterial and ventricular elastances, but not intrinsic contractility. The clinician should be aware of its numerous limitations when measuring and reporting it. And make a step toward more insightful understanding of hemodynamics.
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Affiliation(s)
- Elena-Laura Antohi
- ICCU and Cardiology 1st Department, Emergency Institute for Cardiovascular Diseases “C.C.Iliescu”, 022328 Bucharest, Romania; University for Medicine and Pharmacy “Carol Davila” Bucharest, 020021, Bucharest, Romania
| | - Ovidiu Chioncel
- ICCU and Cardiology 1st Department, Emergency Institute for Cardiovascular Diseases “C.C.Iliescu”, 022328 Bucharest, Romania
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Monitillo F, Di Terlizzi V, Gioia MI, Barone R, Grande D, Parisi G, Brunetti ND, Iacoviello M. Right Ventricular Function in Chronic Heart Failure: From the Diagnosis to the Therapeutic Approach. J Cardiovasc Dev Dis 2020; 7:E12. [PMID: 32283619 PMCID: PMC7344512 DOI: 10.3390/jcdd7020012] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 04/05/2020] [Accepted: 04/06/2020] [Indexed: 12/17/2022] Open
Abstract
There is growing attention for the study of the right ventricle in cardiovascular disease and in particular in heart failure. In this clinical setting, right ventricle dysfunction is a significant marker of poor prognosis, regardless of the degree of left ventricular dysfunction. Novel echocardiographic methods allow for obtaining a more complete evaluation of the right ventricle anatomy and function as well as of the related abnormalities in filling pressures. Specific and effective therapies for the right ventricle dysfunction are still not well defined and this represents the most difficult and important challenge. This article focuses on available diagnostic techniques for studying right ventricle dysfunction as well as on the therapies for right ventricle dysfunction.
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Affiliation(s)
- Francesco Monitillo
- Emergency Cardiology Unit, University Policlinic Hospital, 70124 Bari, Italy;
| | - Vito Di Terlizzi
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
| | | | - Roberta Barone
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
| | - Dario Grande
- Cardiology Unit, Sarcone Hospital, 70038 Terlizzi, Italy; (D.G.); (G.P.)
| | - Giuseppe Parisi
- Cardiology Unit, Sarcone Hospital, 70038 Terlizzi, Italy; (D.G.); (G.P.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University of Foggia, 71122 Foggia, Italy; (V.D.T.); (R.B.); (N.D.B.)
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Rusinovich Y, Rusinovich V. Association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. Phlebology 2020; 35:513-519. [DOI: 10.1177/0268355520901903] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim This study examines the association between right heart diastolic function and clinical presentation of chronic venous disease and primary varicose veins of lower extremities. Material and methods We performed retrospective analysis of clinical, peripheral venous Duplex and tricuspid Doppler (early diastolic inflow E-wave, late diastolic inflow A-wave, ratios of E to A waves, early diastolic annular e′-wave, late diastolic annular a′-wave and systolic annular s′- wave) data of 85 patients, 133 legs with primary varicose veins. Results We found following significant (p-value < 0.05) associations between tricuspid Doppler and clinical presentation of chronic venous disease and primary varicose veins: Clinical Etiological Anatomical Pathophysiological clinical class influenced late diastolic inflow velocities (C6 class A-wave +11.2 cm/s or +27% in comparison with C2), late diastolic annular velocities (C6 class a′-wave +3.3 cm/s or +22% in comparison with C2), systolic annular velocities (C6 class s′-wave +3.7 cm/s or +27% in comparison with C2) and E/A ratios (C6 class E/A ratio −0.22 or −21% in comparison with C2). Recurrent varices in comparison with previously untreated are associated with significantly lower late diastolic inflow velocities (A-wave −4.4 cm/s or −9%) and preserved E/A ratios. Age significantly influenced tricuspid Doppler (E-, A-, e′-, a′-waves and E/A ratios) in patients with chronic venous disease. Conclusion Clinical presentation of primary varicose veins and chronic venous disease can be associated with the right heart diastolic function: C6 Clinical Etiological Anatomical Pathophysiological class in comparison with C2 is associated with increased right ventricular filling and impaired ventricular relaxation – right heart diastolic dysfunction; recurrent varices in comparison with previously untreated are associated with reduced right ventricular filling and preserved right heart diastolic function. Older age is the most important risk factor for varicose veins and chronic venous disease possible due to significant changes in right ventricular filling and in right heart diastolic function with age.
