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Gojevic T, Van Ryckeghem L, Jogani S, Frederix I, Bakelants E, Petit T, Stroobants S, Dendale P, Bito V, Herbots L, Hansen D, Verwerft J. Pulmonary hypertension during exercise underlies unexplained exertional dyspnoea in patients with Type 2 diabetes. Eur J Prev Cardiol 2023; 30:37-45. [PMID: 35881689 DOI: 10.1093/eurjpc/zwac153] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/16/2022] [Accepted: 07/21/2022] [Indexed: 01/14/2023]
Abstract
AIMS To compare the cardiac function and pulmonary vascular function during exercise between dyspnoeic and non-dyspnoeic patients with Type 2 diabetes mellitus (T2DM). METHODS AND RESULTS Forty-seven T2DM patients with unexplained dyspnoea and 50 asymptomatic T2DM patients underwent exercise echocardiography combined with ergospirometry. Left ventricular (LV) function [stroke volume, cardiac output (CO), LV ejection fraction, systolic annular velocity (s')], estimated LV filling pressures (E/e'), mean pulmonary arterial pressures (mPAPs) and mPAP/COslope were assessed at rest, low- and high-intensity exercise with colloid contrast. Groups had similar patient characteristics, glycemic control, stroke volume, CO, LV ejection fraction, and E/e' (P > 0.05). The dyspnoeic group had significantly lower systolic LV reserve at peak exercise (s') (P = 0.021) with a significant interaction effect (P < 0.001). The dyspnoeic group also had significantly higher mPAP and mPAP/CO at rest and exercise (P < 0.001) with significant interaction for mPAP (P < 0.009) and insignificant for mPAP/CO (P = 0.385). There was no significant difference in mPAP/COslope between groups (P = 0.706). However, about 61% of dyspnoeic vs. 30% of non-dyspnoeic group had mPAP/COslope > 3 (P = 0.009). The mPAP/COslope negatively predicted V̇O2peak in dyspneic group (β = -1.86, 95% CI: -2.75, -0.98; multivariate model R2:0.54). CONCLUSION Pulmonary hypertension and less LV systolic reserve detected by exercise echocardiography with colloid contrast underlie unexplained exertional dyspnoea and reduced exercise capacity in T2DM.
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Affiliation(s)
- Tin Gojevic
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Belgium
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
| | - Lisa Van Ryckeghem
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Belgium
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
| | | | - Ines Frederix
- Department of Cardiology, Zuyderland MC, 6419 PC Heerlen, The Netherlands
- Faculty of Medicine and Health Sciences, Antwerp University, 2610 WILRIJK (Antwerpen), Belgium
| | - Elise Bakelants
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Department of Cardiology, Geneva University Hospital, 1205 Genève, Switzerland
| | - Thibault Petit
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | | | - Paul Dendale
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Virginie Bito
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
| | - Lieven Herbots
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
| | - Dominique Hansen
- REVAL - Rehabilitation Research Centre, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan, Building A, 3590 Diepenbeek, Belgium
- BIOMED - Biomedical Research Centre, Faculty of Medicine and Life Sciences, Hasselt University, 3500 Diepenbeek, Belgium
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
| | - Jan Verwerft
- Jessa Hospital, Heart Centre Hasselt, 3500 Hasselt, Belgium
- Faculty of Medicine and Life Sciences, Hasselt University, 3500 Hasselt, Belgium
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Foulkes S, Claessen G, Howden EJ, Daly RM, Fraser SF, La Gerche A. The Utility of Cardiac Reserve for the Early Detection of Cancer Treatment-Related Cardiac Dysfunction: A Comprehensive Overview. Front Cardiovasc Med 2020; 7:32. [PMID: 32211421 PMCID: PMC7076049 DOI: 10.3389/fcvm.2020.00032] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/21/2020] [Indexed: 12/20/2022] Open
Abstract
With progressive advancements in cancer detection and treatment, cancer-specific survival has improved dramatically over the past decades. Consequently, long-term health outcomes are increasingly defined by comorbidities such as cardiovascular disease. Importantly, a number of well-established and emerging cancer treatments have been associated with varying degrees of cardiovascular injury that may not emerge until years following the completion of cancer treatment. Of particular concern is the development of cancer treatment related cardiac dysfunction (CTRCD) which is associated with an increased risk of heart failure and high risk of morbidity and mortality. Early detection of CTRCD appears critical for preventing long-term cardiovascular morbidity in cancer survivors. However, current clinical standards for the identification of CTRCD rely on assessments of cardiac function in the resting state. This provides incomplete information about the heart's reserve capacity and may reduce the sensitivity for detecting sub-clinical myocardial injury. Advances in non-invasive imaging techniques have enabled cardiac function to be quantified during exercise thereby providing a novel means of identifying early cardiac dysfunction that has proved useful in several cardiovascular pathologies. The purpose of this narrative review is (1) to discuss the different non-invasive imaging techniques that can be used for quantifying different aspects of cardiac reserve; (2) discuss the findings from studies of cancer patients that have measured cardiac reserve as a marker of CTRCD; and (3) highlight the future directions important knowledge gaps that need to be addressed for cardiac reserve to be effectively integrated into routine monitoring for cancer patients exposed to cardiotoxic therapies.
