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Cavefors O, Einarsson F, Holmqvist J, Bech-Hanssen O, Ricksten SE, Redfors B, Oras J. Cardiac biomarkers for screening and prognostication of cardiac dysfunction in critically ill patients. ESC Heart Fail 2024. [PMID: 39087599 DOI: 10.1002/ehf2.14980] [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: 11/20/2023] [Revised: 04/04/2024] [Accepted: 07/01/2024] [Indexed: 08/02/2024] Open
Abstract
AIMS This study aimed to assess the use of high-sensitivity troponin T (hsTNT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) in screening for cardiac dysfunction [left ventricular (LV) systolic or diastolic dysfunction or right ventricular (RV) dysfunction] in mixed intensive care unit (ICU) patients and establish whether these biomarkers are independently associated with an increased risk of death. METHODS We performed a secondary analysis of a single-centre prospective observational study in which consecutive ICU patients were examined with transthoracic echocardiography (TTE) and cardiac biomarkers. Patients with systolic or diastolic LV dysfunction, RV dysfunction or a combination of these were compared with patients with normal cardiac function. Sensitivity and specificity for different cut-off levels were calculated using receiver operating characteristic curves. Regression models were used to evaluate the associations between cardiac biomarkers, sepsis, renal failure and mortality. RESULTS A total of 276 patients were included. Most of the patients had cardiac dysfunction on TTE (64%). Combined cardiac dysfunction was most prevalent (71 patients, 26%), followed by isolated diastolic LV dysfunction (40 patients, 15%). Levels of hsTNT and NT-proBNP were higher in all types of cardiac dysfunction versus patients with normal cardiac function. The area under the curve (AUC) for hsTNT to detect any cardiac dysfunction was 0.75. An optimal cut-off at 30.5 ng/L rendered a positive predictive value (PPV) of 80% and a negative predictive value (NPV) of 58%. The AUC for NT-proBNP to detect any cardiac dysfunction was 0.788. Using an optimal cut-off at 1145 ng/L rendered a PPV of 86% and an NPV of 58%. Using a clinically relevant 90% sensitivity for detecting cardiac dysfunction put the cut-offs at 14.1 ng/L for hsTNT and 247 ng/L for NT-proBNP, resulting in a specificity of 48% and 46%, respectively. Levels of NT-proBNP were associated with sepsis and renal failure (P < 0.001), while levels of hsTNT were associated with renal failure only (P < 0.001) after adjustment for cardiac dysfunction. Levels of biomarkers were associated with an increased risk of 90 day mortality after adjustments for age, Simplified Acute Physiology Score 3, cardiac dysfunction and factors independently associated with biomarker increase (sepsis and renal failure) (P = 0.048 for hsTNT and P < 0.006 for NT-proBNP). CONCLUSION Cardiac biomarkers, hsTNT and NT-proBNP, are strongly correlated to cardiac dysfunction in ICU patients and have a robust association with increased mortality. However, the relatively low NPV and the low specificity at relevant sensitivity levels of the biomarkers make them unsuitable for use in screening for cardiac dysfunction.
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Affiliation(s)
- Oscar Cavefors
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Freyr Einarsson
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jakob Holmqvist
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Anaesthesiology and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden
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Reiter C, Reiter U, Kräuter C, Kolesnik E, Scherr D, Schmidt A, Fuchsjäger M, Reiter G. MR 4D flow-derived left atrial acceleration factor for differentiating advanced left ventricular diastolic dysfunction. Eur Radiol 2024; 34:4065-4076. [PMID: 37953367 PMCID: PMC11166802 DOI: 10.1007/s00330-023-10386-9] [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: 08/23/2023] [Revised: 08/23/2023] [Accepted: 10/02/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES The magnetic resonance (MR) 4D flow imaging-derived left atrial (LA) acceleration factor α was recently introduced as a means to non-invasively estimate LA pressure. We aimed to investigate the association of α with the severity of left ventricular (LV) diastolic dysfunction using echocardiography as the reference method. METHODS Echocardiographic assessment of LV diastolic function and 3-T cardiac MR 4D flow imaging were prospectively performed in 94 subjects (44 male/50 female; mean age, 62 ± 12 years). LA early diastolic peak outflow velocity (vE), systolic peak inflow velocity (vS), and early diastolic peak inflow velocity (vD) were evaluated from 4D flow data. α was calculated from α = vE / [(vS + vD) / 2]. Mean parameter values were compared by t-test; diagnostic performance of α in predicting diastolic (dys)function was investigated by receiver operating characteristic curve analysis. RESULTS Mean α values were 1.17 ± 0.14, 1.20 ± 0.08, 1.33 ± 0.15, 1.77 ± 0.18, and 2.79 ± 0.69 for grade 0 (n = 51), indeterminate (n = 9), grade I (n = 13), grade II (n = 13), and grade III (n = 8) LV diastolic (dys)function, respectively. α differed between subjects with non-advanced (grade < II) and advanced (grade ≥ II) diastolic dysfunction (1.20 ± 0.15 vs. 2.16 ± 0.66, p < 0.001). The area under the curve (AUC) for detection of advanced diastolic dysfunction was 0.998 (95% CI: 0.958-1.000), yielding sensitivity of 100% (95% CI: 84-100%) and specificity of 99% (95% CI: 93-100%) at cut-off α ≥ 1.58. The AUC for differentiating grade III diastolic dysfunction was also 0.998 (95% CI: 0.976-1.000) at cut-off α ≥ 2.14. CONCLUSION The 4D flow-derived LA acceleration factor α allows grade II and grade III diastolic dysfunction to be distinguished from non-advanced grades as well as from each other. CLINICAL RELEVANCE STATEMENT As a single continuous parameter, the 4D flow-derived LA acceleration factor α shows potential to simplify the multi-parametric imaging algorithm for diagnosis of advanced LV diastolic dysfunction, thereby identifying patients at increased risk for cardiovascular events. KEY POINTS • Detection of advanced diastolic dysfunction is typically performed using a complex, multi-parametric approach. • The 4D flow-derived left atrial acceleration factor α alone allows accurate detection of advanced left ventricular diastolic dysfunction. • As a single continuous parameter, the left atrial acceleration factor α could simplify the diagnosis of advanced diastolic dysfunction.
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Affiliation(s)
- Clemens Reiter
- Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ursula Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria.
| | - Corina Kräuter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Ewald Kolesnik
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Daniel Scherr
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Albrecht Schmidt
- Division of Cardiology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Michael Fuchsjäger
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
| | - Gert Reiter
- Division of General Radiology, Department of Radiology, Medical University of Graz, Auenbruggerplatz 9/P, 8036, Graz, Austria
- Research and Development, Siemens Healthcare Diagnostics GmbH, Graz, Austria
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Hegner P, Wester M, Tafelmeier M, Provaznik Z, Klatt S, Schmid C, Maier LS, Arzt M, Wagner S, Lebek S. Systemic inflammation predicts diastolic dysfunction in patients with sleep disordered breathing. Eur Respir J 2024; 63:2400579. [PMID: 38636989 PMCID: PMC11154749 DOI: 10.1183/13993003.00579-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 04/02/2024] [Indexed: 04/20/2024]
Abstract
Heart failure with preserved ejection fraction (HFpEF) constitutes approximately half of all patients with heart failure and causes mortality similar to heart failure with reduced ejection fraction [1]. HFpEF is highly relevant as novel evidence-based therapies emerge but treatment options remain limited [1]. Diastolic dysfunction is a hallmark of HFpEF and is also very common in up to 80% of high-risk cardiovascular patients undergoing cardiac surgery [2]. Even without overt HFpEF, echocardiographic diastolic dysfunction is independently associated with increased mortality [3]. Another important characteristic of HFpEF is the frequent presence of comorbidities, with one of the most important being sleep disordered breathing (SDB). SDB affects over one billion patients in the general population and is highly prevalent in cardiovascular high-risk patients, which underscores its high socioeconomic relevance [4]. Interestingly, SDB patients frequently exhibit diastolic dysfunction [5]; however, the underlying mechanisms remain elusive thus far [6]. In this cross-sectional experimental study, we analysed the role of inflammation and fibrosis for diastolic dysfunction in cardiovascular high-risk patients stratified by the prevalence of SDB, which may provide a groundwork for future therapeutic strategies. Systemic and myocardial inflammation are associated with diastolic cardiac dysfunction in patients with sleep disordered breathing, which may have therapeutic implications https://bit.ly/3vxAECC
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Affiliation(s)
- Philipp Hegner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Wester
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Maria Tafelmeier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Zdenek Provaznik
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Susanne Klatt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Christof Schmid
- Department of Cardiothoracic Surgery, University Hospital Regensburg, Regensburg, Germany
| | - Lars Siegfried Maier
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Michael Arzt
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
| | - Stefan Wagner
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- S. Wagner and S. Lebek contributed equally to this article as senior authors
| | - Simon Lebek
- Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA
- S. Wagner and S. Lebek contributed equally to this article as senior authors
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Duan S, Ma Y, Lu F, Zhang C, Guo H, Zeng M, Sun B, Yuan Y, Xing C, Mao H, Zhang B. High sodium intake and fluid overhydration predict cardiac structural and functional impairments in chronic kidney disease. Front Nutr 2024; 11:1388591. [PMID: 38860161 PMCID: PMC11164051 DOI: 10.3389/fnut.2024.1388591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/14/2024] [Indexed: 06/12/2024] Open
Abstract
Background High sodium intake and fluid overhydration are common factors of and strongly associated with adverse outcomes in chronic kidney disease (CKD) patients. Yet, their effects on cardiac dysfunction remain unclear. Aims The study aimed to explore the impact of salt and volume overload on cardiac alterations in non-dialysis CKD. Methods In all, 409 patients with CKD stages 1-4 (G1-G4) were enrolled. Daily salt intake (DSI) was estimated by 24-h urinary sodium excretion. Volume status was evaluated by the ratio of extracellular water (ECW) to total body water (TBW) measured by body composition monitor. Recruited patients were categorized into four groups according to DSI (6 g/day) and median ECW/TBW (0.439). Echocardiographic and body composition parameters and clinical indicators were compared. Associations between echocardiographic findings and basic characteristics were performed by Spearman's correlations. Univariate and multivariate binary logistic regression analysis were used to determine the associations between DSI and ECW/TBW in the study groups and the incidence of left ventricular hypertrophy (LVH) and elevated left ventricular filling pressure (ELVFP). In addition, the subgroup effects of DSI and ECW/TBW on cardiac abnormalities were estimated using Cox regression. Results Of the enrolled patients with CKD, the median urinary protein was 0.94 (0.28-3.14) g/d and estimated glomerular filtration rate (eGFR) was 92.05 (IQR: 64.52-110.99) mL/min/1.73 m2. The distributions of CKD stages G1-G4 in the four groups was significantly different (p = 0.020). Furthermore, compared to group 1 (low DSI and low ECW/TBW), group 4 (high DSI and high ECW/TBW) showed a 2.396-fold (95%CI: 1.171-4.902; p = 0.017) excess risk of LVH and/or ELVFP incidence after adjusting for important CKD and cardiovascular disease risk factors. Moreover, combined with eGFR, DSI and ECW/TBW could identify patients with higher cardiac dysfunction risk estimates with an AUC of 0.704 (sensitivity: 75.2%, specificity: 61.0%). The specificity increased to 85.7% in those with nephrotic proteinuria (AUC = 0.713). The magnitude of these associations was consistent across subgroups analyses. Conclusion The combination of high DSI (>6 g/d) and high ECW/TBW (>0.439) independently predicted a greater risk of LVH or ELVFP incidence in non-dialysis CKD patients. Moreover, the inclusion of eGFR and proteinuria improved the risk stratification ability of DSI and ECW/TBW in cardiac impairments in CKD.
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Vasapollo B, Novelli GP, Maellaro F, Gagliardi G, Pais M, Silvestrini M, Pometti F, Farsetti D, Valensise H. Maternal cardiovascular profile is altered in the preclinical phase of normotensive early and late intrauterine growth restriction. Am J Obstet Gynecol 2024:S0002-9378(24)00597-0. [PMID: 38763339 DOI: 10.1016/j.ajog.2024.05.015] [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: 11/06/2023] [Revised: 05/01/2024] [Accepted: 05/13/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND The maternal cardiovascular profile of patients who develop late fetal growth restriction has yet to be well characterized, however, a subclinical impairment in maternal hemodynamics and cardiac function may be present before pregnancy and may become evident because of the hemodynamic alterations associated with pregnancy. OBJECTIVE This study aimed to investigate if maternal hemodynamics and the cardiovascular profile might be different in the preclinical stages (22-24 weeks' gestation) in cases of early and late fetal growth restriction in normotensive patients. STUDY DESIGN This was a prospective echocardiographic study of 1152 normotensive nulliparous pregnant women at 22 to 24 weeks' gestation. The echocardiographic evaluation included morphologic parameters (left ventricular mass index and relative wall thickness, left atrial volume index) and systolic and diastolic maternal left ventricular function (ejection fraction, left ventricular global longitudinal strain, E/A ratio, and E/e' ratio). Patients were followed until the end of pregnancy to note the development of normotensive early or late fetal growth restriction. RESULTS Of the study cohort, 1049 patients had no complications, 73 were classified as having late fetal growth restriction, and 30 were classified as having early fetal growth restriction. In terms of left ventricular morphology, the left ventricular end-diastolic diameter was greater in uneventful pregnancies (4.84±0.28 cm) than in late (4.67±0.26 cm) and in early (4.55±0.26 cm) (P<.001) fetal growth restriction cases, whereas left ventricular end-systolic diameter was smaller in uneventful pregnancies (2.66±0.39 cm) than in late (2.83±0.40 cm) and in early (2.82±0.38 cm) (P<.001) fetal growth restriction cases. The relative wall thickness was slightly higher in early (0.34±0.05) and late (0.35±0.04) fetal growth restriction cases than in uneventful pregnancies (0.32±0.05) (P<.05). In terms of systolic left ventricular function, at 22 to 24 weeks' gestation, cardiac output was higher in uneventful pregnancies (6.58±1.07 L/min) than in late (5.40±0.97 L/min) and in early (4.76±1.05 L/min) (P<.001) fetal growth restriction cases with the lowest values in the early-onset group. Left ventricular global longitudinal strain was lower in appropriate for gestational age neonates (-21.6%±2.0%) and progressively higher in late (-20.1%±2.2%) and early (-18.5%±2.3%) (P<.001) fetal growth restriction cases. In terms of diastolic left ventricular function, the E/e' ratio showed intermediate values in the late fetal growth restriction group (7.90±2.73) when compared with the appropriate for gestational age group (7.24±2.43) and with the early fetal growth restriction group (10.76±3.25) (P<.001). The total peripheral vascular resistance was also intermediate in the late fetal growth restriction group (1300±199 dyne·s·cm-5) when compared with the appropriate for gestational age group (993±175 dyne·s·cm-5) and the early fetal growth restriction group (1488±255 dyne.s.cm-5) (P<.001). CONCLUSION Early and late fetal growth restriction share similar maternal hemodynamic and cardiovascular profiles with a different degree of expression. These features are already present at 22 to 24 weeks' gestation and are characterized by a hypodynamic state. The degree of these cardiovascular changes may influence the timing of the manifestation of the disease; a hypovolemic, high resistance, low cardiac output state might be associated with early-onset fetal growth restriction, whereas a milder hypovolemic state seems to favor the development of the disease in the final stages of pregnancy.