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Affiliation(s)
- Yury Rusinovich
- Department of Vascular Surgery, Krankenhausgesellschaft Sankt Vincenz GmbH, Limburg, Germany
- Department of Vascular Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Volha Rusinovich
- Department of Postgraduate Medical Education, Biermann Verlag GmbH, Koln, Germany
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Bootsma IT, Scheeren TWL, de Lange F, Jainandunsing JS, Boerma EC. The Reduction in Right Ventricular Longitudinal Contraction Parameters Is Not Accompanied by a Reduction in General Right Ventricular Performance During Aortic Valve Replacement: An Explorative Study. J Cardiothorac Vasc Anesth 2020; 34:2140-2147. [PMID: 32139346 DOI: 10.1053/j.jvca.2020.01.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/06/2020] [Accepted: 01/08/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The aim of the present study was to identify whether the decrease of longitudinal parameters after cardiothoracic surgery (ie, tricuspid annular systolic plane excursion [TAPSE] and systolic excursion velocity [S']) is accompanied by a reduction in global right ventricular (RV) performance. DESIGN Prospective, observational study. SETTING Single-center explorative study in a tertiary teaching hospital. PARTICIPANTS The study comprised 20 patients who underwent aortic valve replacement with or without coronary artery bypass grafting. INTERVENTIONS During cardiac surgery, simultaneous measurements of RV function were performed with a pulmonary artery catheter and transesophageal echocardiography. MEASUREMENTS AND MAIN RESULTS TAPSE and S' were reduced significantly directly after surgery compared with the time before surgery (TAPSE from 20.8 [16.6-23.4] mm to 9.1 [5.6-15.5] mm; p < 0.001 and S' from 8.7 [7.9-10.7] cm/s to 7.2 [5.7-8.6] cm/s; p = 0.041). However, the reduction in TAPSE and S' was not accompanied by a reduction in RV performance, as assessed with the TEE-derived myocardial performance index (MPI) and pulmonary artery catheter-derived RV ejection fraction (RVEF). Both remained statistically unaltered before and after the procedure (MPI from 0.52 [0.43-0.58] to 0.50 [0.42-0.88]; p = 0.278 and RVEF from 27% [22%-32%] to 26% [22%-28%]; p = 0.294). CONCLUSIONS In the direct postoperative phase, the reduction of echocardiographic parameters of longitudinal RV contractility (TAPSE and S') were not accompanied by a reduction in global RV performance, expressed as MPI and RVEF. Solely relying on a single RV parameter as a marker for global RV performance may not be adequate to assess the complex adaptation of the right ventricle to aortic valve replacement.