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Affiliation(s)
- Stephen Foulkes
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia.,Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Guido Claessen
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Erin J Howden
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robin M Daly
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Steve F Fraser
- School of Exercise and Nutrition Sciences, Institute of Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | - Andre La Gerche
- Department of Sports Cardiology, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia.,Cardiology Department, St. Vincent's Hospital Melbourne, Melbourne, VIC, Australia
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Platts DG, Vaishnav M, Burstow DJ, Craig CH, Chan J, Sedgwick JF, Scalia GM. Contrast microsphere enhancement of the tricuspid regurgitant spectral Doppler signal - Is it still necessary with contemporary scanners? IJC HEART & VASCULATURE 2017; 17:1-10. [PMID: 28913410 PMCID: PMC5582638 DOI: 10.1016/j.ijcha.2017.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 07/16/2017] [Accepted: 08/05/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Accurate evaluation of the tricuspid regurgitant (TR) spectral Doppler signal is important during transthoracic echocardiographic (TTE) evaluation for pulmonary hypertension (PHT). Contrast enhancement improves Doppler backscatter. However, its incremental benefit with contemporary scanners is less well established. The aim of this study was to assess whether the TR spectral Doppler signal using contemporary scanners was improved using a second generation contrast agent, Definity® (CE), compared to unenhanced TTE (UE). METHODS Analysis of patients who underwent UE then CE TR interrogation was performed. TR signal was evaluated by an experienced reader and graded 1 (clear-high level of confidence of interpretation and complete spectral Doppler envelope), 2 (suboptimal with medium-low level of confidence of interpretation and incomplete envelope), 3 (poor-absent and no measurable spectral Doppler signal). Maximal TR velocity (TRV) was defined as peak velocity that could be clearly identified. An inexperienced sonographer read 30 randomly selected studies. RESULTS 176 TTE were performed in 173 patients (mean age 57 ± 14.8 years). Wilcoxon signed rank test demonstrated significant improvement (p < 0.0001) in TR spectral Doppler signal quality with CE TTE. Mean score CE TTE vs. TTE = 2.32 ± 0.85 vs. 2.56 ± 0.75 respectively (p < 0.0001). Mean maximal TRV CE TTE vs. UE TTE = 2.61 ± 0.44 m/s vs. 2.54 ± 0.49 m/s respectively (p < 0.0001). The inexperienced reader had a greater improvement in scoring CE TTE signals vs. UE TTE (p < 0.0001). CONCLUSION In the era of contemporary scanners, CE improved the ability to detect and measure TRV, except in those with clear unenhanced TR spectral Doppler signals or greater than mild tricuspid regurgitation.