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Affiliation(s)
- Barbara Vasapollo
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy; Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
| | - Gian Paolo Novelli
- Prehospitalization Unit, Department of Integrated Care Processes, Policlinico di Tor Vergata, Rome, Italy.
| | - Filomena Maellaro
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy; Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
| | - Giulia Gagliardi
- Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
| | - Marcello Pais
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Marco Silvestrini
- Prehospitalization Unit, Department of Integrated Care Processes, Policlinico di Tor Vergata, Rome, Italy; Department of Sports Medicine, Tor Vergata University, Rome, Italy
| | - Francesca Pometti
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy
| | - Daniele Farsetti
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy; Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
| | - Herbert Valensise
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy; Division of Obstetrics and Gynecology, Policlinico Casilino, Rome, Italy
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Lindow T, Manouras A, Lindqvist P, Manna D, Wieslander B, Kozor R, Strange G, Playford D, Ugander M. Echocardiographic estimation of pulmonary artery wedge pressure: invasive derivation, validation, and prognostic association beyond diastolic dysfunction grading. Eur Heart J Cardiovasc Imaging 2024; 25:498-509. [PMID: 37949842 DOI: 10.1093/ehjci/jead301] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/01/2023] [Accepted: 11/04/2023] [Indexed: 11/12/2023] Open
Abstract
AIMS Grading of diastolic function can be useful, but indeterminate classifications are common. We aimed to invasively derive and validate a quantitative echocardiographic estimation of pulmonary artery wedge pressure (PAWP) and to compare its prognostic performance to diastolic dysfunction grading. METHODS AND RESULTS Echocardiographic measures were used to derive an estimated PAWP (ePAWP) using multivariable linear regression in patients undergoing right heart catheterization (RHC). Prognostic associations were analysed in the National Echocardiography Database of Australia (NEDA). In patients who had undergone both RHC and echocardiography within 2 h (n = 90), ePAWP was derived using left atrial volume index, mitral peak early velocity (E), and pulmonary vein systolic velocity (S). In a separate external validation cohort (n = 53, simultaneous echocardiography and RHC), ePAWP showed good agreement with invasive PAWP (mean ± standard deviation difference 0.5 ± 5.0 mmHg) and good diagnostic accuracy for estimating PAWP >15 mmHg [area under the curve (95% confidence interval) 0.94 (0.88-1.00)]. Among patients in NEDA [n = 38,856, median (interquartile range) follow-up 4.8 (2.3-8.0) years, 2756 cardiovascular deaths], ePAWP was associated with cardiovascular death even after adjustment for age, sex, and diastolic dysfunction grading [hazard ratio (HR) 1.08 (1.07-1.09) per mmHg] and provided incremental prognostic information to diastolic dysfunction grading (improved C-statistic from 0.65 to 0.68, P < 0.001). Increased ePAWP was associated with worse prognosis across all grades of diastolic function [HR normal, 1.07 (1.06-1.09); indeterminate, 1.08 (1.07-1.09); abnormal, 1.08 (1.07-1.09), P < 0.001 for all]. CONCLUSION Echocardiographic ePAWP is an easily acquired continuous variable with good accuracy that associates with prognosis beyond diastolic dysfunction grading.
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Affiliation(s)
- Thomas Lindow
- Clinical Physiology, Clinical Sciences, Lund University, Lund, Sweden
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales 2065, Australia
| | - Aristomenis Manouras
- Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Per Lindqvist
- Department of Clinical Physiology, Surgical and Perioperative sciences, Umeå University, Umeå, Sweden
| | - Daniel Manna
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
- Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - Björn Wieslander
- Department of Clinical Physiology, Växjö Central Hospital, Växjö, Sweden
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales 2065, Australia
| | - Geoff Strange
- Institute for Health Research, School of Medicine, University of Notre Dame, Fremantle, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Heart Research Institute, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
| | - David Playford
- Institute for Health Research, School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, University of Sydney, Kolling Building, St Leonards, Sydney, New South Wales 2065, Australia
- Department of Clinical Physiology, Karolinska University Hospital, Karolinska Institutet, Stockholm 17176, Sweden
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Ratwatte S, Stewart S, Strange G, Playford D, Celermajer DS. Association of Pulmonary Artery Pressures With Mortality in Adults With Reduced Left Ventricular Ejection Fraction. JACC. HEART FAILURE 2024:S2213-1779(24)00147-1. [PMID: 38520460 DOI: 10.1016/j.jchf.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/19/2024] [Accepted: 01/24/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND The independent effect of pulmonary hypertension (PHT) severity on mortality in those with reduced left ventricular ejection fraction (LVEF) is not well known. OBJECTIVES The authors aimed to examine the prognostic impact of increasingly elevated pulmonary pressures in a large clinical cohort of adults with reduced LVEF. METHODS The authors analyzed data from the National Echocardiography Database of Australia, a large clinical registry linking routine echocardiographic investigations to mortality. In 23,675 adults with a recorded tricuspid regurgitation peak velocity (TRV) and reduced LVEF (<50%), the authors evaluated the relationship between conventional thresholds of increasing risk of PHT and mortality during median follow-up of 2.9 years (Q1-Q3: 1.0-5.4 years). RESULTS Mean age was 70 ± 15 years, and 7,498 (31.7%) individuals were female. Overall, 8,801 (37.2%) had normal (TRV <2.5 m/s), 7,061 (29.8%) had borderline (2.5-2.8 m/s), 5,676 (24.0%) intermediate (2.9-3.4 m/s), and 2,137 (9.0%) individuals had high-risk PHT (>3.4 m/s). With increasing risk of PHT, 1- and 5-year actuarial mortality increased from 13.3% and 43.8% to 41.5% and 81.4%, respectively (P < 0.0001) from normal to severely elevated TRV. The adjusted HR of mortality increased by 1.31-fold (95% CI: 1.23-1.38), 1.82-fold (95% CI: 1.72-1.93), and 2.38-fold (95% CI: 2.21-2.56) in those with borderline, intermediate, and high risk of PHT respectively, compared with normal TRV. Further analyses suggested a distinctive threshold with a TRV reached >2.41 m/s (adjusted HR: 1.18 [95% CI: 1.04-1.33]). CONCLUSIONS The authors demonstrate the prevalence and negative prognostic impact of increasingly elevated TRV levels in individuals with reduced LVEF, with a threshold for mortality lying within the range of "borderline risk" PHT.
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Affiliation(s)
- Seshika Ratwatte
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia
| | - Simon Stewart
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom; Institute for Health Research, The University of Notre Dame Australia, Freemantle, Western Australia, Australia
| | - Geoff Strange
- Institute for Health Research, The University of Notre Dame Australia, Freemantle, Western Australia, Australia; Heart Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Playford
- Institute for Health Research, The University of Notre Dame Australia, Freemantle, Western Australia, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia; University of Sydney, Faculty of Medicine and Health, Sydney, New South Wales, Australia; Heart Research Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
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Janssens JV, Raaijmakers AJA, Weeks KL, Bell JR, Mellor KM, Curl CL, Delbridge LMD. The cardiomyocyte origins of diastolic dysfunction: cellular components of myocardial "stiffness". Am J Physiol Heart Circ Physiol 2024; 326:H584-H598. [PMID: 38180448 DOI: 10.1152/ajpheart.00334.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 12/07/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
The impaired ability of the heart to relax and stretch to accommodate venous return is generally understood to represent a state of "diastolic dysfunction" and often described using the all-purpose noun "stiffness." Despite the now common qualitative usage of this term in fields of cardiac patho/physiology, the specific quantitative concept of stiffness as a molecular and biophysical entity with real practical interpretation in healthy and diseased hearts is sometimes obscure. The focus of this review is to characterize the concept of cardiomyocyte stiffness and to develop interpretation of "stiffness" attributes at the cellular and molecular levels. Here, we consider "stiffness"-related terminology interpretation and make links between cardiomyocyte stiffness and aspects of functional and structural cardiac performance. We discuss cross bridge-derived stiffness sources, considering the contributions of diastolic myofilament activation and impaired relaxation. This includes commentary relating to the role of cardiomyocyte Ca2+ flux and Ca2+ levels in diastole, the troponin-tropomyosin complex role as a Ca2+ effector in diastole, the myosin ADP dissociation rate as a modulator of cross bridge attachment and regulation of cross-bridge attachment by myosin binding protein C. We also discuss non-cross bridge-derived stiffness sources, including the titin sarcomeric spring protein, microtubule and intermediate filaments, and cytoskeletal extracellular matrix interactions. As the prevalence of conditions involving diastolic heart failure has escalated, a more sophisticated understanding of the molecular, cellular, and tissue determinants of cardiomyocyte stiffness offers potential to develop imaging and molecular intervention tools.
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Affiliation(s)
- Johannes V Janssens
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Antonia J A Raaijmakers
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Kate L Weeks
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Baker Department of Cardiometabolic Health, University of Melbourne, Melbourne, Victoria, Australia
- Department of Diabetes, Monash University, Parkville, Victoria, Australia
| | - James R Bell
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Microbiology, Anatomy, Physiology and Pharmacology, La Trobe University, Melbourne, Victoria, Australia
| | - Kimberley M Mellor
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiology, University of Auckland, Auckland, New Zealand
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Claire L Curl
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
| | - Lea M D Delbridge
- Department of Anatomy and Physiology, University of Melbourne, Melbourne, Victoria, Australia
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9
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Levene J, Voigt A, Thoma F, Mulukutla S, Bhonsale A, Kancharla K, Shalaby A, Estes NM, Jain S, Saba S. Patient Outcomes by Ventricular Systolic and Diastolic Function. J Am Heart Assoc 2024; 13:e033211. [PMID: 38353214 PMCID: PMC11010111 DOI: 10.1161/jaha.123.033211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 12/27/2023] [Indexed: 02/21/2024]
Abstract
BACKGROUND Left ventricular dysfunction is characterized by systolic and diastolic parameters, leading to heart failure (HF) with reduced or preserved ejection fraction (EF), respectively. The goal of this study is to examine the impact of left ventricular systolic and diastolic dysfunction (DD) on patient outcomes. METHODS AND RESULTS Two cohorts were used in this analysis: Cohort A included 136 455 patients with EF ≥50%, stratified by the presence and grade of DD. Cohort B included 16 850 patients with EF <50%, stratified by EF quartiles. Patients were followed to the end points of all-cause death and cardiovascular, HF, or cardiac arrest hospitalizations. Over a median follow-up of 3.42 years, 23 946 (16%) patients died and 31 113 (20%), 13 305 (9%), and 1269 (1%) were hospitalized for cardiovascular, HF, or cardiac arrest causes, respectively. With adjustment for comorbidities, the risk of all-cause mortality and of cardiovascular and HF hospitalizations increased steadily with increasing grade of DD in patients with normal EF, and even more so in patients with worsening EF. The risk of hospitalization for cardiac arrest in patients with grade III DD, however, was comparable to that of patients with EF <25% (hazard ratio, 1.00 [95% CI, 0.98-1.01]) and worse than that of patients in better EF quartiles. CONCLUSIONS Although systolic dysfunction is associated with a greater risk of overall death and HF hospitalizations than DD, the risk of cardiac arrest in patients with grade II and III DD is comparable to that of patients with moderate and severe systolic dysfunction, respectively. Future studies are needed to examine treatment strategies than can improve these outcomes.
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Affiliation(s)
- Jacqueline Levene
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Andrew Voigt
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Floyd Thoma
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Suresh Mulukutla
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Aditya Bhonsale
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Krishna Kancharla
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Alaa Shalaby
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - N.A. Mark Estes
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Sandeep Jain
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
| | - Samir Saba
- Heart and Vascular Institute at the University of Pittsburgh School of MedicinePittsburghPAUSA
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10
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Gonzalez FA, Santonocito C, Maybauer MO, Lopes LR, Almeida AG, Sanfilippo F. Diastology in the intensive care unit: Challenges for the assessment and future directions. Echocardiography 2024; 41:e15773. [PMID: 38380688 DOI: 10.1111/echo.15773] [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] [Received: 12/17/2023] [Revised: 01/19/2024] [Accepted: 01/20/2024] [Indexed: 02/22/2024] Open
Abstract
Myocardial dysfunction is common in patients admitted to the intensive care unit (ICU). Septic disease frequently results in cardiac dysfunction, and sepsis represents the most common cause of admission and death in the ICU. The association between left ventricular (LV) systolic dysfunction and mortality is not clear for critically ill patients. Conversely, LV diastolic dysfunction (DD) seems increasingly recognized as a factor associated with poor outcomes, not only in sepsis but also more generally in critically ill patients. Despite recent attempts to simplify the diagnosis and grading of DD, this remains relatively complex, with the need to use several echocardiographic parameters. Furthermore, the current guidelines have several intrinsic limitations when applied to the ICU setting. In this manuscript, we discuss the challenges in DD classification when applied to critically ill patients, the importance of left atrial pressure estimates for the management of patients in ICU, and whether the study of cardiac dysfunction spectrum during critical illness may benefit from the integration of left ventricular and left atrial strain data to improve diagnostic accuracy and implications for the treatment and prognosis.
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Affiliation(s)
- Filipe A Gonzalez
- Intensive Care Department of Hospital Garcia de Orta, Almada, Portugal
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Cristina Santonocito
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
| | - Marc O Maybauer
- Department of Anesthesiology, Division of Critical Care Medicine, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Luís Rocha Lopes
- Inherited Cardiac Disease Unit, Bart's Heart Centre St Bartholomew's Hospital London, London, UK
- Institute of Cardiovascular Science, University College London, London, UK
| | - Ana G Almeida
- Centro Cardiovascular da Universidade de Lisboa, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
| | - Filippo Sanfilippo
- Department of Anesthesia and Intensive Care, "Policlinico-San Marco" University Hospital, Catania, Italy
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
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11
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Playford D, Strange GA, Atherton JJ, Harris S, Chan YK, Stewart S. Clinical to Population Prevalence of Hypertrophic Cardiomyopathy Phenotype: Insights From the National Echo Database Australia. Heart Lung Circ 2024; 33:212-221. [PMID: 38177016 DOI: 10.1016/j.hlc.2023.10.021] [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] [Received: 03/07/2023] [Revised: 10/22/2023] [Accepted: 10/29/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND There is a paucity of data describing the underlying prevalence of hypertrophic cardiomyopathy (HCM), a primary genetic disorder characterised by progressive left ventricular (LV) hypertrophy and sudden death, from both a clinical and a population perspective. METHODS We screened the echocardiographic reports of 155,668 men and 147,880 women within the multicentre National Echo Database Australia (NEDA) (2001-2019). End-diastolic wall thickness ≥15 mm anywhere in the left ventricle was identified as a characteristic of an HCM phenotype according to current guideline recommendations. Applying a septal-to-posterior wall thickness ratio >1.3 and LV outflow tract obstruction ≥30 mmHg (when documented), we further identified asymmetric septal hypertrophy and obstructive HCM (oHCM), respectively. The observed pattern of phenotypical HCM within the overall NEDA cohort (>650,000 cases) was then extrapolated to the ∼539,000 (5.7% of adult population) and ∼474,000 (4.8%) Australian men and women, respectively, who were investigated with echocardiography in 2021 on an age-specific basis. RESULTS Overall, 15,380 cases (mean age 71.1±14.6 years, 10,138 men [65.9%]) with the characteristic HCM phenotype within the NEDA cohort were identified. Of these 15,380 cases, 5,552 (36.1%) had asymmetric septal hypertrophy, and 2,276 of the 10,290 cases with LV outflow tract obstruction profiling data (22.1%) had obstructive HCM. A further 3,389 of 13,715 cases (24.7%) had evidence of LV systolic dysfunction (LV ejection fraction <55%). Within the entire NEDA cohort (including those without LV profiling), HCM was found in 10,138 of 342,161 men (2.96%; 95% confidence interval [CI] 2.91%-3.02%) and 5,242 of 308,539 women (1.70%; 95% CI 1.65%-1.75%). When extrapolated to the Australian population, we estimate that a minimum of 15,971 men and 8,057 women presented with echocardiographic features of phenotypical HCM in 2021. This translates into a minimum caseload/prevalence of ∼17 adult men (∼2.5 in those aged ≤50 years) and eight adult women (∼1 in those aged ≤50 years) per 10,000 population meeting phenotypical HCM criteria. CONCLUSIONS Using contemporary Australian echocardiographic and population data, we estimate that a minimum of 15,971 (17.5 cases/10,000) men and 8,057 women (8.2 cases/10,000) had echocardiographic evidence of phenotypical HCM in 2021. These disease burden data are particularly relevant as new treatment options are emerging.