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Affiliation(s)
- Inge T Bootsma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
| | - Thomas W L Scheeren
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Fellery de Lange
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
| | - Jayant S Jainandunsing
- Department of Anaesthesiology, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - E Christiaan Boerma
- Department of Intensive Care, Medical Centre Leeuwarden, Leeuwarden, The Netherlands
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Porter T, Shillcutt S, Adams M, Desjardins G, Glas K, Olson J, Troughton R. Guidelines for the use of echocardiography as a monitor for therapeutic intervention in adults: A report from the american society of echocardiography. JOURNAL OF THE INDIAN ACADEMY OF ECHOCARDIOGRAPHY & CARDIOVASCULAR IMAGING 2020. [DOI: 10.4103/2543-1463.282192] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
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Nagano N, Yano T, Fujita Y, Kouzu H, Koyama M, Ikeda H, Yasui K, Muranaka A, Nishikawa R, Takahashi R, Kishiue N, Yuda S, Miura T. Assessment of prognosis in immunoglobulin light chain amyloidosis patients with severe heart failure: a predictive value of right ventricular function. Heart Vessels 2019; 35:521-530. [PMID: 31559459 DOI: 10.1007/s00380-019-01513-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 09/20/2019] [Indexed: 12/26/2022]
Abstract
Although the benefit of updated therapeutic regimens, including bortezomib, on the survival of immunoglobulin light chain (AL) amyloidosis patients with heart failure (HF) has been reported, predictors of mortality in the patients treated with the updated therapy remain unclear. We retrospectively enrolled AL amyloidosis patients who had severe HF at the time of diagnosis and received the updated therapy, including bortezomib (n = 19, 61 ± 6 years old, 68% male). Severe HF was defined as the presence of both NYHA functional class III or IV and BNP > 200 pg/ml or NT-pro-BNP > 900 pg/ml. One-year mortality rate during follow-up after commencement of the treatment was 37%. Left ventricular morphological parameters and indexes of left ventricular diastolic function on admission were similar in the non-survivors and survivors. However, non-survivors had higher incidences of atrial fibrillation and ventricular tachycardia, higher serum total bilirubin levels (1.34 ± 0.55 vs. 0.61 ± 0.29 mg/dl), higher right atrial volume index (RAVI 49.7 ± 29.9 vs. 27.3 ± 6.8 ml/m2), lower tricuspid annular peak velocities during systole (RVs' 8.0 ± 1.8 vs. 11.6 ± 3.7 cm/sec) and late diastole (RVa' 3.4 ± 0.9 vs. 11.4 ± 5.3 cm/sec), and larger inferior vena cava dimension (22.7 ± 6.4 vs. 16.3 ± 4.9 mm) than those in survivors. Kaplan-Meier curve analyses showed that larger RAVI and lower RVs' and RVa', but not left ventricular systolic/diastolic dysfunction, predicted higher mortality during 1-year follow-up. The present results suggest that the presence of right-sided heart abnormality on admission is associated with high 1-year mortality in AL amyloidosis patients with severe HF under the updated therapeutic regimens.
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Affiliation(s)
- Nobutaka Nagano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Toshiyuki Yano
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan.
| | - Yugo Fujita
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Hidemichi Kouzu
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Masayuki Koyama
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Ikeda
- Department of Hematology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kenji Yasui
- Division of Laboratory Diagnosis, Sapporo Medical University Hospital, Sapporo, Japan
| | - Atsuko Muranaka
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryo Nishikawa
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Ryo Takahashi
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Naohiro Kishiue
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
| | - Satoshi Yuda
- Division of Cardiology, Cardiovascular Center, Teine Keijinkai Hospital, Sapporo, Japan
| | - Tetsuji Miura
- Department of Cardiovascular, Renal and Metabolic Medicine, Sapporo Medical University School of Medicine, South-1, West-16, Chuo-ku, Sapporo, 060-8543, Japan
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Ifeoluwa AA, Adewole AA, Abiodun AM, Akinyemi A. Right ventricular systolic function in Nigerians with heart failure secondary to hypertensive heart disease. Afr Health Sci 2019; 19:2130-2139. [PMID: 31656497 PMCID: PMC6794531 DOI: 10.4314/ahs.v19i2.37] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Right ventricular (RV) dysfunction has been shown to be a major contributor to the adverse outcomes in subjects with heart failure. Few studies evaluating the right ventricle in heart failure subjectshave been carried out in Sub-Saharan Africa. This studywas therefore designed to evaluate the right ventricular systolic function in subjects with heart failure secondary to hypertensive heart disease presenting to the University College Hospital, Ibadan Nigeria. Methodology Seventy-six subjects with heart failure secondary to hypertension and 92 normal controls underwent clinical, electrocardiographic and echocardiographic evaluation. Indices of right ventricular systolic function that were measured include tricuspid annular plane systolic excursion (TAPSE), tissue Doppler derived tricuspid peak systolic lateral annulus velocity(S′) and right ventricular fractional areachange(RVFAC). Results Sixty-two (81.6%) heart failure subjects had right ventricular systolic dysfunction, 31(40.8%) had abnormal TAPSE, 42(55.5%) had abnormal S′ while 49(64.5%) had abnormal RVFAC. Elevated pulmonary artery systolic pressure was found in 25(32.9%) of the subjects. There was no relationship between the indices of right ventricular systolic function and the estimated systolic pulmonary artery pressures. The independent predictor of right ventricular systolic dysfunction was the right atrial size. Conclusion Right ventricular systolic function is impaired in patients with heart failure secondary to hypertensive heart disease. There is no relationship between the indices of right ventricular systolic function and systolic pulmonary artery pressure. Further studies are needed to assess right ventricular systolic function in Nigerians.