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Affiliation(s)
- David G. Platts
- Department of Echocardiography, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- Heart and Lung Program, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland Brisbane, QLD, Australia
| | - Manan Vaishnav
- Heart and Lung Program, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
| | - Darryl J. Burstow
- Department of Echocardiography, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- Heart and Lung Program, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland Brisbane, QLD, Australia
| | - Christian Hamilton Craig
- Department of Echocardiography, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- Heart and Lung Program, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland Brisbane, QLD, Australia
- Centre for Advanced Imaging, University of Queensland Brisbane, QLD, Australia
- University of Washington, Seattle, WA, USA
| | - Jonathan Chan
- Department of Echocardiography, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- Heart and Lung Program, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- School of Medicine and Menzies Health Institute Queensland, Griffith University, QLD, Australia
| | - John F. Sedgwick
- Department of Echocardiography, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- Heart and Lung Program, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland Brisbane, QLD, Australia
| | - Gregory M. Scalia
- Department of Echocardiography, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- Heart and Lung Program, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4032, Australia
- School of Medicine, The University of Queensland Brisbane, QLD, Australia
- Heart Care Partners, Brisbane 4066, QLD, Australia
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Parra JA, Cuesta JM, Zarrabeitia R, Fariñas-Álvarez C, Bueno J, Marqués S, Parra-Fariñas C, Botella ML, Bernabéu C, Zarauza J. Screening pulmonary arteriovenous malformations in a large cohort of Spanish patients with hemorrhagic hereditary telangiectasia. Int J Cardiol 2016; 218:240-245. [DOI: 10.1016/j.ijcard.2016.05.065] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/06/2016] [Accepted: 05/12/2016] [Indexed: 11/26/2022]
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Duke JW, Elliott JE, Lovering AT. Clinical consideration for techniques to detect and quantify blood flow through intrapulmonary arteriovenous anastomoses: lessons from physiological studies. Echocardiography 2015; 32 Suppl 3:S195-204. [PMID: 25693624 DOI: 10.1111/echo.12839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Intrapulmonary arteriovenous anastomoses (IPAVA) are large diameter (>50 μm) vascular conduits, present in >95% of healthy humans. Because IPAVA are large diameter pathways that allow blood flow to bypass the pulmonary capillary network, blood flow through IPAVA (QIPAVA) can permit the transpulmonary passage of particles larger than pulmonary capillaries. IPAVA have been known to exist for over 50 years, but their physiological and clinical significance are still being established; although, currently suggested roles for QIPAVA include allowing emboli to reach the systemic circulation and providing a source of shunt. Studying QIPAVA is an important area of research and as the suggested roles become better established, detecting and quantifying QIPAVA may become significantly more important in the clinic. Several techniques that can be used to quantify and/or detect QIPAVA in animals, ex vivo human/animal lungs, and intact healthy humans; microspheres, radiolabeled macroaggregated albumin particles, and saline contrast echocardiography, are reviewed with limitations and advantages to each. The current body of literature using these techniques to study QIPAVA in animals, ex vivo lungs, and healthy humans has established conditions when QIPAVA is present, such as during exercise or with arterial hypoxemia and conditions when QIPAVA is absent, such as at rest or during exercise breathing 100% O2 . Many of these physiological studies have direct application to patient populations and we discuss each of these findings in the context of their potential to influence the clinical utility, and interpretation, of the results from these techniques highlighted in this review.
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Affiliation(s)
- Joseph W Duke
- Division of Exercise Physiology, Ohio University, Athens, Ohio
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Boissier F, Razazi K, Thille AW, Roche-Campo F, Leon R, Vivier E, Brochard L, Brun-Buisson C, Mekontso Dessap A. Echocardiographic detection of transpulmonary bubble transit during acute respiratory distress syndrome. Ann Intensive Care 2015; 5:5. [PMID: 25859416 PMCID: PMC4388070 DOI: 10.1186/s13613-015-0046-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 03/09/2015] [Indexed: 11/27/2022] Open
Abstract
Background Transpulmonary bubble transit (TPBT) detected with contrast echocardiography is reported as a sign of intrapulmonary shunt during cirrhosis or exercise in healthy humans. However, its physiological meaning is not clear during acute respiratory distress syndrome (ARDS). Our aim was to determine the prevalence, significance, and prognosis of TPBT detection during ARDS. Methods This was a prospective observational study in an academic medical intensive care unit in France. Two hundred and sixteen consecutive patients with moderate-to-severe ARDS underwent transesophageal echocardiography with modified gelatine contrast. Moderate-to-large TPBT was defined as right-to-left passage of at least ten bubbles through a pulmonary vein more than three cardiac cycles after complete opacification of the right atrium. Patients with intra-cardiac shunt through patent foramen ovale were excluded. Results The prevalence of moderate-to-large TPBT was 26% (including 42 patients with moderate and 15 with large TPBT). Patients with moderate-to-large TPBT had higher values of cardiac index and heart rate as compared to those without TPBT. There was no significant difference in PaO2/FIO2 ratio between groups, and TPBT was not influenced by end-expiratory positive pressure level in 93% of tested patients. Prevalence of septic shock was higher in the group with moderate-to-large TPBT. Patients with moderate-to-large TPBT had fewer ventilator-free days and intensive care unit-free days within the first 28 days, and higher in-hospital mortality as compared to others. Conclusions Moderate-to-large TPBT was detected with contrast echocardiography in 26% of patients with ARDS. This finding was associated with a hyperdynamic and septic state, but did not influence oxygenation.