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Affiliation(s)
- David Playford
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia.
| | - Geoff A Strange
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia; Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John J Atherton
- Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, QLD, Australia; Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Sarah Harris
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Yih-Kai Chan
- Mary MacKillop Institute for Health Research, Australian Catholic University, Melbourne, Vic, Australia
| | - Simon Stewart
- Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, UK
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12
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Giorgione V, Di Fabrizio C, Giallongo E, Khalil A, O'Driscoll J, Whitley G, Kennedy G, Murdoch CE, Thilaganathan B. Angiogenic markers and maternal echocardiographic indices in women with hypertensive disorders of pregnancy. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2024; 63:206-213. [PMID: 37675647 DOI: 10.1002/uog.27474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE The maternal cardiovascular system of women with hypertensive disorders of pregnancy (HDP) can be impaired, with higher rates of left ventricular (LV) remodeling and diastolic dysfunction compared to those with normotensive pregnancy. The primary objective of this prospective study was to correlate cardiac indices obtained by transthoracic echocardiography (TTE) and circulating angiogenic markers, such as soluble fms-like tyrosine kinase-1 (sFlt-1) and placental growth factor (PlGF). METHODS In this study, 95 women with a pregnancy complicated by HDP and a group of 25 with an uncomplicated pregnancy at term underwent TTE and blood tests to measure sFlt-1 and PlGF during the peripartum period (before delivery or within a week of giving birth). Spearman's rank correlation was used to derive correlation coefficients between biomarkers and cardiac indices in the HDP and control populations. RESULTS The HDP group included 61 (64.2%) pre-eclamptic patients and, among them, 42 (68.9%) delivered before 37 weeks' gestation. Twelve women with HDP (12.6%) underwent blood sampling and TTE after delivery, and, as they showed significantly lower levels of angiogenic markers, they were excluded from the analysis. There was a correlation between sFlt-1 and LV mass index (LVMI) (r = 0.246; P = 0.026) and early diastolic mitral inflow velocity (E) and early diastolic mitral annular velocity (e') ratio (r = 0.272; P = 0.014) in the HDP group (n = 83), while in the controls, sFlt-1 showed a correlation with relative wall thickness (r = 0.409; P = 0.043), lateral e' (r = -0.562; P = 0.004) and E/e' ratio (r = 0.417; P = 0.042). PlGF correlated with LVMI (r = -0.238; P = 0.031) in HDP patients and with lateral e' (r = 0.466; P = 0.022) in controls. sFlt-1/PlGF ratio correlated with lateral e' (r = -0.568; P = 0.004) and E/e' ratio (r = 0.428; P = 0.037) in controls and with LVMI (r = 0.252; P = 0.022) and E/e' ratio (r = 0.269; P = 0.014) in HDP. CONCLUSIONS Although the current data are not able to infer causality, they confirm the intimate relationship between the maternal cardiovascular system and angiogenic markers that are used both to diagnose and indicate the severity of HDP. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- V Giorgione
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - C Di Fabrizio
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - E Giallongo
- Intensive Care National Audit & Research Centre, London, UK
| | - A Khalil
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
| | - J O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, UK
- School of Psychology and Life Sciences, Canterbury Christ Church University, Kent, UK
| | - G Whitley
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - G Kennedy
- Immunoassay Biomarker Core Laboratory, School of Medicine, University of Dundee, Dundee, UK
| | - C E Murdoch
- Division of Systems Medicine, School of Medicine, University of Dundee, Dundee, UK
| | - B Thilaganathan
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
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13
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Wasserstrum Y, Gilead R, Ben-Zekry S, Mazor-Dray E, Younis A, Segev A, Maor E, Kuperstein R. Modifiers of the Association between E/e' Ratio and Survival among Patients with No Apparent Structural or Functional Cardiac Abnormality. Hellenic J Cardiol 2024:S1109-9666(24)00005-8. [PMID: 38280633 DOI: 10.1016/j.hjc.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 11/30/2023] [Accepted: 01/17/2024] [Indexed: 01/29/2024] Open
Abstract
BACKGROUND The ratio between early mitral flow wave to early diastolic mitral annulus velocity (E/e' ratio) varies according to age and sex and is associated with mortality in heart failure. We sought to describe the association between E/e' and mortality in patients with no apparent structural or functional cardiac abnormality and explore possible modifiers of this association. METHODS A retrospective study of 104,315 patients who underwent echocardiographic evaluation during 2009-2021 in the largest tertiary center in Israel. Patients with cancer, ventricular dysfunction, significant valvular or structural heart disease, or evidence of pulmonary hypertension were excluded. RESULTS The final analysis included 32,836 patients with a median age of 56 (43-66) years, and 13,547 (41%) were female. The median E/e' was 8.3 (6.8-10.3), and 9,306 (28%) had an E/e' >10. During a median follow-up of 5.7 (3.3-8.5) years, 2,396 (7.3%) individuals died. E/e' >10 was associated with mortality (adjusted hazard ratio [HR] 1.16, 95% confidence interval [CI] 1.07-1.27, p<0.001). The mortality risk associated with E/e' >10 was significantly higher in those aged ≤70 (HR 1.26, 95% CI 1.12-1.42, p<0.001), males (HR 1.34, 95% CI 1.19-1.49, p<0.001), a normal left ventricular mass (HR 1.13, 95% CI 1.02-1.24, p = 0.017), and pulmonary artery pressure <30 mmHg (HR 1.18, 95% CI 1.06-1.30, p = 0.003). CONCLUSION An elevated E/e' is associated with mortality, specifically in younger individuals, males, and those with a normal left ventricular mass and lower pulmonary artery pressure. This suggests that an elevated E/e' might be a marker of subclinical risk in these subgroups. Further studies are needed to identify whether an elevated E/e' is useful in shared decision-making regarding the management of cardiovascular risk factors.
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Affiliation(s)
- Yishay Wasserstrum
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rami Gilead
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sagit Ben-Zekry
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Mazor-Dray
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Anan Younis
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Amit Segev
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Elad Maor
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Rafael Kuperstein
- Chaim Sheba Medical Center, Tel Hashomer, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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14
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Mocumbi A, Humbert M, Saxena A, Jing ZC, Sliwa K, Thienemann F, Archer SL, Stewart S. Pulmonary hypertension. Nat Rev Dis Primers 2024; 10:1. [PMID: 38177157 DOI: 10.1038/s41572-023-00486-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 01/06/2024]
Abstract
Pulmonary hypertension encompasses a range of conditions directly or indirectly leading to elevated pressures within the pulmonary arteries. Five main groups of pulmonary hypertension are recognized, all defined by a mean pulmonary artery pressure of >20 mmHg: pulmonary arterial hypertension (rare), pulmonary hypertension associated with left-sided heart disease (very common), pulmonary hypertension associated with lung disease (common), pulmonary hypertension associated with pulmonary artery obstructions, usually related to thromboembolic disease (rare), and pulmonary hypertension with unclear and/or multifactorial mechanisms (rare). At least 1% of the world's population is affected, with a greater burden more likely in low-income and middle-income countries. Across all its forms, pulmonary hypertension is associated with adverse vascular remodelling with obstruction, stiffening and vasoconstriction of the pulmonary vasculature. Without proactive management this leads to hypertrophy and ultimately failure of the right ventricle, the main cause of death. In older individuals, dyspnoea is the most common symptom. Stepwise investigation precedes definitive diagnosis with right heart catheterization. Medical and surgical treatments are approved for pulmonary arterial hypertension and chronic thromboembolic pulmonary hypertension. There are emerging treatments for other forms of pulmonary hypertension; but current therapy primarily targets the underlying cause. There are still major gaps in basic, clinical and translational knowledge; thus, further research, with a focus on vulnerable populations, is needed to better characterize, detect and effectively treat all forms of pulmonary hypertension.
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Affiliation(s)
- Ana Mocumbi
- Faculdade de Medicina, Universidade Eduardo Mondlane, Maputo, Moçambique.
- Instituto Nacional de Saúde, EN 1, Marracuene, Moçambique.
| | - Marc Humbert
- Service de Pneumologie et Soins Intensifs Respiratoires, Hôpital Bicêtre (Assistance Publique Hôpitaux de Paris), Université Paris-Saclay, INSERM UMR_S 999, Paris, France
- ERN-LUNG, Le Kremlin Bicêtre, Paris, France
| | - Anita Saxena
- Sharma University of Health Sciences, Haryana, New Delhi, India
| | - Zhi-Cheng Jing
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, China
| | - Karen Sliwa
- Cape Heart Institute, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
| | - Friedrich Thienemann
- Department of Medicine, Groote Schuur Hospital, Faculty of Health Science, University of Cape Town, Cape Town, South Africa
- Department of Internal Medicine, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Stephen L Archer
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Simon Stewart
- Institute of Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
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15
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Playford D, Stewart S, Harris SA, Chan Y, Strange G. Pattern and Prognostic Impact of Regional Wall Motion Abnormalities in 255 697 Men and 236 641 Women Investigated with Echocardiography. J Am Heart Assoc 2023; 12:e031243. [PMID: 37947119 PMCID: PMC10727298 DOI: 10.1161/jaha.123.031243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 10/03/2023] [Indexed: 11/12/2023]
Abstract
Background Regional wall motion abnormalities (WMAs) after myocardial infarction are associated with adverse remodeling and increased mortality in the short to medium term. Their long-term prognostic impact is less well understood. Methods and Results Via the National Echo Database of Australia (2000-2019), we identified normal wall motion versus WMA for each left ventricular wall among 492 338 individuals aged 61.9±17.9 years. The wall motion score index was also calculated. We then examined actual 1- and 5-year mortality, plus adjusted risk of long-term mortality according to WMA status. Overall, 39 346/255 697 men (15.4%) and 17 834/236 641 women (7.5%) had a WMA. The likelihood of a WMA was associated with increasing age and greater systolic/diastolic dysfunction. A defect in the inferior versus anterior wall was the most and least common WMA in men (8.0% and 2.5%) and women (3.3% and 1.1%), respectively. Any WMA increased 5-year mortality from 17.5% to 29.7% in men and from 14.9% to 30.8% in women. Known myocardial infarction (hazard ratio [HR], 0.86 [95% CI, 0.80-0.93]) or revascularization (HR, 0.87 [95% CI, 0.82-0.92]) was independently associated with a better prognosis, whereas men (1.22-fold increase) and those with greater systolic/diastolic dysfunction had a worse prognosis. Among those with any WMA, apical (HR, 1.08 [95% CI, 1.02-1.13]) or inferior (HR, 1.09 [95% CI, 1.04-1.15]) akinesis, dyskinesis or aneurysm, or a wall motion score index >3.0 conveyed the worst prognosis. Conclusions In a large real-world clinical cohort, twice as many men as women have a WMA, with inferior WMA the most common. Any WMA confers a poor prognosis, especially inferoapical akinesis/dyskinesis/aneurysm.
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Affiliation(s)
- David Playford
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of MedicineThe University of Notre DameFremantleWestern AustraliaAustralia
| | - Simon Stewart
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- School of Medicine, Dentistry and NursingUniversity of GlasgowGlasgowUnited Kingdom
| | - Sarah Ann Harris
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
| | - Yih‐Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic UniversityMelbourneVictoriaAustralia
| | - Geoff Strange
- Institute for Health Research, University of Notre DameFremantleWestern AustraliaAustralia
- Heart Research InstituteSydneyNew South WalesAustralia
- Department of CardiologyRoyal Prince Alfred HospitalSydneyNew South WalesAustralia
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16
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Fung ASY, Soundappan D, Loewenstein DE, Playford D, Strange G, Kozor R, Otton J, Ugander M. Prognostic association supports indexing size measures in echocardiography by body surface area. Sci Rep 2023; 13:19390. [PMID: 37938592 PMCID: PMC10632399 DOI: 10.1038/s41598-023-46183-z] [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: 02/06/2023] [Accepted: 10/29/2023] [Indexed: 11/09/2023] Open
Abstract
Body surface area (BSA) is the most commonly used metric for body size indexation of echocardiographic measures, but its use in patients who are underweight or obese is questioned (body mass index (BMI) < 18.5 kg/m2 or ≥ 30 kg/m2, respectively). We aim to use survival analysis to identify an optimal body size indexation metric for echocardiographic measures that would be a better predictor of survival than BSA regardless of BMI. Adult patients with no prior valve replacement were selected from the National Echocardiography Database Australia. Survival analysis was performed for echocardiographic measures both unindexed and indexed to different body size metrics, with 5-year cardiovascular mortality as the primary endpoint. Indexation of echocardiographic measures (left ventricular end-diastolic diameter [n = 230,109] and mass [n = 224,244], left atrial volume [n = 150,540], aortic sinus diameter [n = 90,805], right atrial area [n = 59,516]) by BSA had better prognostic performance vs unindexed measures (underweight: C-statistic 0.655 vs 0.647; normal weight/overweight: average C-statistic 0.666 vs 0.625; obese: C-statistic 0.627 vs 0.613). Indexation by other body size metrics (lean body mass, height, and/or weight raised to different powers) did not improve prognostic performance versus BSA by a clinically relevant magnitude (average C-statistic increase ≤ 0.02), with smaller differences in other BMI subgroups. Indexing measures of cardiac and aortic size by BSA improves prognostic performance regardless of BMI, and no other body size metric has a clinically meaningful better performance.
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Affiliation(s)
- Angus S Y Fung
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Dhnanjay Soundappan
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Daniel E Loewenstein
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Geoffrey Strange
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia
| | - James Otton
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Liverpool, Australia
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Kolling Building, Level 12, St Leonards, Sydney, NSW, 2065, Australia.
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
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Su L, Yan X, Pan Y, Yang S. Cross-sectional associations between questionnaire-measured physical activity and tissue doppler indices of left ventricular diastolic function. BMC Cardiovasc Disord 2023; 23:527. [PMID: 37891468 PMCID: PMC10612190 DOI: 10.1186/s12872-023-03559-3] [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] [Received: 07/05/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The prevalence of left ventricular (LV) diastolic dysfunction has been increasing over the past decade, and to date, effective pharmacotherapies that enhance LV diastolic function have not yet been identified. Though some data has demonstrated the beneficial effects of exercise training on LV diastolic function, little is known about the adaptations of diastolic function to daily physical activity (PA). Accordingly, our study aimed to investigate the impact of daily PA on tissue Doppler indices of LV diastolic function. METHODS A total of 432 participants were enrolled for clinically indicated echocardiography from July 2019 to July 2020 at Peking University People's Hospital. Participants aged ≥ 18 years were included if they had stable PA in the past six months and normal LV systolic function. A questionnaire was used to collect demographic characteristics, medical history, and daily PA. According to PA Guidelines for Americans, we identified these participants into low-intensity PA (LPA) group and moderate-high-intensity PA (MHPA) group. Propensity score matching (PSM) was performed to match potential confounding factors between the two groups. The clinical characteristics and echocardiographic parameters between LPA group and MHPA group were compared using student's t-test, Mann-Whitney U test, and chi-square test as appropriate. RESULTS After matching potential confounding factors using PSM with a 1:3 matching ratio, our final analysis included 86 cases in the MHPA group and 214 cases in the LPA group. All demographic characteristics and comorbidities were statistically similar between the two groups. Compared to the LPA group, the MHPA group showed higher septal e' (7.9 ± 2.9 cm/s versus 7.2 ± 2.6 cm/s, P = 0.047). Other echocardiographic parameters associated with LV diastolic function concerning lateral e' and average E/e', also trended towards improved LV diastolic function in the MHPA group, but failed to reach statistical significance. CONCLUSIONS Our study demonstrated that moderate-high-intensity daily PA was associated with improved septal e', suggesting that moderate-high-intensity PA could potentially ameliorate LV diastolic dysfunction.
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Affiliation(s)
- Lina Su
- Department of Cardiology, Peking University People's Hospital, 11 Xizhimen South St, Beijing, 100044, PR China
| | - Xiaodi Yan
- Department of Cardiology, Peking University People's Hospital, 11 Xizhimen South St, Beijing, 100044, PR China
| | - Yongmei Pan
- Department of Cardiology, Peking University People's Hospital, 11 Xizhimen South St, Beijing, 100044, PR China
| | - Songna Yang
- Department of Cardiology, Peking University People's Hospital, 11 Xizhimen South St, Beijing, 100044, PR China.