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Affiliation(s)
| | - Adesoji Adebiyi Adewole
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Adeoye M Abiodun
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, College of Medicine, University of Ibadan, Ibadan, Nigeria
- Department of Medicine, University College Hospital, Ibadan, Nigeria
| | - Aje Akinyemi
- Department of Medicine, University College Hospital, Ibadan, Nigeria
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Baumann F, Obeid S, Gilhofer T, Siegrist P, von Spiczak J, Lüscher TF, Binder RK. Right coronary artery motion analysis: a novel method to measure right ventricular systolic function by selective coronary angiography. Int J Cardiovasc Imaging 2019; 35:1557-1561. [PMID: 31044328 DOI: 10.1007/s10554-019-01606-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 04/17/2019] [Indexed: 11/24/2022]
Abstract
Right ventricular systolic dysfunction is prognostic in various cardiovascular diseases. Right ventricular systolic function is not commonly assessed in the catheterization laboratory. Therefore, we developed a novel, reproducible method to measure right ventricular systolic function during selective coronary angiography. We analyzed the angiographic systolic translational motion and maximum speed of the right coronary artery (RCA) in 97 consecutive patients and compared it to the tricuspid annular plane systolic excursion (TAPSE) as measured by echocardiography. All measurements were performed by two independent operators on two occasions. Inter-observer variability and intra-observer variability were excellent for RCA motion distance and for RCA maximum speed. There was a significant correlation of the RCA motion distance and RCA maximum speed with the TAPSE measured by echocardiography (Pearson's correlation for RCA distance: r = 0.59, p < 0.001, r2 = 0.35; for RCA speed: r = 0.40, p < 0.001, r2 = 0.16). The area under the receiver operating curve for the RCA motion distance was 0.88 (95% CI 0.80-0.96) for discrimination of normal and abnormal right ventricular systolic function. A cut-off value less than 22.3 mm systolic RCA motion had a specificity of 93.3% and a sensitivity of 75.6% for identifying an abnormal right ventricular systolic function. Analysis of the RCA motion is a reproducible and reliable method to measure right ventricular systolic function during selective coronary angiography. It is a simple and useful tool to assess right ventricular function in the catheterization laboratory and may serve for risk assessment for right ventricular failure. CLINICAL TRIAL REGISTRATION: Data for this study was collected retrospectively from Swiss Transcatheter Aortic Valve Implantation Registry (NCT01368250). https://clinicaltrials.gov/show/NCT01368250 .
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Affiliation(s)
- Flavia Baumann
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Slayman Obeid
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Thomas Gilhofer
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Patrick Siegrist
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Jochen von Spiczak
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Thomas F Lüscher
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland
| | - Ronald K Binder
- Department of Cardiology, University Hospital Zurich, University Heart Center, Zurich, Switzerland. .,Department of Cardiology and Intensive Care, University Teaching Hospital Klinikum Wels-Grieskrichen, Grieskrichnerstrasse 42, 4600, Wels, Austria.