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Affiliation(s)
- Florence Boissier
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France ; INSERM, Unité U955 (IMRB), 8 rue du Général Sarrail, Créteil, 94010 France ; Faculté de Médecine, Université Paris Est Créteil, 8, rue du Général Sarrail, Créteil, 94010 France
| | - Keyvan Razazi
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France
| | - Arnaud W Thille
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France ; CHU de Poitiers, Réanimation médicale, Poitiers, France; INSERM CIC 1402 (équipe 5 ALIVE), Université de Poitiers, 2 Rue de la Milétrie, 86021 Poitiers, France
| | - Ferran Roche-Campo
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France ; Servei de Medicina Intensiva, Hospital Verge de la Cinta, Carrer de les Esplanetes, 14, 43500 Tortosa, Tarragona Spain
| | - Rusel Leon
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France ; Centre Hospitalier Intercommunal de Créteil, Réanimation polyvalente, 40 avenue de Verdun, 94010 Créteil, France
| | - Emmanuel Vivier
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France ; Centre Hospitalier Saint Luc Saint Joseph, Réanimation Polyvalente, 20, quai Claude Bernard, 69007 Lyon, France
| | - Laurent Brochard
- Saint Michael's Hospital, 30 Bond Street, ON M5B 1 W8 Toronto, Canada
| | - Christian Brun-Buisson
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France ; INSERM, Unité U955 (IMRB), 8 rue du Général Sarrail, Créteil, 94010 France ; Faculté de Médecine, Université Paris Est Créteil, 8, rue du Général Sarrail, Créteil, 94010 France
| | - Armand Mekontso Dessap
- AP-HP, Hôpital Henri Mondor, DHU A-TVB, Service de Réanimation Médicale, Groupe de recherche CARMAS, 51 Av Mal de Lattre de Tassigny, Créteil, 94010 France ; INSERM, Unité U955 (IMRB), 8 rue du Général Sarrail, Créteil, 94010 France ; Faculté de Médecine, Université Paris Est Créteil, 8, rue du Général Sarrail, Créteil, 94010 France
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Cardozo S, Gunasekaran P, Patel H, McGorisk T, Toosi M, Faraz H, Zalawadiya S, Alesh I, Kottam A, Afonso L. Is bacteriostatic saline superior to normal saline as an echocardiographic contrast agent? Int J Cardiovasc Imaging 2014; 30:1483-9. [PMID: 25017710 DOI: 10.1007/s10554-014-0493-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 07/05/2014] [Indexed: 11/27/2022]
Abstract
Objective data on the performance characteristics and physical properties of commercially available saline formulations [normal saline (NS) vs. bacteriostatic normal saline (bNS)] are sparse. This study sought to compare the in vitro physical properties and in vivo characteristics of two commonly employed echocardiographic saline contrast agents in an attempt to assess superiority. Nineteen patients undergoing transesophageal echocardiograms were each administered agitated regular NS and bNS injections in random order and in a blinded manner according to a standardized protocol. Video time-intensity (TI) curves were constructed from a representative region of interest, placed paraseptally within the right atrium, in the bicaval view. TI curves were analyzed for maximal plateau acoustic intensity (Vmax, dB) and dwell time (DT, s), defined as time duration between onset of Vmax and decay of video intensity below clinically useful levels, reflecting the duration of homogenous opacification of the right atrium. To further characterize the physical properties of the bubbles in vitro, fixed aliquots of similarly agitated saline were injected into a glass well slide-cover slip assembly and examined using an optical microscope to determine bubble diameter in microns (µm) and concentration [bubble count/high power field (hpf)]. A higher acoustic intensity (a less negative dB level), higher bubble concentration and longer DT were considered properties of a superior contrast agent. For statistical analysis, a paired t test was conducted to evaluate the differences in means of Vmax and DT. Compared to NS, bNS administration was associated with superior opacification (video intensity -8.69 ± 4.7 vs. -10.46 ± 4.1 dB, P = 0.002), longer DT (17.3 ± 6.1 vs. 10.2 ± 3.7 s) in vivo and smaller mean bubble size (43.4 vs. 58.6 μm) and higher bubble concentration (1,002 vs. 298 bubble/hpf) in vitro. bNS provides higher intensity and more sustained opacification of the right atrium compared to NS. Higher bubble concentration and stability appear to be additional desirable rheological characteristics favoring bNS as a contrast agent.