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Xiang S, Zuo M, Deng Y, Luo X, Dong Q, Chen J, Siu CW, Yin L. Volume markers in left ventricular diastolic dysfunction and adverse outcomes in peritoneal dialysis patients: a prospective cohort study. Sci Rep 2023; 13:16892. [PMID: 37803046 PMCID: PMC10558440 DOI: 10.1038/s41598-023-43442-x] [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: 07/25/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023] Open
Abstract
Left ventricular diastolic dysfunction (LVDD) is an early event associated with cardiovascular complications and poor prognosis in chronic kidney disease patients undergoing dialysis. In this study, we investigated whether diastolic dysfunction, measured by the E/E' ratio, affects adverse outcomes in peritoneal dialysis (PD) patients (n = 148). Our results showed that patients with an E/E' ratio ≥ 15 were more likely to be female, have a longer dialysis vintage, have significantly higher left atrial volume index and left atrial kinetic energy levels, have lower E' levels and LV hypertrophy (LVH) degree, and have higher volume markers. Kaplan-Meier curves revealed that patients with a higher E/E' ratio had worse survival and a higher risk of heart failure than those with a lower E/E' ratio. Subgroup analysis demonstrated that non-diabetic patients with a higher E/E' ratio had a higher risk of heart failure than those with a lower E/E' ratio. Cox proportional hazard regression analysis indicated that the ECW/ICW ratio was strongly associated with LVDD and confirmed that the E/E' ratio was an independent risk factor for overall death. Our study suggests that monitoring the E/E' ratio in PD patients is important for improving their prognosis.
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Affiliation(s)
- Shoubo Xiang
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mingliang Zuo
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
| | - Yan Deng
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Xian Luo
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qianhua Dong
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Jin Chen
- Department of Nephrology, Institute of Nephrology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong SAR, China
| | - Lixue Yin
- Ultrasound in Cardiac Electrophysiology and Biomechanics Key Laboratory of Sichuan Province, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China.
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19
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Chen X, Yang F, Zhang P, Lin X, Wang W, Pu H, Chen X, Chen Y, Yu L, Deng Y, Liu B, Bai Y, Burkhoff D, He K. Artificial Intelligence-Assisted Left Ventricular Diastolic Function Assessment and Grading: Multiview Versus Single View. J Am Soc Echocardiogr 2023; 36:1064-1078. [PMID: 37437669 DOI: 10.1016/j.echo.2023.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 06/28/2023] [Accepted: 07/01/2023] [Indexed: 07/14/2023]
Abstract
BACKGROUND Clinical assessment and grading of left ventricular diastolic function (LVDF) requires quantification of multiple echocardiographic parameters interpreted according to established guidelines, which depends on experienced clinicians and is time consuming. The aim of this study was to develop an artificial intelligence (AI)-assisted system to facilitate the clinical assessment of LVDF. METHODS In total, 1,304 studies (33,404 images) were used to develop a view classification model to select six specific views required for LVDF assessment. A total of 2,238 studies (16,794 two-dimensional [2D] images and 2,198 Doppler images) to develop 2D and Doppler segmentation models, respectively, to quantify key metrics of diastolic function. We used 2,150 studies with definite LVDF labels determined by two experts to train single-view classification models by AI interpretation of strain metrics or video. The accuracy and efficiency of these models were tested in an external data set of 388 prospective studies. RESULTS The view classification model identified views required for LVDF assessment with good sensitivity (>0.9), and view segmentation models successfully outlined key regions of these views with intersection over union > 0.8 in the internal validation data set. In the external test data set of 388 cases, AI quantification of 2D and Doppler images showed narrow limits of agreement compared with the two experts (e.g., left ventricular ejection fraction, -12.02% to 9.17%; E/e' ratio, -3.04 to 2.67). These metrics were used to detect LV diastolic dysfunction (DD) and grade DD with accuracy of 0.9 and 0.92, respectively. Concerning the single-view method, the overall accuracy of DD detection was 0.83 and 0.75 by strain-based and video-based models, and the accuracy of DD grading was 0.85 and 0.8, respectively. These models could achieve diagnosis and grading of LVDD in a few seconds, greatly saving time and labor. CONCLUSION AI models successfully achieved LVDF assessment and grading that compared favorably with human experts reading according to guideline-based algorithms. Moreover, when Doppler variables were missing, AI models could provide assessment by interpreting 2D strain metrics or videos from a single view. These models have the potential to save labor and cost and to facilitate work flow of clinical LVDF assessment.
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Affiliation(s)
- Xu Chen
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China; Department of Cardiology, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Feifei Yang
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China; Department of Cardiology, The Fourth Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Peifang Zhang
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Xixiang Lin
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Wenjun Wang
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Haitao Pu
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Xiaotian Chen
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Yixin Chen
- BioMind Technology, Zhongguancun Medical Engineering Center, Beijing, China
| | - Liheng Yu
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yujiao Deng
- Department of Ultrasound Diagnosis, The First Medical Center of Chinese PLA General Hospital, Beijing, China
| | - Bohan Liu
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China
| | - Yongyi Bai
- Department of Cardiology, The Second Medical Center of Chinese PLA General Hospital, Beijing, China
| | | | - Kunlun He
- Medical Big Data Research Center, Chinese PLA General Hospital, Beijing, China.
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20
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Huang WM, Chang HC, Lee CW, Huang CJ, Yu WC, Cheng HM, Guo CY, Chiang CE, Chen CH, Sung SH. Association between spirometry pattern, left ventricular diastolic function, and mortality. Eur J Clin Invest 2023; 53:e14043. [PMID: 37340550 DOI: 10.1111/eci.14043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Revised: 05/22/2023] [Accepted: 06/08/2023] [Indexed: 06/22/2023]
Abstract
BACKGROUND Spirometric abnormalities have been related to incident heart failure in general population, who generally have preserved left ventricular ejection fraction (LVEF). We aimed to investigate the association between spirometric indices, cardiac functions and clinical outcomes. METHODS Subjects presenting with exertional dyspnoea and received spirometry and echocardiography were eligible for this study. Forced vital capacity (FVC) and forced expiratory volume in the first second (FEV1)/FVC ratio were measured to define the spirometry patterns: normal (FEV1/FVC ≥ 70%, FVC ≥ 80%), obstructive (FEV1/FVC < 70%, FVC ≥ 80%), restrictive pattern (FEV1/FVC ≥ 70%, FVC < 80%) and mixed (FEV1/FVC < 70%, FVC < 80%). The diastolic dysfunction index (DDi) was the counts of the indicators, including septal e' velocity <7 cm/s, septal E/e' > 15, pulmonary artery systolic pressure > 35 mmHg and left atrial dimension >40 mm. RESULTS Among a total of 8669 participants (65.8 ± 16.3 years, 56% men), 3739 (43.1%), 829 (9.6%), 3050 (35.2%) and 1051 (12.1%) had normal, obstructive, restrictive and mixed spirometry pattern, respectively. Subjects with restrictive or mixed spirometry pattern had higher DDi and worse long-term survival than those with obstructive or normal ventilation. FVC but not FEV1/FVC was predictive of 5-year mortality, independent of age, sex, renal function, LVEF, DDi, body mass index, and comorbidities (hazard ratio, 95% confidence intervals: .981, .977-.985). Furthermore, there was an inverse nonlinear relationship between FVC and DDi, suggesting the declined FVC may mediate 43% of the prognostic hazard of left ventricular diastolic dysfunction. CONCLUSIONS The restrictive spirometry pattern or the declined FVC was associated with left ventricular diastolic dysfunction, which aggravated the long-term mortality in the ambulatory dyspnoeic subjects.
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Affiliation(s)
- Wei-Ming Huang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Kinmen Hospital, Ministry of Health and Welfare, Kinmen, Taiwan
| | - Hao-Chih Chang
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital Taoyuan Branch, Taoyuan, Taiwan
| | - Ching-Wei Lee
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chi-Jung Huang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Chung Yu
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hao-Min Cheng
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Yu Guo
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chern-En Chiang
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- General Clinical Research Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chen-Huan Chen
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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21
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Haas P, Santos ABS, Cañon-Montañez W, Bittencourt MS, Torres FS, Ribeiro ALP, Duncan BB, Foppa M. Associations Between Coronary Artery Calcification and Left Ventricular Global Longitudinal Strain and Diastolic Parameters: the ELSA-Brasil Study. Am J Cardiol 2023; 204:215-222. [PMID: 37556890 DOI: 10.1016/j.amjcard.2023.06.124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Accepted: 06/29/2023] [Indexed: 08/11/2023]
Abstract
Atherosclerosis burden can be evaluated in asymptomatic patients by measuring coronary artery calcification (CAC), whereas the global longitudinal strain (GLS) and diastolic function parameters (mitral E/e' ratio, septal e', and lateral e') are used to evaluate subclinical left ventricular (LV) dysfunction. We investigated whether subjects with CAC (CAC >0 Agatston units) would present with an impairment in LV functional parameters. Among the participants of the ELSA-Brasil cohort free of clinically prevalent cardiovascular disease who performed cardiac computed tomography and echocardiography within the study protocol, we tested whether those with CAC >0 presented with worse GLS and diastolic function parameters. CAC >0 was present in 203 of the 612 included participants (33.17%; age 51.4 ± 8.6 years, 52.1% women). Absolute CAC values did not correlate with GLS (ro = 0.07, p = 0.105) but did so with E/e' (ro = 0.19, p <0.001), septal e' (ro = 0.28, p <0.001), and lateral e' (ro = 0.30, p <0.001), with stronger correlations in men. Those with CAC >0 had worse mitral E/e' ratios (7.75 ± 0.13 vs 7.01 ± 0.09; p ≤0.001), septal e' (8.25 ± 0.15 vs 9.59 ± 0.11 cm/s; p <0.001), and lateral e' (10.13 ± 0.20 vs 11.99 ± 0.14 cm/s; p ≤0.001), respectively. However, these associations were not independent of diabetes, obesity, hypertension, smoking, and low-density lipoprotein cholesterol, persisting only as significant associations of CAC >0 with mitral E/e' ratio and septal e' in men. There is an association between subclinical coronary atherosclerosis and impaired LV functional parameters. These associations are more likely attributed to the presence of common cardiovascular risk factors in the general population. However, in men, it seems to exist as an independent association.
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Affiliation(s)
- Priscila Haas
- Postgraduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Angela B S Santos
- Postgraduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Marcio S Bittencourt
- University of Pittsburgh, Pittsburgh, Pennsylvania, United States and School of Medicine, Universidade de São Paulo, São Paulo, Brazil
| | | | - Antonio L P Ribeiro
- School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Bruce B Duncan
- Postgraduate Program in Epidemiology, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Murilo Foppa
- Postgraduate Program in Cardiology and Cardiovascular Sciences, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
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22
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Soundappan D, Fung ASY, Loewenstein DE, Playford D, Strange G, Kozor R, Otton J, Ugander M. Decreased diastolic hydraulic forces incrementally associate with survival beyond conventional measures of diastolic dysfunction. Sci Rep 2023; 13:16396. [PMID: 37773251 PMCID: PMC10541860 DOI: 10.1038/s41598-023-41694-1] [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: 03/08/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
Decreased hydraulic forces during diastole contribute to reduced left ventricular (LV) filling and heart failure with preserved ejection fraction. However, their association with diastolic function and patient outcomes are unknown. The aim of this retrospective, cross-sectional study was to determine the mechanistic association between diastolic hydraulic forces, estimated by echocardiography as the atrioventricular area difference (AVAD), and both diastolic function and survival. Patients (n = 5176, median [interquartile range] 5.5 [5.0-6.1] years follow-up, 1213 events) were selected from the National Echo Database Australia (NEDA) based on the presence of relevant transthoracic echocardiographic measures, LV ejection fraction (LVEF) ≥ 50%, heart rate 50-100 beats/minute, the absence of moderate or severe valvular disease, and no prior prosthetic valve surgery. NEDA contains echocardiographic and linked national death index mortality outcome data from 1985 to 2019. AVAD was calculated as the cross-sectional area difference between the LV and left atrium. LV diastolic dysfunction was graded according to 2016 guidelines. AVAD was weakly associated with E/e', left atrial volume index, and LVEF (multivariable global R2 = 0.15, p < 0.001), and not associated with e' and peak tricuspid regurgitation velocity. Decreased AVAD was independently associated with poorer survival, and demonstrated improved model discrimination after adjustment for diastolic function grading (C-statistic [95% confidence interval] 0.644 [0.629-0.660] vs 0.606 [0.592-0.621], p < 0.001) and E/e' (0.649 [0.635-0.664] vs 0.634 [0.618-0.649], p < 0.001), respectively. Therefore, decreased hydraulic forces, estimated by AVAD, are weakly associated with diastolic dysfunction and demonstrate an incremental prognostic association with survival beyond conventional measures used to grade diastolic dysfunction.
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Affiliation(s)
- Dhnanjay Soundappan
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Angus S Y Fung
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia
| | - Daniel E Loewenstein
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden
| | - David Playford
- School of Medicine, University of Notre Dame, Fremantle, Australia
| | - Geoffrey Strange
- School of Medicine, University of Notre Dame, Fremantle, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Rebecca Kozor
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia
| | - James Otton
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Liverpool, Australia
| | - Martin Ugander
- Kolling Institute, Royal North Shore Hospital, and University of Sydney, Sydney, Australia.
- St Vincent's Clinical School, University of New South Wales, Sydney, Australia.
- Department of Clinical Physiology, Karolinska University Hospital, and Karolinska Institutet, Stockholm, Sweden.
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23
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Giorgione V, Khalil A, O'Driscoll J, Thilaganathan B. Postpartum cardiovascular function in patients with hypertensive disorders of pregnancy: a longitudinal study. Am J Obstet Gynecol 2023; 229:292.e1-292.e15. [PMID: 36935069 DOI: 10.1016/j.ajog.2023.03.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/19/2023] [Accepted: 03/12/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Women with a history of hypertensive disorders of pregnancy are at increased risk of cardiovascular diseases, which are usually mediated by the development of cardiovascular risk factors, such as chronic hypertension, metabolic syndrome, or subclinical myocardial dysfunction. Increasing evidence has been showing that little time elapses between the end of pregnancy and the development of these cardiovascular risk factors. OBJECTIVE This study aimed to assess the persistence of hypertension and myocardial dysfunction at 4 months postpartum in a cohort of women with hypertensive disorders of pregnancy, and to compare the echocardiographic parameters between the peripartum and the postpartum period. STUDY DESIGN In a longitudinal prospective study, a cohort of women with preterm or term hypertensive disorders of pregnancy and an unmatched group of women with term normotensive pregnancy were recruited. Women with preexisting chronic hypertension (n=29) were included in the hypertensive disorders of pregnancy cohort. All participants underwent 2 cardiovascular assessments: the first was conducted either before or within 1 week of delivery (V1: peripartum assessment), and the second between 3 and 12 months following delivery (V2: postpartum assessment). The cardiovascular evaluation included blood pressure profile, maternal transthoracic echocardiography (left ventricular mass index, relative wall thickness, left atrial volume index, E/A, E/e', peak velocity of tricuspid regurgitation, ejection fraction, and left ventricular global longitudinal strain and twist), and metabolic assessment (fasting glycemia, insulin, lipid profile, and waist measurement). Echocardiographic data were compared between V1 and V2 using paired t test or McNemar test in hypertensive disorders of pregnancy and in the control groups. RESULTS Among 260 patients with pregnancies complicated by hypertensive disorders of pregnancy and 33 patients with normotensive pregnancies, 219 (84.2%) and 30 (90.9%) attended postpartum follow-up, respectively. Patients were evaluated at a median of 124 days (interquartile range, 103-145) after delivery. Paired comparisons of echocardiographic findings demonstrated significant improvements in cardiac remodeling rates (left ventricular mass index [g/m2], 63.4±14.4 vs 78.9±16.2; P<.001; relative wall thickness, 0.35±0.1 vs 0.42±0.1; P<.001), most diastolic indices (E/e', 6.3±1.6 vs 7.4±1.9; P<.001), ejection fraction (ejection fraction <55%, 9 [4.1%] vs 28 [13.0%]; P<.001), and global longitudinal strain (-17.3±2.6% vs -16.2±2.4%; P<.001) in the postpartum period compared with the peripartum. The same improvements in cardiac indices were observed in the normotensive group. However, at the postnatal assessment, 153 of 219 (69.9%) had either hypertension (76/219; 34.7%) or an abnormal global longitudinal strain (125/219; 57.1%), 13 of 67 (19.4%) had metabolic syndrome, and 18 of 67 (26.9%) exhibited insulin resistance. CONCLUSION Although persistent postpartum cardiovascular impairment was evident in a substantial proportion of patients given that more than two-thirds had either hypertension or myocardial dysfunction postpartum, cardiac modifications because of pregnancy-related overload and hypertension were more pronounced in the peripartum than in the postpartum period.
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Affiliation(s)
- Veronica Giorgione
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Asma Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom
| | - Jamie O'Driscoll
- Department of Cardiology, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; School of Psychology and Life Sciences, Canterbury Christ Church University, Canterbury, United Kingdom
| | - Basky Thilaganathan
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, London, United Kingdom; Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, United Kingdom.