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Dalén M, Oliveira Da Silva C, Sartipy U, Winter R, Franco-Cereceda A, Barimani J, Bäck M, Svenarud P. Comparison of right ventricular function after ministernotomy and full sternotomy aortic valve replacement: a randomized study. Interact Cardiovasc Thorac Surg 2019; 26:790-797. [PMID: 29325064 DOI: 10.1093/icvts/ivx422] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 11/18/2017] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Right ventricular (RV) function is impaired after cardiac surgery, possibly because of the opening of the pericardium. In minimally invasive aortic valve replacement, the pericardium is only partially incised. METHODS A randomized trial compared RV function after ministernotomy versus full sternotomy in 40 adults undergoing aortic valve replacement at the Karolinska University Hospital. Primary outcomes were tricuspid annular plane systolic excursion, RV pulsed-wave tissue Doppler velocity, RV fractional area change and basal and mid-RV transversal diameters on postoperative Days 4 and 40. RESULTS On postoperative Day 4, the tricuspid annular plane systolic excursion had decreased in both groups [ministernotomy: median (Q1-Q3) 25 (21-28) vs 16 (11-18), P < 0.001; sternotomy: 22.5 (22-22.5) vs 8 (7-12) mm, P < 0.001] but was higher in the ministernotomy group (P < 0.001). Pulsed-wave tissue Doppler RV velocity decreased significantly in patients who underwent sternotomy [10.5 (10-12) vs 6.5 (5-8) cm/s, P < 0.001] but did not decrease significantly in patients who underwent ministernotomy [11.5 (11-12) vs 10 (9-11) cm/s, P = 0.054]. Fractional area change was equally decreased in both groups [ministernotomy: 46 (39-51) vs 38 (34-44)%, P < 0.001; sternotomy: 45 (40-49) vs 37 (25-39.5)%, P = 0.003]. RV dimensions did not change on postoperative Day 4 in both groups. The differences between the 2 groups were similar 40 days postoperatively. CONCLUSIONS RV long-axis function was reduced after both ministernotomy and full sternotomy aortic valve replacement, but the reduction was more pronounced in the full sternotomy group. Global RV function was equally impaired in both groups postoperatively. Clinical trial registration http://www.clinicaltrials.gov. Unique identifier: NCT01972555.
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Affiliation(s)
- Magnus Dalén
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | | | - Ulrik Sartipy
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Reidar Winter
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Franco-Cereceda
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Jasmin Barimani
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden
| | - Magnus Bäck
- Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Peter Svenarud
- Department of Cardiac Surgery, Karolinska University Hospital, Stockholm, Sweden.,Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
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Talwar S, Anand A, Siddarth B, Ramakrishnan S, Choudhary SK, Airan B. Early right ventricular function following trans-right atrial versus trans-right atrial, trans-right ventricular repair of Tetralogy of Fallot: Results of a prospective randomized study. Ann Pediatr Cardiol 2019; 12:3-9. [PMID: 30745763 PMCID: PMC6343382 DOI: 10.4103/apc.apc_40_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective: We compared the pre- and post-operative right ventricular (RV) function by tricuspid annular plane systolic excursion (TAPSE) between trans-right atrial (t-RA) versus t-RA/RV (RA/RV) approach for the repair of Tetralogy of Fallot (TOF). Patients and Methods: Fifty consecutive patients, 1–15 years of age, undergoing intracardiac repair of TOF between September 2015 and June 2016 were randomized into two groups based on the approach for repair as follows: t-RA or t-RA/RV approach. TAPSE was used for the assessment of pre- and post-operative RV function. Results: Age, body surface area, preoperative saturation, cardiopulmonary bypass and aortic cross-clamp times, inotropic score, postoperative intensive care unit, and hospital stay were similar in both the groups. However, t-RA/RV group had significant mediastinal drainage (169 ± 163 ml vs. 90.6 ± 58.7 ml, P < 0.05) and pleural effusions (8 vs. 2 patients, P < 0.05), but had better relief of RV outflow tract gradients. The mean follow-up was 23 ± 6.7 (median 26, range 21–29) months. There were no differences in arrhythmias in either group up to the 1st month and at last follow-up. Preoperative TAPSE for t-RA and t-RA/RV was similar (1.49 ± 0.29 vs. 1.66 ± 0.34, P > 0.05) and so was the post-operative TAPSE at discharge (1.52 ± 0.30 vs. 1.43 ± 0.32, P > 0.05), at 1 month (1.6 ± 0.27 vs. 1.43 ± 0.032, P > 0.05) and at last follow-up (1.79 ± 0.15, median 1.8 vs. 1.72 ± 0.17, median 1.7 P > 0.05). Conclusion: Both t-RA and t-RA/RV approaches provide safe palliation for patients with TOF. A limited right ventriculotomy neither leads to deleterious effects on early RV function nor does it increase the incidence of arrhythmias at early follow-up. Larger studies with longer follow-up are needed to further address these issues.