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Affiliation(s)
- Shaun Cardozo
- Division of Cardiology, Department of Internal Medicine, Detroit Medical Center, Harper University Hospital, Wayne State University, 3990 John R, 8 Brush, Detroit, MI, 48201, USA
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Lalande S, Yerly P, Faoro V, Naeije R. Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals. J Physiol 2012; 590:4279-88. [PMID: 22733662 DOI: 10.1113/jphysiol.2012.234310] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
It has been suggested that shallow slopes of mean pulmonary artery pressure (MPPA)–cardiac output (Q) relationships and pulmonary transit of agitated contrast during exercise may be associated with a higher maximal aerobic capacity V(O(2)max). If so, individuals with a higher V(O(2)max) could also exhibit a higher pulmonary vascular distensibility and increased pulmonary capillary blood volume during exercise. Exercise stress echocardiography was performed with repetitive injections of agitated contrast and measurements of MPPA, Q and lung diffusing capacities for carbon monoxide (D(L,CO)) and nitric oxide (D(L,CO)) in 24 healthy individuals. A pulmonary vascular distensibility coefficient α was mathematically determined from the slight natural curvilinearity of multipoint MPPA–Q plots. Membrane (D(m)) and capillary blood volume (V(c)) components of lung diffusing capacity were calculated. Maximal exercise increased MPPA, cardiac index (CI), D(L,CO) and (D(L,NO). The slope of the linear best fit of MPPA–CI was 3.2 ± 0.5 mmHg min l(-1) m(2) and α was 1.1 ± 0.3% mmHg(-1). A multivariable analysis showed that higher α and greater V(c) independently predicted V(O(2)max). All individuals had markedly positive pulmonary transit of agitated contrast at maximal exercise, with increases proportional to increases in pulmonary capillary pressure and V(c). Pulmonary transit of agitated contrast was not related to pulse oximetry arterial oxygen saturation. Therefore, a more distensible pulmonary circulation and a greater pulmonary capillary blood volume are associated with a higher V(O(2)max) in healthy individuals. Agitated contrast commonly transits through the pulmonary circulation at exercise, in proportion to increased pulmonary capillary pressures.
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Affiliation(s)
- Sophie Lalande
- Laboratory of Cardiorespiratory Physiology, Faculté des Sciences de la Motricité, Université Libre de Bruxelles, Brussels, Belgium.