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24
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Teodorovich N, Fabrikant Y, Gandelman G, Swissa M, Jonas M, George J, Shimoni S. The Additive Effect of Left Ventricular Filling Pressure and Renal Function on Long-Term Prognosis of High-Risk Patients Undergoing Coronary Angiography. Cardiorenal Med 2023; 13:271-281. [PMID: 37604117 PMCID: PMC10664344 DOI: 10.1159/000533589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 06/27/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION Impaired relaxation is the earliest manifestation of ischemic cascade. Risk factors and renal function abnormalities are associated with coronary disease and diastolic dysfunction as well. We aimed to study the association of noninvasive assessment of left ventricular filling pressures and renal function with mortality in high-risk patients undergoing coronary angiography. PATIENTS AND METHODS An observational prospective study of 564 consecutive patients undergoing coronary angiography was conducted. The median follow-up was 2,293 days. Patients were categorized into 2 groups according to presence of significant diastolic dysfunction: group 1, 382 patients, with normal and group 2, 182 patients, with elevated filling pressure. Renal insufficiency was determined as calculated glomerular filtration rate <60 mL/min. Patients demographic, clinical, echocardiography, laboratory, and angiographic data were prospectively collected. RESULTS Fifty-three percent of patients underwent angiography due to acute coronary syndrome (ACS), 85.5% had coronary artery disease, 53.4% had reduced (<50%) left ventricular ejection fraction (LVEF), and 47.4% had abnormal renal function. The mortality during the follow-up period was 30.0%. Patients with elevated filling pressure had significantly higher mortality (50.5% vs. 20.2%, p < 0.0001). Impaired renal failure as well, was associated with higher mortality (48% vs. 15%, p < 0.001). The association remained significant in subgroups of patients with and without ACS and reduced and preserved LVEF. In Cox regression model which combined elevated filling pressure, renal insufficiency, age, diabetes mellitus, hypertension, presence of atrial fibrillation, LVEF, and anemia, elevated filling pressure and renal function impairment were independently associated with higher mortality (HR: 3.717, CI: 1.623-8.475, p < 0.0001 and HR: 0.972, CI: 0.958-0.985, p = 0.0001, respectively). There was an incremental prognostic value of elevated filling pressures and renal function impairment on mortality. CONCLUSIONS Advanced diastolic dysfunction and impaired renal function are signals toward worse outcomes and are associated with mortality in high-risk patients undergoing coronary angiography.
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Affiliation(s)
- Nicholay Teodorovich
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Yakov Fabrikant
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Gera Gandelman
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Moshe Swissa
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Michael Jonas
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Jacob George
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Sara Shimoni
- Cardiology Department, Kaplan Medical Center, Rehovot, Faculty of Medicine, Hebrew University, Jerusalem, Israel
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Ratwatte S, Playford D, Stewart S, Strange G, Celermajer DS. Prevalence of pulmonary hypertension in aortic regurgitation and its influence on outcomes. Heart 2023; 109:1310-1318. [PMID: 37012044 DOI: 10.1136/heartjnl-2022-322187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/02/2023] [Indexed: 04/05/2023] Open
Abstract
OBJECTIVE Aortic regurgitation (AR) can lead to pulmonary hypertension (PHT). There is a paucity of data on the prognostic importance of PHT in these patients. We therefore aimed to describe the prevalence and prognostic importance of PHT in such patients. METHODS In this retrospective study, we analysed the National Echocardiography Database of Australia (data from 2000 to 2019). Adults with an estimated right ventricular systolic pressure (eRVSP), left ventricular ejection fraction (LVEF) >50% and with moderate or greater AR were included (n=8392). These subjects were then categorised according to their eRVSP. The relationship between PHT severity and mortality outcomes were evaluated (median follow-up of 3.1 years, IQR 1.5-5.7 years). RESULTS Subjects were aged 74±14 years and 58.4% (4901) were female. Overall, 1417 (16.9%) had no PHT, and 3253 (38.8%), 2249 (26.9%), 893 (10.6%) and 580 (6.9%) patients had borderline, mild, moderate and severe PHT, respectively. Mean eRVSP was slightly higher in females than males (41±13 vs 39±12 mm Hg, p<0.0001) and increased with age in both sexes. After adjustment for age and sex, the risk of long-term mortality increased as eRVSP increased (adjusted HR (aHR) 1.20, 95% CI 1.06 to 1.36 in borderline PHT, to aHR 3.32, 95% CI 2.85 to 3.86 in severe PHT, p<0.0001). There was a mortality threshold seen from mild PHT onwards (eRVSP 41.36-44.15 mm Hg; aHR 1.41, 95%CI 1.17 to 1.68). CONCLUSIONS In this large cohort study, we characterise the relationship between AR and PHT in adults. In patients with ≥moderate AR, PHT is associated with a progressive risk of mortality, even at mildly elevated levels.
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Affiliation(s)
- Seshika Ratwatte
- Department of Cardiology, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - David Playford
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Simon Stewart
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Geoff Strange
- Heart Research Institute Ltd, Newtown, New South Wales, Australia
- The University of Notre Dame Australia School of Medicine, Fremantle, Western Australia, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Albert Hospital, Camperdown, New South Wales, Australia
- Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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26
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Akerman AP, Porumb M, Scott CG, Beqiri A, Chartsias A, Ryu AJ, Hawkes W, Huntley GD, Arystan AZ, Kane GC, Pislaru SV, Lopez-Jimenez F, Gomez A, Sarwar R, O'Driscoll J, Leeson P, Upton R, Woodward G, Pellikka PA. Automated Echocardiographic Detection of Heart Failure With Preserved Ejection Fraction Using Artificial Intelligence. JACC. ADVANCES 2023; 2:100452. [PMID: 38939447 PMCID: PMC11198161 DOI: 10.1016/j.jacadv.2023.100452] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 05/18/2023] [Accepted: 05/29/2023] [Indexed: 06/29/2024]
Abstract
Background Detection of heart failure with preserved ejection fraction (HFpEF) involves integration of multiple imaging and clinical features which are often discordant or indeterminate. Objectives The authors applied artificial intelligence (AI) to analyze a single apical 4-chamber transthoracic echocardiogram video clip to detect HFpEF. Methods A 3-dimensional convolutional neural network was developed and trained on apical 4-chamber video clips to classify patients with HFpEF (diagnosis of heart failure, ejection fraction ≥50%, and echocardiographic evidence of increased filling pressure; cases) vs without HFpEF (ejection fraction ≥50%, no diagnosis of heart failure, normal filling pressure; controls). Model outputs were classified as HFpEF, no HFpEF, or nondiagnostic (high uncertainty). Performance was assessed in an independent multisite data set and compared to previously validated clinical scores. Results Training and validation included 2,971 cases and 3,785 controls (validation holdout, 16.8% patients), and demonstrated excellent discrimination (area under receiver-operating characteristic curve: 0.97 [95% CI: 0.96-0.97] and 0.95 [95% CI: 0.93-0.96] in training and validation, respectively). In independent testing (646 cases, 638 controls), 94 (7.3%) were nondiagnostic; sensitivity (87.8%; 95% CI: 84.5%-90.9%) and specificity (81.9%; 95% CI: 78.2%-85.6%) were maintained in clinically relevant subgroups, with high repeatability and reproducibility. Of 701 and 776 indeterminate outputs from the Heart Failure Association-Pretest Assessment, Echocardiographic and Natriuretic Peptide Score, Functional Testing (HFA-PEFF), and Final Etiology and Heavy, Hypertensive, Atrial Fibrillation, Pulmonary Hypertension, Elder, and Filling Pressure (H2FPEF) scores, the AI HFpEF model correctly reclassified 73.5% and 73.6%, respectively. During follow-up (median: 2.3 [IQR: 0.5-5.6] years), 444 (34.6%) patients died; mortality was higher in patients classified as HFpEF by AI (HR: 1.9 [95% CI: 1.5-2.4]). Conclusions An AI HFpEF model based on a single, routinely acquired echocardiographic video demonstrated excellent discrimination of patients with vs without HFpEF, more often than clinical scores, and identified patients with higher mortality.
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Affiliation(s)
| | | | - Christopher G. Scott
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Alexander J. Ryu
- Division of Hospital Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Geoffrey D. Huntley
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Ayana Z. Arystan
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Garvan C. Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Sorin V. Pislaru
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | | | - Rizwan Sarwar
- Ultromics Ltd, Oxford, United Kingdom
- Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
- Experimental Therapeutics, Medical Sciences Division, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Jamie O'Driscoll
- Ultromics Ltd, Oxford, United Kingdom
- Department of Cardiology, St George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - Paul Leeson
- Ultromics Ltd, Oxford, United Kingdom
- Cardiovascular Clinical Research Facility, University of Oxford, Oxford, United Kingdom
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27
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Playford D, Schwarz N, Chowdhury E, Williamson A, Duong M, Kearney L, Stewart S, Strange G. Comorbidities and Symptom Status in Moderate and Severe Aortic Stenosis: A Multicenter Clinical Cohort Study. JACC. ADVANCES 2023; 2:100356. [PMID: 38938261 PMCID: PMC11198361 DOI: 10.1016/j.jacadv.2023.100356] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 03/31/2023] [Indexed: 06/29/2024]
Abstract
Background Symptoms associated with severe aortic stenosis (AS) are used to guide management. Objectives The purpose of this study was to examine the pattern of symptoms, comorbidities, and cardiac damage in moderate and severe AS. Methods A total of 846,198 echocardiographic investigations from 330,940 individuals aged >18 years were selected for the most recent echocardiogram, moderate or severe AS (mean gradient 20.0-39.9 mm Hg, aortic valve peak gradient 3.0-3.9 m/s and aortic valve area >1.0 cm2; or ≥ 40.0 mm Hg, ≥4.0 m/s or ≤1.0 cm2, respectively), and a cardiologist consultation. Natural Language Processing was applied to letters to extract comorbidities, dyspnea, chest pain, and syncope. Patients with prior aortic valve replacement were excluded. Results 2,213 patients (0.7% overall, 32.8% females) had moderate and 3,416 (1.0%, 47.3% females) had severe AS. Comorbidities were common, including hypertension, (56.6% moderate AS, 53.1% severe AS, P = 0.01), coronary disease (46.0% and 46.8%, respectively, P = 0.58) and atrial fibrillation (29.6% and 34.8%, respectively, P < 0.001). Symptoms were also common in both moderate (n = 915, 41.3%) and severe (n = 1,630, 47.7%) AS (P < 0.001). Comorbidities were more likely in symptomatic vs asymptomatic patients (P < 0.001). Dyspnea was more likely in severe AS, whereas angina and syncope were similar in moderate vs severe AS. In multivariable analysis, only dyspnea was associated with severe (vs moderate) AS (OR: 1.73, 95% CI: 1.41-2.13, P < 0.001). In both adjusted and unadjusted models, the degree of cardiac damage did not relate to presence of any symptoms but was associated with AS severity. Conclusions Dyspnea is common in both moderate and severe AS, is associated with comorbidities and is not related to the degree of cardiac damage. Symptom-guided management decisions in AS may need revision.
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Affiliation(s)
- David Playford
- Advara Heart Care, Leabrook, Adelaide, Australia
- School of Medicine, The University of Notre Dame, Fremantle, Australia
| | | | | | | | - MyNgan Duong
- Advara Heart Care, Leabrook, Adelaide, Australia
| | - Leighton Kearney
- Advara Heart Care, Leabrook, Adelaide, Australia
- Cardiology, Warringal Private Hospital, Heidelberg, Victoria, Australia
| | - Simon Stewart
- Institute for Health Research, The University of Notre Dame, Fremantle, Australia
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, United Kingdom
| | - Geoff Strange
- School of Medicine, The University of Notre Dame, Fremantle, Australia
- Heart Research Institute, Sydney, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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28
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Ostovar R, Schröter F, Hartrumpf M, Kuehnel RU, Bruch D, Motazedian F, Albes JM. Mitral Valve Repair in Advanced Age Groups: Does Cardiac Age Differ from Chronological Age? J Clin Med 2023; 12:jcm12113790. [PMID: 37297984 DOI: 10.3390/jcm12113790] [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: 04/12/2023] [Revised: 05/16/2023] [Accepted: 05/28/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE Advanced age is a risk factor in cardiac surgery contributing significantly to a worse outcome. The reasons are frailty and multimorbidity. In this study, we asked: Is there an aging of the heart which differs from chronological age? METHODS Propensity score matching was performed between 115 seniors ≥ 80 years and 345 juniors < 80 years. After the patients were found to be comparable in terms of cardiac and noncardiac disease and risk profiles, they were further analyzed for cardiac parameters. In addition, the seniors and juniors were compared in terms of cardiac health and postoperative outcome. Furthermore, the patients were subdivided into several age groups (<60 years, 60-69 years, 70-79 years, and >80 years) and compared regarding outcome. RESULTS The seniors demonstrated significantly lower tricuspid annular plane systolic excursion (TAPSE), significantly more frequent diastolic dysfunction, significantly higher plasma levels of NT-proBNP, and significantly larger left ventricular end-diastolic and end-systolic diameters and left atrial diameters (p < 0.001, respectively). Furthermore, in-hospital mortality and most postoperative complications were significantly higher in seniors compared with juniors. While old cardiac healthy patients showed better outcome than old cardiac aged patients, the outcome from young cardiac aged patients was better than old cardiac aged patients. The outcome and survival deteriorated with increasing life decades. CONCLUSIONS The elderly suffer significantly more from cardiac deterioration, i.e., cardiac aging, and show higher multimorbidity. Mortality risk is significantly higher and they suffer more often from a complicated postoperative course compared to younger patients. Further approaches to prevention and treatment of cardiac aging are needed to address the needs of an aging society.
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Affiliation(s)
- Roya Ostovar
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany
| | - Filip Schröter
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany
| | - Martin Hartrumpf
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany
| | - Ralf-Uwe Kuehnel
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany
| | - Dunja Bruch
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany
| | - Farnoosh Motazedian
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany
| | - Johannes Maximilian Albes
- Department of Cardiovascular Surgery, Heart Center Brandenburg, Faculty of Health Sciences, University Hospital Brandenburg Medical School "Theodor Fontane", 16321 Bernau, Germany
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29
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Lakkas L, Naka KK, Bechlioulis A, Duni A, Moustakli M, Balafa O, Theodorou I, Katsouras CS, Dounousi E, Michalis LK. Coronary microcirculation and left ventricular diastolic function but not myocardial deformation indices are impaired early in patients with chronic kidney disease. Echocardiography 2023. [PMID: 37229577 DOI: 10.1111/echo.15598] [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: 12/28/2022] [Revised: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
AIM To investigate abnormalities in myocardial strain and classic echocardiographic indices and coronary flow reserve (CFR), in younger versus older CKD patients. METHODS Sixty consecutive CKD patients (<60 years old n = 30, ≥60 years old n = 30) and 30 healthy controls (age- and gender-matched with younger CKD patients) were recruited. An echocardiographic assessment including myocardial strain indices (i.e. global longitudinal strain -GLS -, TWIST, UNTWIST rate) was performed at baseline and following dipyridamole administration in all participants. RESULTS Younger CKD patients had higher E/e', left ventricular mass index and relative wall thickness and lower E' (p < .005 for all) compared to healthy controls. Older CKD patients had lower E/A and E' (p < .05 for both) compared to younger CKD patients; these differences did not remain significant after adjustment for age. CFR was higher in healthy controls compared to younger and older CKD patients (p < .05 for both) without a significant difference between CKD groups. There were no significant differences in GLS, TWIST or UNTWIST values among the three groups of patients. Dipyridamole-induced changes did not differ significantly among the three groups. CONCLUSIONS Compared to healthy controls, impaired coronary microcirculation and left ventricular diastolic function, but not myocardial strain abnormalities, are found in young CKD patients and deteriorate with aging.