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Affiliation(s)
- Sachin Talwar
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Abhishek Anand
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Bharat Siddarth
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shiv Kumar Choudhary
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
| | - Balram Airan
- Cardiothoracic Center, All India Institute of Medical Sciences, New Delhi, India
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Zakaria N, El-Rabat KED, Bastwesy R, ELMeligy N, Farag S. Predictors of complications among patients with acute inferior and right myocardial infarction. Res Cardiovasc Med 2019. [DOI: 10.4103/rcm.rcm_21_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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46
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Kang Y, Wang S, Huang J, Cai L, Keller BB. Right ventricular dysfunction and remodeling in diabetic cardiomyopathy. Am J Physiol Heart Circ Physiol 2019; 316:H113-H122. [DOI: 10.1152/ajpheart.00440.2018] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The increasing prevalence of diabetic cardiomyopathy (DCM) is an important threat to health worldwide. While left ventricular (LV) dysfunction in DCM is well recognized, the accurate detection, diagnosis, and treatment of changes in right ventricular (RV) structure and function have not been well characterized. The pathophysiology of RV dysfunction in DCM may share features with LV diastolic and systolic dysfunction, including pathways related to insulin resistance and oxidant injury, although the RV has a unique cellular origin and composition and unique biomechanical properties and is coupled to the lower-impedance pulmonary vascular bed. In this review, we discuss potential mechanisms responsible for RV dysfunction in DCM and review the imaging approaches useful for early detection, protection, and intervention strategies. Additional data are required from animal models and clinical trials to better identify the onset and features of altered RV and pulmonary vascular structure and function during the onset and progression of DCM and to determine the efficacy of early detection and treatment of RV dysfunction on clinical symptoms and outcomes.
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Affiliation(s)
- Yin Kang
- Department of Anesthesiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
| | - Sheng Wang
- Department of Anesthesiology, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
- Department of Anesthesiology, Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiapeng Huang
- Department of Anesthesiology and Perioperative Medicine, University of Louisville, and Department of Anesthesiology, Jewish Hospital, Louisville, Kentucky
| | - Lu Cai
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
| | - Bradley B. Keller
- Pediatric Research Institute, Department of Pediatrics, University of Louisville, Louisville, Kentucky
- Pharmacology and Toxicology, University of Louisville, Louisville, Kentucky
- Kosair Charities Pediatric Heart Research Program, Cardiovascular Innovation Institute, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
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47
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Seo HS, Lee H. Assessment of Right Ventricular Function in Pulmonary Hypertension with Multimodality Imaging. J Cardiovasc Imaging 2018; 26:189-200. [PMID: 30607386 PMCID: PMC6310752 DOI: 10.4250/jcvi.2018.26.e28] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Revised: 10/29/2018] [Accepted: 11/21/2018] [Indexed: 02/06/2023] Open
Abstract
Pulmonary hypertension (PH) is defined as resting mean pulmonary artery pressure ≥ 25 mmHg and is caused by multiple etiologies including heart, lung or other systemic diseases. Evaluation of right ventricular (RV) function in PH is very important to plan treatment and determine prognosis. However, quantification of volume and function of the RV remains difficult due to complicated RV geometry. A number of imaging tools has been utilized to diagnose PH and assess RV function. Each imaging technique including conventional echocardiography, three-dimensional echocardiography, strain echocardiography, computed tomography and cardiac magnetic resonance imaging has-advantages and limitations and can provide unique information. In this article, we provide a comprehensive review of the utility, advantages and shortcomings of the multimodality imaging used to evaluate patients with PH.