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Johansson MC, Eriksson P, Guron CW, Dellborg M. Authors’ Reply. J Am Soc Echocardiogr 2011. [DOI: 10.1016/j.echo.2010.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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The authors reply:. Crit Care Med 2011. [DOI: 10.1097/ccm.0b013e318205c084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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La Gerche A, MacIsaac AI, Burns AT, Mooney DJ, Inder WJ, Voigt JU, Heidbüchel H, Prior DL. Pulmonary transit of agitated contrast is associated with enhanced pulmonary vascular reserve and right ventricular function during exercise. J Appl Physiol (1985) 2010; 109:1307-17. [DOI: 10.1152/japplphysiol.00457.2010] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Pulmonary transit of agitated contrast (PTAC) occurs to variable extents during exercise. We tested the hypothesis that the onset of PTAC signifies flow through larger-caliber vessels, resulting in improved pulmonary vascular reserve during exercise. Forty athletes and fifteen nonathletes performed maximal exercise with continuous echocardiographic Doppler measures [cardiac output (CO), pulmonary artery systolic pressure (PASP), and myocardial velocities] and invasive blood pressure (BP). Arterial gases and B-type natriuretic peptide (BNP) were measured at baseline and peak exercise. Pulmonary vascular resistance (PVR) was determined as the regression of PASP/CO and was compared according to athletic and PTAC status. At peak exercise, athletes had greater CO (16.0 ± 2.9 vs. 12.4 ± 3.2 l/min, P < 0.001) and higher PASP (60.8 ± 12.6 vs. 47.0 ± 6.5 mmHg, P < 0.001), but PVR was similar to nonathletes ( P = 0.71). High PTAC (defined by contrast filling of the left ventricle) occurred in a similar proportion of athletes and nonathletes (18/40 vs. 10/15, P = 0.35) and was associated with higher peak-exercise CO (16.1 ± 3.4 vs. 13.9 ± 2.9 l/min, P = 0.010), lower PASP (52.3 ± 9.8 vs. 62.6 ± 13.7 mmHg, P = 0.003), and 37% lower PVR ( P < 0.0001) relative to low PTAC. Right ventricular (RV) myocardial velocities increased more and BNP increased less in high vs. low PTAC subjects. On multivariate analysis, maximal oxygen consumption (V̇o2max) ( P = 0.009) and maximal exercise output ( P = 0.049) were greater in high PTAC subjects. An exercise-induced decrease in arterial oxygen saturation (98.0 ± 0.4 vs. 96.7 ± 1.4%, P < 0.0001) was not influenced by PTAC status ( P = 0.96). Increased PTAC during exercise is a marker of pulmonary vascular reserve reflected by greater flow, reduced PVR, and enhanced RV function.
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Affiliation(s)
- André La Gerche
- Departments of 1Medicine and of
- Department of Cardiovascular Medicine, University Hospital, University of Leuven, Leuven, Belgium
| | - Andrew I. MacIsaac
- Cardiology, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; and
| | - Andrew T. Burns
- Cardiology, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; and
| | - Don J. Mooney
- Cardiology, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; and
| | | | - Jens-Uwe Voigt
- Department of Cardiovascular Medicine, University Hospital, University of Leuven, Leuven, Belgium
| | - Hein Heidbüchel
- Department of Cardiovascular Medicine, University Hospital, University of Leuven, Leuven, Belgium
| | - David L. Prior
- Departments of 1Medicine and of
- Cardiology, St. Vincent's Hospital, University of Melbourne, Melbourne, Australia; and
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Prevalence and prognosis of shunting across patent foramen ovale during acute respiratory distress syndrome. Crit Care Med 2010; 38:1786-92. [PMID: 20601861 DOI: 10.1097/ccm.0b013e3181eaa9c8] [Citation(s) in RCA: 94] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Right-to-left shunting across a patent foramen ovale may occur in acute respiratory distress syndrome as a result of pulmonary hypertension and positive-pressure mechanical ventilation. The shunt may worsen the hypoxemia. The objective of our study was to determine the prevalence, clinical implications, and prognosis of patent foramen ovale shunting during acute respiratory distress syndrome. DESIGN Prospective study. SETTING Medical intensive care unit of a university hospital in Créteil, France. PATIENTS Two hundred three consecutive patients with acute respiratory distress syndrome. INTERVENTIONS Patent foramen ovale shunting was detected by using transesophageal echocardiography with modified gelatin contrast. Moderate-to-large shunting was defined as right-to-left passage of at least 10 bubbles through a valve-like structure within three cardiac cycles after complete opacification of the right atrium. In 85 patients without and 31 with shunting, the influence of the positive end-expiratory pressure level on shunting was studied. MEASUREMENTS AND RESULTS The prevalence of moderate-to-large patent foramen ovale shunting was 19.2% (39 patients). Compared to those in the group without shunting, the patients in group with shunting had larger right ventricle dimensions, higher pulmonary artery systolic pressure, and a higher prevalence of cor pulmonale. Compared to patients without shunting, patients with shunting had a poorer Pa(O(2))/Fi(O(2)) ratio response to positive end-expiratory pressure, more often required prone positioning and nitric oxide as adjunctive interventions, and had fewer ventilator-free and intensive care unit-free days within the first 28 days. CONCLUSIONS Moderate-to-large patent foramen ovale shunting occurred in 19.2% of patients with acute respiratory distress syndrome, in keeping with findings from autopsy studies. Patent foramen ovale was associated with a poor oxygenation response to positive end-expiratory pressure, greater use of adjunctive interventions, and a longer intensive care unit stay.