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Affiliation(s)
- Lampros Lakkas
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Katerina K Naka
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Aris Bechlioulis
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Anila Duni
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Maria Moustakli
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
| | - Olga Balafa
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Ioanna Theodorou
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | | | - Evangelia Dounousi
- Department of Nephrology, University Hospital of Ioannina, Ioannina, Greece
| | - Lampros K Michalis
- 2nd Department of Cardiology, University Hospital of Ioannina, Ioannina, Greece
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30
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Cavefors O, Ljung Faxén U, Bech-Hanssen O, Lundin S, Ricksten SE, Redfors B, Oras J. Isolated diastolic dysfunction is associated with increased mortality in critically ill patients. J Crit Care 2023; 76:154290. [PMID: 36947970 DOI: 10.1016/j.jcrc.2023.154290] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/18/2023] [Accepted: 03/08/2023] [Indexed: 03/22/2023]
Abstract
PURPOSE Left ventricular (LV) diastolic dysfunction is important in critically ill patients, but prevalence and impact on mortality is not well studied. We classified intensive care patients with normal left ventricular function according to current diastolic guidelines and explored associations with mortality. MATERIAL AND METHODS Echocardiography was performed within 24 h of intensive care admission. Patients with reduced LV ejection fraction, regional wall motion abnormality, or a history of cardiac disease were excluded. Patients were classified according to the 2016 EACVI guidelines, Recommendations for the Evaluation of LV Diastolic Function by Echocardiography. RESULTS Out of 218 patients, 162 (74%) had normal diastolic function, 21 (10%) had diastolic dysfunction, and 35 (17%) had indeterminate diastolic function. Diastolic dysfunction were more common in female patients, older patients and associated with sepsis, respiratory and cardiovascular comorbidity as well as higher SAPS Score. In a risk-adjusted logistic regression model, patients with indeterminate diastolic dysfunction (OR 4.3 [1.6-11.4], p = 0.004) or diastolic dysfunction (OR 5.1 [1.6-16.5], p = 0.006) had an increased risk of death at 90 days compared to patients with normal diastolic function. CONCLUSION Isolated diastolic dysfunction, assessed by a multi-parameter approach, is common in critically ill patients and is associated with mortality. TRIAL REGISTRATION Secondary analysis of data from a single-center prospective observational study focused on systolic dysfunction in intensive care unit patients (Clinical Trials ID: NCT03787810.
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Affiliation(s)
- Oscar Cavefors
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Ulrika Ljung Faxén
- Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Cardiology Unit, Karolinska Institutet, Stockholm, Sweden
| | - Odd Bech-Hanssen
- Department of Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Stefan Lundin
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Redfors
- Department of Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Anesthesiology and Intensive Care Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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31
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Wu VCC, Huang YC, Wang CL, Huang YC, Lin YS, Kuo CF, Chen SW, Wu M, Wen MS, Huang YT, Chang SH. Association of Echocardiographic Parameter E/e' With Cardiovascular Events in a Diverse Population of Inpatients and Outpatients With and Without Cardiac Diseases and Risk Factors. J Am Soc Echocardiogr 2023; 36:284-294. [PMID: 36332804 DOI: 10.1016/j.echo.2022.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Revised: 08/10/2022] [Accepted: 10/25/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The echocardiographic parameter E/e' has been associated with cardiovascular (CV) events. However, few studies have analyzed multiple associated CV outcomes using E/e' in a diverse population of both inpatients and outpatients with and without cardiac diseases and risk factors. METHODS Medical records of 75,393 patients without atrial fibrillation (AF) with first available E/e' were retrieved from our hospital database. Patients with mitral valve disease were excluded, and the remainder were studied in protocol 1 (70,819 patients). Patients with hypertension, diabetes mellitus, hyperlipidemia, CV diseases, prior CV events, CV surgeries, and left ventricular ejection fraction <50% or missing left ventricular ejection fraction were further excluded, and the remaining patients were studied in protocol 2 (14,665 patients). The study outcomes are major adverse CV events (MACE), which included myocardial infarction (MI), AF, ischemic and hemorrhagic stroke (IHS), hospitalization for heart failure (HHF), and cardiac death. The primary outcomes were MACE and each of the MACE components. RESULTS At the end of maximal 5-year follow-up (median 22.18 months with interquartile range 7.20-49.08 months for MACE in protocol 1 and 23.46 months with interquartile range 8.15-49.02 months for MACE in protocol 2), compared with an E/e' value of <8, an intermediate value of E/e' 8 to 15 and a high value of E/e' >15 were significantly associated with MACE, MI, AF, IHS, HHF, and cardiac death in protocol 1 (all P < .0001). In protocol 2, an intermediate E/e' value of 8 to 15 and a high value of E/e' >15 were significantly associated with MACE, MI, AF, IHS, HHF, and CV death (all P < .05), except an intermediate value E/e' 8 to 15 was not associated with AF. CONCLUSIONS In a diverse population of inpatients and outpatients with and without cardiac diseases and risk factors, the echocardiographic parameter E/e' was associated with CV events and is a useful marker of risk.
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Affiliation(s)
- Victor Chien-Chia Wu
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yi-Chun Huang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Chun-Li Wang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Ya-Chi Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Yu-Sheng Lin
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Shao-Wei Chen
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan
| | - Michael Wu
- Division of Cardiovascular Medicine, Arrhythmia Services Section, Rhode Island Hospital, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island
| | - Ming-Shien Wen
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Tung Huang
- Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
| | - Shang-Hung Chang
- Division of Cardiology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Graduate Institute of Nursing, Chang Gung University of Science and Technology, Taoyuan City, Taiwan
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32
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Moonen A, Ng MKC, Playford D, Strange G, Scalia GM, Celermajer DS. Atrial functional mitral regurgitation: prevalence, characteristics and outcomes from the National Echo Database of Australia. Open Heart 2023; 10:openhrt-2022-002180. [PMID: 36792312 PMCID: PMC9933756 DOI: 10.1136/openhrt-2022-002180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
AIMS Atrial functional mitral regurgitation (AFMR) is characterised by left atrial and consequent mitral annular dilatation causing mitral regurgitation. AFMR is likely to become more common with population ageing, alongside increases in atrial fibrillation and heart failure with preserved ejection fraction; conditions causing atrial dilatation. Here, we aim to define the prevalence and characterise the patient and survival characteristics of AFMR in the National Echocardiographic Database of Australia (NEDA). METHODS AND RESULTS 14 004 adults with moderate or severe FMR were identified from NEDA. AFMR or ventricular FMR (VFMR) was classified by LA size, LV size and LVEF. AFMR was found in 40% (n=5562) and VFMR in 60% (n=8442). Compared with VFMR, the AFMR subgroup were significantly older (mean age 78±11 years), with a higher proportion of females and of AF. Participants were followed up for a median of 65 months (IQR 36-116 months). After adjustment for age, sex, AF, and pulmonary hypertension, the prognosis for VFMR was significantly worse than for AFMR (HR 1.57, 95% CI 1.47 to 1.68 for all-cause and 1.73, 95% CI 1.60 to 1.88, p<0.001 for both). After further adjustment for LVEF, mortality rates were similar in VFMR and AFMR patients (HR 0.93, p=NS), though advancing age and pulmonary hypertension remained independently associated with prognosis. CONCLUSIONS AFMR is a common cause of significant functional MR that predominantly affects elderly female patients with AF. Advancing age and pulmonary hypertension independently associated with survival in FMR. Prognosis was better in AFMR compared with VFMR; however, this difference was accounted for by LV systolic impairment and not by MR severity.
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Affiliation(s)
- Avalon Moonen
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia
| | - Martin K C Ng
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - David Playford
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Geoff Strange
- School of Medicine, The University of Notre Dame Australia, Fremantle, Western Australia, Australia
| | - Gregory M Scalia
- The University of Queensland, Saint Lucia, Queensland, Australia,Department of Cardiology, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - David S Celermajer
- School of Medicine, The University of Sydney, Sydney, New South Wales, Australia .,Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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33
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Carluccio E, Cameli M, Rossi A, Dini FL, Biagioli P, Mengoni A, Jacoangeli F, Mandoli GE, Pastore MC, Maffeis C, Ambrosio G. Left Atrial Strain in the Assessment of Diastolic Function in Heart Failure: A Machine Learning Approach. Circ Cardiovasc Imaging 2023; 16:e014605. [PMID: 36752112 DOI: 10.1161/circimaging.122.014605] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) assessment in heart failure is still challenging. Peak atrial longitudinal strain (PALS) is strongly related to end-diastolic pressure and prognosis, but it is still not part of standard DD assessment. We tested the hypothesis that a machine learning approach would be useful to include PALS in DD classification and refine prognostic stratification. METHODS In a derivation cohort of 864 heart failure patients in sinus rhythm (age, 66.6±12 years; heart failure with reduced ejection fraction, n=541; heart failure with mildly reduced ejection fraction, n=129; heart failure with preserved ejection fraction, n=194), machine learning techniques were retrospectively applied to PALS and guideline-recommended diastolic variables. Outcome (death/heart failure rehospitalization) of the identified DD-clusters was compared with that by guidelines-based classification. To identify the best combination of variables able to classify patients in one of the identified DD-clusters, classification and regression tree analysis was applied (with DD-clusters as dependent variable and PALS plus guidelines-recommended diastolic variables as explanatory variables). The algorithm was subsequently validated in a prospective cohort of 189 heart failure outpatients (age, 65±13 years). RESULTS Three distinct echocardiographic DD-clusters were identified (cluster-1, n=212; cluster-2, n=376; cluster-3 DD, n=276), with modest agreement with guidelines-recommended classification (kappa=0.40; P<0.001). DD-clusters were predicted by a simple algorithm including E/A ratio, left atrial volume index, E/e' ratio, and PALS. After 36.5±29.4 months follow-up, 318 events occurred. Compared to guideline-based classification, DD-clusters showed a better association with events in multivariable models (C-index 0.720 versus 0.733, P=0.033; net reclassification improvement 0.166 [95% CI, 0.035-0.276], P=0.013), without interaction with ejection fraction category. In the validation cohort (median follow-up: 18.5 months), cluster-based classification better predicted outcome than guideline-based classification (C-index 0.80 versus 0.78, P=0.093). CONCLUSIONS Integrating PALS by machine learning algorithm in DD classification improves risk stratification over recommended current criteria, regardless of ejection fraction status. This proof of concept study needs further validation of the proposed algorithm to assess generalizability to other populations.
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Affiliation(s)
- Erberto Carluccio
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Italy (E.C., P.B., A.M., F.J., G.A.)
| | - Matteo Cameli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Italy (M.C., G.E.M., M.C.P.)
| | - Andrea Rossi
- Azienda Ospedaliero-Universitaria, Verona, Italy (A.R., C.M.)
| | - Frank Lloyd Dini
- Cardiac, Thoracic and Vascular Department, University of Pisa, Italy (F.L.D.)
| | - Paolo Biagioli
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Italy (E.C., P.B., A.M., F.J., G.A.)
| | - Anna Mengoni
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Italy (E.C., P.B., A.M., F.J., G.A.)
| | - Francesca Jacoangeli
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Italy (E.C., P.B., A.M., F.J., G.A.)
| | - Giulia Elena Mandoli
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Italy (M.C., G.E.M., M.C.P.)
| | - Maria Concetta Pastore
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Italy (M.C., G.E.M., M.C.P.)
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Italy (E.C., P.B., A.M., F.J., G.A.)
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Chan YK, Stickland N, Stewart S. An inevitable or modifiable trajectory towards heart failure in high-risk individuals: insights from the nurse-led intervention for less chronic heart failure (NIL-CHF) study. Eur J Cardiovasc Nurs 2023; 22:33-42. [PMID: 35986905 DOI: 10.1093/eurjcn/zvac036] [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: 07/29/2021] [Revised: 04/04/2022] [Accepted: 04/05/2022] [Indexed: 01/20/2023]
Abstract
AIMS We extended follow-up of a heart failure (HF) prevention study to determine if initially positive findings of improved cardiac recovery were translated into less de novo HF and/or all-cause mortality (primary endpoint) in the longer term. METHODS AND RESULTS The Nurse-led Intervention for Less Chronic HF (NIL-CHF) study was a single-centre randomized trial of nurse-led prevention involving cardiac inpatients without HF. At 3 years, 454 survivors (aged 66 ± 11 years, 71% men and 68% coronary artery disease) had the following: (i) a normal echocardiogram (128 cases/28.2%), (ii) structural heart disease (196/43.2%), or (iii) left ventricular diastolic dysfunction/left ventricular systolic dysfunction (LVDD/LVSD: 130/28.6%). Outcomes were examined during median 8.3 (interquartile range 7.8-8.8) years according to these hierarchal groups and change in cardiac status from baseline to 3 years. Overall, 109 (24.0%) participants had a de novo HF admission or died while accumulating 551 cardiovascular-related admissions/3643 days of hospital stay. Progressively worse cardiac status correlated with increased hospitalizations (P < 0.001). The mean rate (95% confidence interval) of cardiovascular admissions/days of hospital stay being 0.09 (0.05-0.12) admissions/0.33 (0.13-0.54) days vs. 0.27 (0.20-0.34) admissions/2.20 (1.36-3.04) days per annum for those with a normal echocardiogram vs. LVDD/LVSD at 3 years. With progressively higher event rates, the adjusted hazard ratio for a de novo HF admission and/or death associated with a structural abnormality (24.5% of cases) and LVDD/LVSD (36.2%) at 3 years was 1.57 (0.82-3.01; P = 0.173) and 2.07 (1.05-4.05; P = 0.035) compared with a normal echocardiogram (10.9%). Mortality also mirrored the direction/extent of cardiac status/trajectory. CONCLUSIONS These data suggest the positive initial effects of NIL-CHF intervention on cardiac recovery contributed to better long-term outcomes among patients at high risk of HF. However, prevention of HF remains challenging.
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Affiliation(s)
- Yih-Kai Chan
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Nerolie Stickland
- Mary MacKillop Institute for Health Research, The Australian Catholic University, Melbourne, VIC 3000, Australia
| | - Simon Stewart
- Center for Cardiopulmonary Health, Torrens University Australia, Adelaide, SA 5000, Australia.,Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA 6160, Australia
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Strange G, Stewart S, Playford D, Strom JB. Risk for Mortality with Increasingly Severe Aortic Stenosis: An International Cohort Study. J Am Soc Echocardiogr 2023; 36:60-68.e2. [PMID: 36208655 PMCID: PMC9822866 DOI: 10.1016/j.echo.2022.09.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/10/2022] [Accepted: 09/29/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Aortic stenosis (AS) is the most common valvular heart disease in high-income countries. Adjusted for clinical confounders, the risk associated with increasing AS severity across the spectrum of AS severity remains uncertain. METHODS The authors conducted an international, multicenter, parallel-cohort study of 217,599 Australian (mean age, 76.0 ± 7.3 years; 49.3% women) and 30,865 US (mean age, 77.4 ± 7.3 years; 52.2% women) patients aged ≥65 years who underwent echocardiography. Patients with previous aortic valve replacement were excluded. The risk of increasing AS severity, quantified by peak aortic velocity (Vmax), was assessed through linkage to 97,576 and 14,481 all-cause deaths in Australia and the United States, respectively. RESULTS The distribution of AS severity (mean Vmax, 1.7 ± 0.7 m/sec) was similar in both cohorts. Compared with those with Vmax of 1.0 to 1.49 m/sec, those with Vmax of 2.50 to 2.99 m/sec (US cohort) or Vmax of 3.0 to 3.49 m/sec (Australian cohort) had a 1.5-fold increase in mortality risk within 10 years, adjusting for age, sex, presence of left heart disease, and left ventricular ejection fraction. Overall, the adjusted risk for mortality plateaued (1.75- to 2.25-fold increased risk) above a Vmax of 3.5 m/sec. This pattern of mortality persisted despite adjustment for a comprehensive list of comorbidities and treatments within the US cohort. CONCLUSIONS Within large, parallel patient cohorts managed in different health systems, similar patterns of mortality linked to increasingly severe AS were observed. These findings support ongoing clinical trials of aortic valve replacement in patients with nonsevere AS and suggest the need to develop and apply more proactive surveillance strategies in this high-risk population.