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Affiliation(s)
- Hye Sun Seo
- Department of Cardiology, Soonchunhyang University Hospital, Bucheon, Korea
| | - Heon Lee
- Department of Radiology, Soonchunhyang University Hospital, Bucheon, Korea
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Maniwa N, Hozumi T, Takemoto K, Wada T, Kashiwagi M, Shimamura K, Shiono Y, Kuroi A, Matsuo Y, Ino Y, Kitabata H, Kubo T, Tanaka A, Akasaka T. Value of tissue-tracking tricuspid annular plane by speckle-tracking echocardiography for the assessment of right ventricular systolic dysfunction. Echocardiography 2018; 36:110-118. [PMID: 30520160 DOI: 10.1111/echo.14206] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/01/2018] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Assessment of right ventricular (RV) function remains challenging because of its complex geometry. Application of speckle-tracking echocardiography (STE) to the tricuspid annulus provides rapid and automated assessment of the midpoint of the tricuspid annular plane displacement (TAD). The aim of this study was to investigate the value of tissue-tracking TAD for the assessment of RV systolic dysfunction. METHODS We retrospectively studied 61 patients in whom RV ejection fraction (EF) measured by 3-dimensional echocardiography was performed. STE-derived displacement of the midpoint between the septal and lateral tricuspid annulus and its percentage of RV length at end-diastole (MTAD) were automatically assessed. We performed comparative analyses between the RVEF ≥45% group and the RVEF <45% group in each parameter for the assessment of RV systolic function. RESULTS MTAD was successfully assessed in 56 (91.2%). According to receiver operating characteristics analysis, RVEF <45% was best detected by MTAD <14.7% with area under curve (AUC) 0.97, sensitivity 93%, specificity 95%, followed by RV free wall longitudinal strain (AUC 0.86), RV fractional area change (AUC 0.84), tricuspid annular plane systolic excursion (AUC 0.79), and systolic peak velocity of tricuspid annulus (AUC 0.70), although there was no significant difference between MTAD and RV free wall strain (P = 0.14). CONCLUSION The present study showed that MTAD was simple index and useful for the assessment of RV systolic dysfunction.
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Affiliation(s)
- Naoki Maniwa
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazushi Takemoto
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Teruaki Wada
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Manabu Kashiwagi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kunihiro Shimamura
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasutsugu Shiono
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Akio Kuroi
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yoshiki Matsuo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Yasushi Ino
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Hironori Kitabata
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Kubo
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Atsushi Tanaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
| | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University, Wakayama, Japan
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49
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Kurnicka K, Lichodziejewska B, Ciurzyński M, Kostrubiec M, Goliszek S, Zdończyk O, Dzikowska-Diduch O, Palczewski P, Skowrońska M, Koć M, Grudzka K, Pruszczyk P. Peak systolic velocity of tricuspid annulus is inferior to tricuspid annular plane systolic excursion for 30 days prediction of adverse outcome in acute pulmonary embolism. Cardiol J 2018; 27:558-565. [PMID: 30484266 DOI: 10.5603/cj.a2018.0145] [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: 07/15/2018] [Revised: 11/01/2018] [Accepted: 11/08/2018] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Tricuspid annular plane systolic excursion (TAPSE) is an established index of right ventricular (RV) systolic function and a significant predictor in normotensive patients with pulmonary embolism (PE). Recently, Doppler tissue imaging-derived tricuspid annular systolic velocity (TV S'), a modern parameter of RV function was reported to be useful in the diagnosis and prognosis of a broad spectrum of heart diseases. Therefore, herein, is an analysis of the prognostic value of both parameters in normotensive PE patients. METHODS One hundred and thirty nine consecutive PE patients (76 female, age 56.4 ± 19.5 years) were included in this study. All patients were initially anticoagulated. Transthoracic echocardiography was performed on admission. The study endpoint (SE) was defined as PE-related 30-day mortality and/or need for rescue thrombolysis. RESULTS Seven (5%) patients who met the criteria for SE presented more severe RV dysfunction at echocardiography. Univariable Cox regression analysis showed that RV/LV ratio predicted SE with hazard risk (HR) 10.6 (1.4-80.0; p = 0.02); TAPSE and TV S' showed HR 0.77 (0.67-0.89), p < 0.001, and 0.71 (0.52-0.97), p = 0.03, respectively. Area under the curve for TAPSE in the prediction of SE was 0.881; 95% CI 0.812-0.932, p = 0.0001, for TV S' was 0.751; 95% CI 0.670-0.820, p = 0.001. Multivariable analysis showed that the optimal prediction model included TAPSE and systolic blood pressure (SBP showed HR 0.89 95% CI 0.83-0.95, p < 0.001 and TAPSE HR 0.67, 95% CI 0.52-0.87, p<0.03). Kaplan-Meier analysis showed that initially PE patients with TAPSE ≥ 18 mm had a much more favorable prognosis that patients with TAPSE < 18 mm (p < 0.01), while analysis of S' was only of borderline statistical significance. CONCLUSIONS It seems that TV S' is inferior to TAPSE for 30 day prediction of adverse outcome in acute pulmonary embolism.