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Cabello B, Borrás X, Carreras F, Thomas B, Leta R, Pons-Lladó G. [Improvement in the measurement technique of pulmonary artery pressure by Doppler echocardiography with contrast in chronic obstructive pulmonary disease]. Med Intensiva 2010; 34:506-12. [PMID: 20598397 DOI: 10.1016/j.medin.2010.05.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 05/07/2010] [Accepted: 05/08/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the benefit of contrast echocardiography in the assessment of systolic pulmonary artery pressure (PAPs). DESIGN Compare standard reference (Doppler-echocardiography) with contrast. LOCATION Echocardiography department. PATIENTS Ambulatory chronic obstructive patient disease (COPD). INTERVENTION Continuous wave Doppler spectral signal of tricuspid regurgitation (TR) was evaluated before and after intravenous injection of a galactose-based intravenous echo-enhancing agent. A four patterns scale classified the quality of the TR signal: 0=absent regurgitation; 1=protosystolic signal not allowing the recognition of peak velocity; 2=non-homogenous signal intensity, albeit allowing the measurement of maximal velocity; and 3=uniform pansystolic velocity signal. PAPs was estimated adding 10 mm Hg to the transtricuspid gradient, calculated from the TR peak velocity. RESULTS PAPs was only calculated reliably in 20 (49%) patients before the administration of contrast. Seventeen patients were classified as pattern 2, and three as pattern 3 on the scale of the TR quality signal. After contrast 41 (95%) patients showed a reliable TR signal. Two were classified as pattern 1, 11 as pattern 2 and 28 as pattern 3 on the scale of the TR quality signal. In the 20 patients in whom PAPs was estimated before contrast, a significant increase in PAPs values occurred after contrast, 44±10 mm Hg vs. 56±15 mm Hg (p<0.01). CONCLUSION The use of an echocardiography contrast agent increases the number of COPD patients in whom PAPs can be estimated non-invasively and may avoid underestimation of the PAP value.
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Affiliation(s)
- B Cabello
- Servicio de Medicina Intensiva, Hospital de Sant Pau, Barcelona, España.
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Echocardiographic Indexes for the Non-Invasive Evaluation of Pulmonary Hemodynamics. J Am Soc Echocardiogr 2010; 23:225-39; quiz 332-4. [DOI: 10.1016/j.echo.2010.01.003] [Citation(s) in RCA: 126] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2009] [Indexed: 11/20/2022]
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Lefèvre J, Lafitte S, Reant P, Perron JM, Roudaut R. Optimization of patent foramen ovale detection by contrast transthoracic echocardiography using second harmonic imaging. Arch Cardiovasc Dis 2008; 101:213-9. [PMID: 18654095 DOI: 10.1016/s1875-2136(08)73695-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Patent foramen ovale is an anomaly responsible for paradoxical embolizations and cerebral ischemic events. Aims. - We want to show second harmonic transthoracic echography sensitized by contrast agent perfusion is as well as transesophageal echography to patent foramen ovale detection. METHODS Onene hundred twenty one patients referred for transesophageal echocardiography for patent foramen ovale detection, underwent additive second harmonic transthoracic echocardiography with one of three randomized contrast agents: a mixture A of dextrose and air, mixture B of dextrose and air and blood, or mixture C of hydroxyethylamidon. The severity of atrial shunting was evaluated on recordings by semi-quantitative scoring. Intensity of contrast was also assessed by objective quantitative videodensitometry. RESULTS No difference was observed between the two techniques, nor between mixture A, B and C in terms of PFO detection during each exam. However, quantitative contrast analysis showed higher intensity with mixtures B and C with mixture A during transthoracic echography. CONCLUSIONS When performed with a contrast agent, second harmonic transthoracic echography and transoesophageal echography are comparable when it comes to patent foramen ovale detection. Although the composition of the contrast agent does not appear to affect the rate of this detection, contrast quality in the right atrium during transthoracic exam is better with mixtures B and C than with mixture A.
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Affiliation(s)
- J Lefèvre
- Laboratoire d'échographie cardiaque, Hôpital Cardiologique du Haut-Levêque, Université de Bordeaux 2, Pessac
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