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Affiliation(s)
- Geoff Strange
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Institute of Health Research, University of Notre Dame, Fremantle, Australia; Heart Research Institute, Sydney, Australia; Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
| | - Simon Stewart
- Institute of Health Research, University of Notre Dame, Fremantle, Australia; School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, United Kingdom
| | - David Playford
- Institute of Health Research, University of Notre Dame, Fremantle, Australia
| | - Jordan B Strom
- Department of Medicine, Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Richard A. and Susan F. Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
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Borde DP, Venkata DB, Joshi S, Jasapara A, Joshi P, Asegaonkar B. Elastic recoil signal on tissue doppler imaging of mitral annulus as a qualitative test to identify left ventricular diastolic function. Ann Card Anaesth 2023; 26:42-49. [PMID: 36722587 PMCID: PMC9997472 DOI: 10.4103/aca.aca_20_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Introduction Left ventricular (LV) diastolic dysfunction is common on preoperative screening among patients undergoing surgery. There is no simple screening test at present to suspect LV diastolic dysfunction. This study was aimed to test the hypothesis, whether elastic recoil signal (ERS) on tissue Doppler imaging of mitral annulus (MA TDI) can be used as a qualitative test to differentiate patients from normal LV diastolic function versus patients with LV diastolic dysfunction. Methods This was a prospective cross-sectional observational study of patients admitted for elective surgeries. Normal diastolic function and categorization of LV diastolic dysfunction into severity grades I, II, or III were performed as per the American Society of Echocardiography/ European Associationof Cardio Vascular Imaging (ASE/EACVI) recommendations for LV diastolic dysfunction. Results There were 41 (61%) patients with normal LV diastolic function and 26 (39%) patients with various grades of LV diastolic dysfunction. In 38 out of 41 patients with normal LV diastolic function, the characteristic ERS was identified. The ERS was absent in all the patients with any grade of LV diastolic dysfunction. Consistency of identification of ERS on echocardiography was tested with a good interobserver variability coefficient of 0.94 (P-value <0.001). The presence of ERS demonstrated an excellent differentiation to rule out any LV diastolic dysfunction with an area under the receiver operating characteristics curve (AUROC) of 0.96 (CI 0.88-0.99; P value <0.001). Conclusions To conclude, in a mixed surgical population, the anesthetist could successfully assess LV diastolic dysfunction in the preoperative period and the characteristic ERS on MA TDI signal can be used as a qualitative test to differentiate patients from normal LV diastolic function versus patients with LV diastolic dysfunction using the transthoracic echocardiography (TTE).
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Affiliation(s)
| | - Devarakonda Bhargava Venkata
- Department of Cardiothoracic Anaesthesiology, Army Institute of Cardiothoracic Sciences, Pune, Maharashtra, India
| | - Shreedhar Joshi
- Cardiac Anaesthesia, Narayana Institute of Cardiac Sciences, Narayana Hospitals, Bengaluru, Karnataka, India
| | - Amish Jasapara
- Cardiac Anaesthesia, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Pooja Joshi
- Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
| | - Balaji Asegaonkar
- Cardiac Anaesthesia, Ozone Anaesthesia Group, Aurangabad, Maharashtra, India
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van Ommen AMLN, Canto ED, Cramer MJ, Rutten FH, Onland-Moret NC, Ruijter HMD. Diastolic dysfunction and sex-specific progression to HFpEF: current gaps in knowledge and future directions. BMC Med 2022; 20:496. [PMID: 36575484 PMCID: PMC9795723 DOI: 10.1186/s12916-022-02650-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 11/07/2022] [Indexed: 12/28/2022] Open
Abstract
Diastolic dysfunction of the left ventricle (LVDD) is equally common in elderly women and men. LVDD is a condition that can remain latent for a long time but is also held responsible for elevated left ventricular filling pressures and high pulmonary pressures that may result in (exercise-induced) shortness of breath. This symptom is the hallmark of heart failure with preserved ejection fraction (HFpEF) which is predominantly found in women as compared to men within the HF spectrum. Given the mechanistic role of LVDD in the development of HFpEF, we review risk factors and mechanisms that may be responsible for this sex-specific progression of LVDD towards HFpEF from an epidemiological point-of-view and propose future research directions.
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Affiliation(s)
- A M L N van Ommen
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - E Dal Canto
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - Maarten J Cramer
- Clinical Cardiology Department, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - F H Rutten
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - N C Onland-Moret
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands
| | - H M den Ruijter
- Laboratory of Experimental Cardiology, University Medical Center Utrecht, Utrecht University, 3508 GA, Utrecht, The Netherlands.
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Romejko K, Rymarz A, Szamotulska K, Bartoszewicz Z, Rozmyslowicz T, Niemczyk S. Left Ventricular Diastolic Dysfunction in Chronic Kidney Disease Patients Not Treated with Dialysis. Nutrients 2022; 14:4664. [PMID: 36364925 PMCID: PMC9655426 DOI: 10.3390/nu14214664] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LVDD) is observed in the early stages of chronic kidney disease (CKD) and may lead to heart failure with preserved ejection fraction (HFpEF). The purpose of our study was to investigate the association between metabolic, nutritional and inflammatory parameters and LVDD in CKD and non-CKD patients. METHODS Two groups of patients were recruited to the study: 93 men with CKD and eGFR lower than 60 mL/min/1.73 m2 and 40 men without kidney function decrease with eGFR ≥ 60 mL/min/1.73 m2. Transthoracic echocardiography was performed to evaluate the diastolic function of the left ventricle. Bioimpedance spectroscopy (BIS) was used to measure overhydration and lean body mass. We also measured the serum concentrations of albumin, glucose, haemoglobin A1c (HgbA1c), fibrinogen, C-reactive protein (CRP), tumor necrosis factor-alpha (TNF-alpha) and osteoprotegerin (OPG). RESULTS We observed that elevated serum fibrinogen and glucose concentrations were associated with LVDD independently of CKD status. Serum fibrinogen concentrations increased with the advancement of LVDD. Low albumin concentrations in CKD were related with LVDD. In the control group, lower muscle mass presented as lean tissue index (LTI) and lean tissue mass (LTM), and overhydration were associated with LVDD. In the group of patients without kidney function decrease the OPG concentrations were significantly higher in those with LVDD, and they rose with the advancement of LVDD. CONCLUSIONS Elevated inflammatory parameters, increased serum glucose concentrations and worse nutritional status are the states that may impair the diastolic function of the left ventricle in CKD and non-CKD patients. Serum OPG levels are elevated in patients without kidney function decrease and LVDD and its concentrations rise with the advancement of LVDD.
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Affiliation(s)
- Katarzyna Romejko
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, 128 Szaserów Street, 04-141 Warsaw, Poland
| | - Aleksandra Rymarz
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, 128 Szaserów Street, 04-141 Warsaw, Poland
| | - Katarzyna Szamotulska
- Department of Epidemiology and Biostatistics, Institute of Mother and Child, Kasprzaka Street, 17a, 01-211 Warsaw, Poland
| | - Zbigniew Bartoszewicz
- Department of Internal Diseases and Endocrinology, Medical University of Warsaw, 1a Banacha Street, 02-097 Warsaw, Poland
| | - Tomasz Rozmyslowicz
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, R.217 John Morgan Building, 3620 Hamilton Walk, Philadelphia, PA 19104, USA
| | - Stanisław Niemczyk
- Department of Internal Diseases, Nephrology and Dialysis, Military Institute of Medicine, 128 Szaserów Street, 04-141 Warsaw, Poland
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Wedin JO, Vedin O, Rodin S, Simonson OE, Hörsne Malmborg J, Pallin J, James SK, Flachskampf FA, Ståhle E, Grinnemo KH. Patients With Bicuspid Aortic Stenosis Demonstrate Adverse Left Ventricular Remodeling and Impaired Cardiac Function Before Surgery With Increased Risk of Postoperative Heart Failure. Circulation 2022; 146:1310-1322. [PMID: 35971843 PMCID: PMC9586833 DOI: 10.1161/circulationaha.122.060125] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Differences in adverse cardiac remodeling between patients who have bicuspid (BAV) and tricuspid aortic valve (TAV) with severe isolated aortic stenosis (AS) and its prognostic impact after surgical aortic valve replacement remains unclear. We sought to investigate differences in preoperative diastolic and systolic function in patients with BAV and TAV who have severe isolated AS and the incidence of postoperative heart failure hospitalization and mortality. METHODS Two hundred seventy-one patients with BAV (n=152) or TAV (n=119) and severe isolated AS without coronary artery disease or other valvular heart disease, scheduled for surgical aortic valve replacement, were prospectively included. Comprehensive preoperative echocardiographic assessment of left ventricular (LV) diastolic and systolic function was performed. The heart failure events were registered during a mean prospective follow-up of 1260 days versus 1441 days for patients with BAV or TAV, respectively. RESULTS Patients with BAV had a more pronounced LV hypertrophy with significantly higher indexed LV mass ([LVMi] 134 g/m2 versus 104 g/m2, P<0.001), higher prevalence of LV diastolic dysfunction (72% versus 44%, P<0.001), reduced LV ejection fraction (55% versus 60%, P<0.001), significantly impaired global longitudinal strain (P<0.001), significantly higher NT-proBNP (N-terminal pro-brain natriuretic peptide) levels (P=0.007), and a higher prevalence of preoperative levosimendan treatment (P<0.001) than patients with TAV. LVMi was associated with diastolic dysfunction in both patients with BAV and TAV. There was a significant interaction between aortic valve morphology and LVMi on LV ejection fraction, which indicated a pronounced association between LVMi and LV ejection fraction for patients with BAV and lack of association between LVMi and LV ejection fraction for patients with TAV. Postoperatively, the patients with BAV required significantly more inotropic support (P<0.001). The patients with BAV had a higher cumulative incidence of postoperative heart failure admissions compared with patients with TAV (28.2% versus 10.6% at 6 years after aortic valve replacement, log-rank P=0.004). Survival was not different between patients with BAV and TAV (log-rank P=0.165). CONCLUSIONS Although they were significantly younger, patients with BAV who had isolated severe AS had worse preoperative LV function and an increased risk of postoperative heart failure hospitalization compared with patients who had TAV. Our findings suggest that patients who have BAV with AS might benefit from closer surveillance and possibly earlier intervention.
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Affiliation(s)
- Johan O. Wedin
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Ola Vedin
- Department of Medical Sciences (O.V., S.K.J., F.A.F.), Uppsala University, Sweden.,Boehringer Ingelheim AB, Stockholm, Sweden (O.V.)
| | - Sergey Rodin
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden
| | - Oscar E. Simonson
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Jonathan Hörsne Malmborg
- Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Johan Pallin
- Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Stefan K. James
- Department of Medical Sciences (O.V., S.K.J., F.A.F.), Uppsala University, Sweden.,Department of Clinical Physiology and Cardiology (S.K.J., F.A.F.), Uppsala University Hospital, Sweden
| | - Frank A. Flachskampf
- Department of Medical Sciences (O.V., S.K.J., F.A.F.), Uppsala University, Sweden.,Department of Clinical Physiology and Cardiology (S.K.J., F.A.F.), Uppsala University Hospital, Sweden
| | - Elisabeth Ståhle
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
| | - Karl-Henrik Grinnemo
- Department of Surgical Sciences (J.O.W., S.R., O.E.S., E.S., K.-H.G.), Uppsala University, Sweden.,Department of Cardiothoracic Surgery and Anesthesiology (J.O.W., O.E.S., J.H.M., J.P., E.S., K.-H.G.), Uppsala University Hospital, Sweden
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Serum Osteoprotegerin Is an Independent Marker of Left Ventricular Hypertrophy, Systolic and Diastolic Dysfunction of the Left Ventricle and the Presence of Pericardial Fluid in Chronic Kidney Disease Patients. Nutrients 2022; 14:nu14142893. [PMID: 35889849 PMCID: PMC9316805 DOI: 10.3390/nu14142893] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/12/2022] [Accepted: 07/14/2022] [Indexed: 12/31/2022] Open
Abstract
Background: Osteoprotegerin (OPG) is a molecule which belongs to the tumor necrosis factor receptor superfamily. OPG concentration is elevated in patients with left ventricle hypertrophy, heart failure and acute myocardial infarction. OPG concentrations rise in chronic kidney disease (CKD). The aim of this study was to investigate the association between OPG concentrations and cardiovascular complications, such as left ventricle hypertrophy, systolic and diastolic dysfunction of left ventricle and dysfunction of right ventricle in chronic kidney disease patients not treated with dialysis. The relation between OPG and the amount of pericardial fluid was also examined. Methods: One hundred and one men with CKD stage 3–5 not treated with dialysis were included in the study. Overhydration, body fat mass and lean body mass were measured using bioimpedance spectroscopy (BIS). Echocardiography was performed to evaluate the amount of pericardial fluid and to measure the thickness of the interventricular septum (IVS), systolic and diastolic function of left ventricle, as well as systolic function of right ventricle. Results: We observed a significant positive association between OPG and the thickness of the interventricular septum, the size of the left atrium (LA) and the presence of pericardial fluid. A negative relationship was observed between OPG and ejection fraction (EF). Conclusions: Our results suggest that OPG can be an independent marker of left ventricular hypertrophy, systolic and diastolic dysfunction of left ventricle and the presence of pericardial fluid in chronic kidney disease patients.
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Chao CJ, Kato N, Scott CG, Lopez-Jimenez F, Lin G, Kane GC, Pellikka PA. Unsupervised Machine Learning for Assessment of Left Ventricular Diastolic Function and Risk Stratification. J Am Soc Echocardiogr 2022; 35:1214-1225.e8. [PMID: 35840082 DOI: 10.1016/j.echo.2022.06.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/28/2022] [Accepted: 06/28/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND The 2016 American Society of Echocardiography (ASE) guidelines have been widely used to assess left ventricular diastolic function. However, limitations are present in the current classification system. We aimed to develop a data-driven, unsupervised machine learning approach for diastolic function classification and risk stratification using the left ventricular diastolic function parameters recommended by the 2016 ASE guidelines; the guideline grading was used as the reference standard. METHODS Baseline demographics, heart failure hospitalization and all-cause mortality data were obtained for all adult patients who underwent transthoracic echocardiography at Mayo Clinic Rochester in 2015. Patients with prior mitral valve intervention, congenital heart disease, cardiac transplant, or cardiac assist device were excluded. Nine left ventricular diastolic function variables (mitral E and A wave peak velocities, E/A, deceleration time, medial and lateral annulus e' and E/e', and tricuspid regurgitation peak velocity) were used for an unsupervised machine learning algorithm to identify different phenotype clusters. The cohort average of each variable was used for imputation. Patients were grouped according to the algorithm-determined clusters for Kaplan-Meier survival analysis. RESULTS Among 24,414 patients, age 63.6 ±16.2 years, all-cause mortality occurred in 4,612 (18.9%) patients during median follow-up 3.1 years. The algorithm determined 3 clusters with echocardiographic measurement characteristics corresponding to normal diastolic function (n= 8,312), impaired relaxation (n=11,779) and increased filling pressure (n =4,323), with 3-year cumulative mortality of 11.8%, 19.9% and 33.4%, respectively (p<0.0001). All 10,694 (43.8%) patients classified as indeterminate were reclassified into the 3 clusters (3,324, 5,353, and 2,017, respectively) with 3-year mortality of 16.6%, 22.9% and 34.4%, respectively. The clusters also outperformed guideline-based grade for prognostication (c-index: 0.607 vs. 0.582, p=0.013). CONCLUSIONS Unsupervised machine learning identified physiologically and prognostically distinct clusters based on 9 diastolic function Doppler variables. The clusters can be potentially applied in echocardiography laboratory practice and future clinical trials for simple, replicable diastolic function related risk stratification.