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Affiliation(s)
- Katarzyna Kurnicka
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland.
| | - Barbara Lichodziejewska
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Michał Ciurzyński
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Maciej Kostrubiec
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Sylwia Goliszek
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Olga Zdończyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Olga Dzikowska-Diduch
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Piotr Palczewski
- 1 st Department of Radiology, Medical University of Warsaw, Chałubińskiego str 5, 02-004 Warsaw, Poland
| | - Marta Skowrońska
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Marcin Koć
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Katarzyna Grudzka
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
| | - Piotr Pruszczyk
- Department of Internal Medicine and Cardiology, Medical University of Warsaw, Warsaw Lindleya str 4, 02-005 Warsaw, Poland
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50
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Chetboul V, Damoiseaux C, Lefebvre HP, Concordet D, Desquilbet L, Gouni V, Poissonnier C, Pouchelon JL, Tissier R. Quantitative assessment of systolic and diastolic right ventricular function by echocardiography and speckle-tracking imaging: a prospective study in 104 dogs. J Vet Sci 2018; 19:683-692. [PMID: 30041288 PMCID: PMC6167344 DOI: 10.4142/jvs.2018.19.5.683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/16/2018] [Accepted: 06/25/2018] [Indexed: 11/20/2022] Open
Abstract
Our aim was (1) to determine the within-day and between-day variability of several indices of systolic and diastolic right ventricular (RV) function by using conventional echocardiography and speckle-tracking echocardiography (STE) (Study 1), (2) to quantify these variables in a large healthy canine population (n = 104) with Doppler-derived estimated systolic pulmonary arterial pressure (SPAP) and left ventricular (LV) function, and (3) to establish the corresponding reference intervals (Study 2). For both studies, RV variables included tricuspid annular plane systolic excursion (TAPSE), right fractional area change (RFAC), STE longitudinal systolic strain (StS) of the RV free wall (RVFW) and of the entire RV (i.e., global RV StS), STE longitudinal systolic RVFW strain rate (SRS), and the diastolic early:late strain rate ratio. All but one within- and between-day coefficients of variation (13/14) were < 15%, the lowest being observed for TAPSE (3.6–9.8%), global RV StS (3.8–9.9%), and RVFW StS (3.7–7.3%). SPAP was weakly and negatively correlated with the TAPSE:body weight ratio (rs = −0.26, p = 0.01) and RVFW SRS (rs = −0.23, p < 0.05). Reference intervals (lower and upper limits with 90% confidence intervals) were provided for all variables. STE provides a non-invasive evaluation of RV function that may be used for clinical investigations in canine cardiology.
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Affiliation(s)
- Valérie Chetboul
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France.,Inserm U955, Team 03, Créteil, 94010 Cedex, France
| | - Cécile Damoiseaux
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
| | - Hervé P Lefebvre
- Research Clinic Unit, National Veterinary School of Toulouse, Toulouse University, Toulouse, F-31076 Cedex 03, France
| | - Didier Concordet
- TOXALIM, National Veterinary School of Toulouse, INRA, Toulouse University, Toulouse, F-31076 Cedex 03, France
| | - Loic Desquilbet
- Clinical Epidemiology and Biostatistics Unit, National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
| | - Vassiliki Gouni
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France.,Inserm U955, Team 03, Créteil, 94010 Cedex, France
| | - Camille Poissonnier
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
| | - Jean-Louis Pouchelon
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France.,Inserm U955, Team 03, Créteil, 94010 Cedex, France
| | - Renaud Tissier
- Inserm U955, Team 03, Créteil, 94010 Cedex, France.,Pharmacology-Toxicology Unit, National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
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