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Affiliation(s)
- Chieh-Ju Chao
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Nahoko Kato
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Christopher G Scott
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | - Grace Lin
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
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Assessment of left ventricular diastolic dysfunction following anthracyclinebased chemotherapy in breast cancer patients. ACTA BIOMEDICA SCIENTIFICA 2022. [DOI: 10.29413/abs.2022-7.3.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Cardiotoxicity is a side effect of anthracycline-based chemotherapy. Clinical and prognostic significance of left ventricular diastolic dysfunction in heart failure patients is undeniable.The aim. To assess dynamic changes in the left ventricular diastolic function after anthracycline-based chemotherapy (ANT) in breast cancer patients.Material and methods. The study included 40 women aged 35 to 72 years with breast cancer (BC) undergoing ANT chemotherapy. The main group (n = 40) consisted of women with breast cancer examined at admission, after 6 months the same women (n = 37) were examined again. Women without breast cancer (n = 25) were used as the control group.Results. Dynamic changes in mitral annular velocities were revealed by Doppler tissue imaging. Lateral early diastolic mitral annular velocity (e’ lateral) was significantly lower in breast cancer patients as compared to the control group (p = 0.031). Six months after ANT chemotherapy, there was a definite increase in the lateral late diastolic mitral annular velocity (a’ lateral) (p = 0.033). Average early diastolic transmitral flow velocity to early diastolic velocity (E/e’ lateral) ratio was within the normative values in all groups, but E/e’ lateral in the main group was higher compared to the control group (p = 0.003). In the main group, septal early diastolic mitral annular velocity (e’ septal) was lower compared to the control group (p = 0.0005). Moreover, an increase in the septal mitral annular velocity (a’ septal) (p = 0.01) and higher E/e’ septal ratio (p = 0.011) were revealed during dynamic observation. Multiple logistic regression disclosed that E/A, e’ lateral, e’/a’ lateral, and E/e’ lateral were affected by heart rate, psychological status, age, hypertension, and body mass index, but not anthracycline chemotherapy. The total dose of anthracycline was independently associated with e’ septal and E/e’ septal: F(4.18) = 16.466 (p < 0.001; R2 = 0.775) and F(3.16) = 7.271 (p = 0.004; R2 = 0.627).Conclusion. Left ventricular diastolic function worsens in women undergoing anthracycline-based chemotherapy for breast cancer (lower e’, e’/a’ lateral, and e’ septal, higher E/e’ septal ratio). However, anthracycline does not significantly affect LVEF and LV deformation indicators. E/e’ septalande’ septal are independently associated with the total dose of anthracycline.
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Chandramouli C, Stewart S, Almahmeed W, Lam CSP. Clinical implications of the universal definition for the prevention and treatment of heart failure. Clin Cardiol 2022; 45 Suppl 1:S2-S12. [PMID: 35789016 PMCID: PMC9254673 DOI: 10.1002/clc.23842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of heart failure (HF) primarily relies on signs and symptoms that are neither sensitive nor specific. This impedes timely diagnosis and delays effective therapies or interventions, despite the availability of several evidence-based treatments for HF. Through monumental collaborative efforts from representatives of HF societies worldwide, the universal definition of HF was published in 2021, to provide the necessary standardized framework required for clinical management, clinical trials, and research. This review elaborates the key concepts of the new universal definition of HF, highlighting the key merits and potential avenues, which can be nuanced further in future iterations. We also discuss the key implications of the universal definition document from the perspectives of various stakeholders within the healthcare framework, including patients, care providers, system/payers and policymakers.
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Affiliation(s)
- Chanchal Chandramouli
- National Heart Centre SingaporeSingaporeSingapore
- Duke‐National University of SingaporeSingaporeSingapore
| | - Simon Stewart
- Torrens University AustraliaAdelaideSouth AustraliaAustralia
- University of GlasgowGlasgowUK
- Institute of Health ResearchUniversity of Notre Dame AustraliaFremantleNew South WalesAustralia
| | - Wael Almahmeed
- Institute of Cardiac Science, Sheikh Khalifa Medical CityAbu DhabiUnited Arab Emirates
- Heart and Vascular Institute, Cleveland ClinicAbu DhabiUnited Arab Emirates
| | - Carolyn Su Ping Lam
- National Heart Centre SingaporeSingaporeSingapore
- Duke‐National University of SingaporeSingaporeSingapore
- University Medical Centre GroningenGroningenThe Netherlands
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Yeo JL, Gulsin GS, Brady EM, Dattani A, Bilak JM, Marsh AM, Sian M, Athithan L, Parke KS, Wormleighton J, Graham-Brown MPM, Singh A, Arnold JR, Lawson C, Davies MJ, Xue H, Kellman P, McCann GP. Association of ambulatory blood pressure with coronary microvascular and cardiac dysfunction in asymptomatic type 2 diabetes. Cardiovasc Diabetol 2022; 21:85. [PMID: 35643571 PMCID: PMC9148453 DOI: 10.1186/s12933-022-01528-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 05/20/2022] [Indexed: 02/07/2023] Open
Abstract
Background Type 2 diabetes (T2D) and hypertension commonly coexist and are associated with subclinical myocardial structural and functional changes. We sought to determine the association between blood pressure (BP) and left ventricular (LV) remodeling, systolic/diastolic function, and coronary microvascular function, among individuals with T2D without prevalent cardiovascular disease. Methods Participants with T2D and age-, sex-, and ethnicity-matched controls underwent comprehensive cardiovascular phenotyping including fasting bloods, transthoracic echocardiography, cardiovascular magnetic resonance imaging with quantitative adenosine stress/rest perfusion, and office and 24-h ambulatory BP monitoring. Multivariable linear regression was performed to determine independent associations between BP and imaging markers of remodeling and function in T2D. Results Individuals with T2D (n = 205, mean age 63 ± 7 years) and controls (n = 40, mean age 61 ± 8 years) were recruited. Mean 24-h systolic BP, but not office BP, was significantly greater among those with T2D compared to controls (128.8 ± 11.7 vs 123.0 ± 13.1 mmHg, p = 0.006). Those with T2D had concentric LV remodeling (mass/volume 0.91 ± 0.15 vs 0.82 ± 0.11 g/mL, p < 0.001), decreased myocardial perfusion reserve (2.82 ± 0.83 vs 3.18 ± 0.82, p = 0.020), systolic dysfunction (global longitudinal strain 16.0 ± 2.3 vs 17.2 ± 2.1%, p = 0.004) and diastolic dysfunction (E/e’ 9.30 ± 2.43 vs 8.47 ± 1.53, p = 0.044) compared to controls. In multivariable regression models adjusted for 14 clinical variables, mean 24-h systolic BP was independently associated with concentric LV remodeling (β = 0.165, p = 0.031), diastolic dysfunction (β = 0.273, p < 0.001) and myocardial perfusion reserve (β = − 0.218, p = 0.016). Mean 24-h diastolic BP was associated with LV concentric remodeling (β = 0.201, p = 0.016). Conclusion 24-h ambulatory systolic BP, but not office BP, is independently associated with cardiac remodeling, coronary microvascular dysfunction, and diastolic dysfunction among asymptomatic individuals with T2D. (Clinical trial registration. URL: https://clinicaltrials.gov/ct2/show/NCT03132129 Unique identifier: NCT03132129). Supplementary Information The online version contains supplementary material available at 10.1186/s12933-022-01528-2.
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Offen S, Playford D, Strange G, Stewart S, Celermajer DS. Adverse Prognostic Impact of Even Mild or Moderate Tricuspid Regurgitation: Insights from The National Echocardiography Database of Australia. J Am Soc Echocardiogr 2022; 35:810-817. [PMID: 35421545 DOI: 10.1016/j.echo.2022.04.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 04/01/2022] [Accepted: 04/02/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND The prevalence and prognostic impact of tricuspid regurgitation (TR) remains incompletely characterized. METHODS The distribution of TR severity was analyzed in 439,558 adults (mean age 62.1 ±17.8 years, 51.5% men) being investigated for heart disease, from 2000-2019, by 25 centers contributing to the National Echocardiography Database of Australia. Survival status and cause of death were ascertained, in all adults, from the National Death Index of Australia. The relationship between TR severity and mortality was examined. RESULTS Of those studied, 311,604 (70.9%) had no/trivial TR; 94,172 (21.4%) mild TR; 26,056 (5.9%) moderate TR; and 7,726 (1.8%) severe TR. During a median 4.1 years (interquartile range 2.2-7.0 years) follow up, 109,004 died (49% from cardiovascular causes). Moderate or greater TR was associated with older age and female sex (p<0.001). Individuals with moderate and severe TR had a 2.0- to 3.2-fold increased risk of all-cause long-term mortality after adjustment for age and sex, compared to those with no/trivial TR (p<0.001 for both comparisons). Even those with mild TR had a significantly increased risk for mortality (HR 1.29, 95% CI 1.27-1.31). In fully adjusted models, including for RV systolic pressure, atrial fibrillation and significant left-heart disease, there remained a 1.24 to 2.65-fold increased risk of mortality with mild (HR 1.24, 95% CI 1.23-1.26), moderate (HR 1.72, 95% CI 1.68-1.75) or severe TR (HR 2.65, 95% CI 2.57-2.73), compared to those with no/trivial TR (p<0.001 for all). CONCLUSIONS TR is a common condition in adults referred for echocardiography. Moreover, even in the presence of other cardiac disease, increasing grades of TR are independently associated with increasing risks of CV and all-cause mortality. Furthermore, we show that even mild TR is independently associated with a significant increase in mortality.
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Affiliation(s)
- Sophie Offen
- Faculty of Medicine and Health, University of Sydney, NSW, Australia; Dept of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - David Playford
- The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Geoff Strange
- Heart Research Institute, Sydney, NSW, Australia; The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Simon Stewart
- Torrens University Australia, Adelaide, SA, Australia; University of Glasgow, Glasgow, Scotland
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, NSW, Australia; Dept of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Heart Research Institute, Sydney, NSW, Australia.
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Thanaj M, Mielke J, McGurk KA, Bai W, Savioli N, de Marvao A, Meyer HV, Zeng L, Sohler F, Lumbers RT, Wilkins MR, Ware JS, Bender C, Rueckert D, MacNamara A, Freitag DF, O’Regan DP. Genetic and environmental determinants of diastolic heart function. NATURE CARDIOVASCULAR RESEARCH 2022; 1:361-371. [PMID: 35479509 PMCID: PMC7612636 DOI: 10.1038/s44161-022-00048-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/08/2022] [Indexed: 01/14/2023]
Abstract
Diastole is the sequence of physiological events that occur in the heart during ventricular filling and principally depends on myocardial relaxation and chamber stiffness. Abnormal diastolic function is related to many cardiovascular disease processes and is predictive of health outcomes, but its genetic architecture is largely unknown. Here, we use machine learning cardiac motion analysis to measure diastolic functional traits in 39,559 participants of the UK Biobank and perform a genome-wide association study. We identified 9 significant, independent loci near genes that are associated with maintaining sarcomeric function under biomechanical stress and genes implicated in the development of cardiomyopathy. Age, sex and diabetes were independent predictors of diastolic function and we found a causal relationship between genetically-determined ventricular stiffness and incident heart failure. Our results provide insights into the genetic and environmental factors influencing diastolic function that are relevant for identifying causal relationships and potential tractable targets.
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Affiliation(s)
- Marjola Thanaj
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Johanna Mielke
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Kathryn A. McGurk
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Wenjia Bai
- Department of Computing, Imperial College London, London, UK
- Department of Brain Sciences, Imperial College London
| | - Nicolò Savioli
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- Department of Computing, Imperial College London, London, UK
| | - Antonio de Marvao
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
| | - Hannah V. Meyer
- Cold Spring Harbor Laboratory, Simons Center for Quantitative Biology, USA
| | - Lingyao Zeng
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Florian Sohler
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | | | - Martin R. Wilkins
- National Heart and Lung Institute, Imperial College London, London, UK
| | - James S. Ware
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Christian Bender
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Daniel Rueckert
- Department of Computing, Imperial College London, London, UK
- Institute for Artificial Intelligence and Informatics, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Aidan MacNamara
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Daniel F. Freitag
- Bayer AG, Research & Development, Pharmaceuticals, Wuppertal, Germany
| | - Declan P. O’Regan
- MRC London Institute of Medical Sciences, Imperial College London, London, UK
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JG, Coats AJ, Crespo-Leiro MG, Farmakis D, Gilard M, Heyman S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CS, Lyon AR, McMurray JJ, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GM, Ruschitzka F, Skibelund AK. Guía ESC 2021 sobre el diagnóstico y tratamiento de la insuficiencia cardiaca aguda y crónica. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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McDonagh TA, Metra M, Adamo M, Gardner RS, Baumbach A, Böhm M, Burri H, Butler J, Čelutkienė J, Chioncel O, Cleland JGF, Coats AJS, Crespo-Leiro MG, Farmakis D, Gilard M, Heymans S, Hoes AW, Jaarsma T, Jankowska EA, Lainscak M, Lam CSP, Lyon AR, McMurray JJV, Mebazaa A, Mindham R, Muneretto C, Francesco Piepoli M, Price S, Rosano GMC, Ruschitzka F, Kathrine Skibelund A. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: Developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). With the special contribution of the Heart Failure Association (HFA) of the ESC. Eur J Heart Fail 2022; 24:4-131. [PMID: 35083827 DOI: 10.1002/ejhf.2333] [Citation(s) in RCA: 889] [Impact Index Per Article: 444.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 12/11/2022] Open
Abstract
Document Reviewers: Rudolf A. de Boer (CPG Review Coordinator) (Netherlands), P. Christian Schulze (CPG Review Coordinator) (Germany), Magdy Abdelhamid (Egypt), Victor Aboyans (France), Stamatis Adamopoulos (Greece), Stefan D. Anker (Germany), Elena Arbelo (Spain), Riccardo Asteggiano (Italy), Johann Bauersachs (Germany), Antoni Bayes-Genis (Spain), Michael A. Borger (Germany), Werner Budts (Belgium), Maja Cikes (Croatia), Kevin Damman (Netherlands), Victoria Delgado (Netherlands), Paul Dendale (Belgium), Polychronis Dilaveris (Greece), Heinz Drexel (Austria), Justin Ezekowitz (Canada), Volkmar Falk (Germany), Laurent Fauchier (France), Gerasimos Filippatos (Greece), Alan Fraser (United Kingdom), Norbert Frey (Germany), Chris P. Gale (United Kingdom), Finn Gustafsson (Denmark), Julie Harris (United Kingdom), Bernard Iung (France), Stefan Janssens (Belgium), Mariell Jessup (United States of America), Aleksandra Konradi (Russia), Dipak Kotecha (United Kingdom), Ekaterini Lambrinou (Cyprus), Patrizio Lancellotti (Belgium), Ulf Landmesser (Germany), Christophe Leclercq (France), Basil S. Lewis (Israel), Francisco Leyva (United Kingdom), AleVs Linhart (Czech Republic), Maja-Lisa Løchen (Norway), Lars H. Lund (Sweden), Donna Mancini (United States of America), Josep Masip (Spain), Davor Milicic (Croatia), Christian Mueller (Switzerland), Holger Nef (Germany), Jens-Cosedis Nielsen (Denmark), Lis Neubeck (United Kingdom), Michel Noutsias (Germany), Steffen E. Petersen (United Kingdom), Anna Sonia Petronio (Italy), Piotr Ponikowski (Poland), Eva Prescott (Denmark), Amina Rakisheva (Kazakhstan), Dimitrios J. Richter (Greece), Evgeny Schlyakhto (Russia), Petar Seferovic (Serbia), Michele Senni (Italy), Marta Sitges (Spain), Miguel Sousa-Uva (Portugal), Carlo G. Tocchetti (Italy), Rhian M. Touyz (United Kingdom), Carsten Tschoepe (Germany), Johannes Waltenberger (Germany/Switzerland) All experts involved in the development of these guidelines have submitted declarations of interest. These have been compiled in a report and published in a supplementary document simultaneously to the guidelines. The report is also available on the ESC website www.escardio.org/guidelines For the Supplementary Data which include background information and detailed discussion of the data that have provided the basis for the guidelines see European Heart Journal online.
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Prevalence and renal prognosis of left ventricular diastolic dysfunction in non-dialysis chronic kidney disease patients with preserved systolic function. J Hypertens 2021; 40:723-731. [DOI: 10.1097/hjh.0000000000003069] [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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Echocardiographic Advances in Dilated Cardiomyopathy. J Clin Med 2021; 10:jcm10235518. [PMID: 34884220 PMCID: PMC8658091 DOI: 10.3390/jcm10235518] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 12/29/2022] Open
Abstract
Although the overall survival of patients with dilated cardiomyopathy (DCM) has improved significantly in the last decades, a non-negligible proportion of DCM patients still shows an unfavorable prognosis. DCM patients not only need imaging techniques that are effective in diagnosis, but also suitable for long-term follow-up with frequent re-evaluations. The exponential growth of echocardiography’s technology and performance in recent years has resulted in improved diagnostic accuracy, stratification, management and follow-up of patients with DCM. This review summarizes some new developments in echocardiography and their promising applications in DCM. Although nowadays cardiac magnetic resonance (CMR) remains the gold standard technique in DCM, the echocardiographic advances and novelties proposed in the manuscript, if properly integrated into clinical practice, could bring echocardiography closer to CMR in terms of accuracy and may certify ultrasound as the technique of choice in the follow-up of DCM patients. The application in DCM patients of novel echocardiographic techniques represents an interesting emergent research area for scholars in the near future.
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