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Emerson P, Stefani L, Boyd A, Richards D, Hui R, Altman M, Thomas L. Alterations in Left Atrial Strain in Breast Cancer Patients Immediately Post Anthracycline Exposure. Heart Lung Circ 2024; 33:684-692. [PMID: 37806911 DOI: 10.1016/j.hlc.2023.06.864] [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: 05/09/2023] [Accepted: 06/19/2023] [Indexed: 10/10/2023]
Abstract
AIMS With improved diagnosis and treatments, a greater percentage of breast cancer patients are achieving long-term survival. Consequently, long-term cardiotoxicity secondary to chemotherapy has become more prevalent, warranting improved cardiac surveillance. We evaluated changes in left atrial (LA) strain in breast cancer patients immediately post anthracycline (AC) therapy to assess its utility as a marker of diastolic dysfunction. METHODS This was a prospective cohort study of 128 consecutive human epidermal growth factor receptor 2 (HER2)-negative breast cancer patients who underwent transthoracic echocardiography prior to and immediately post AC treatment. Traditional left ventricular (LV) systolic and diastolic parameters and LA volumes were evaluated; additionally, LV global longitudinal strain (LV GLS) and LA phasic strain were measured. RESULTS All patients had normal LV ejection fraction (>53%) post AC, though LV GLS was significantly reduced. Peak E and é velocities were reduced post AC, with no change in LA volumes. LA reservoir strain (LASRES 34.8% vs 31.5%, p<0.001) and conduit strain (LASCD 17.2% vs 14.4%, p<0.001) were significantly lower post AC and correlated modestly with LV diastolic parameters. Reduction in LA strain post AC was evident even in patients with preserved LV systolic and diastolic function. More patients demonstrated alteration in diastolic function (≥15% reduction in LASRES from baseline) (32%) compared to alteration in systolic function (≥15% reduction in LV GLS) (23%). CONCLUSIONS LA strain is a promising marker of early diastolic dysfunction. We demonstrate its potential utility in surveillance of breast cancer patients treated with AC.
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Affiliation(s)
- Peter Emerson
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Luke Stefani
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Anita Boyd
- Westmead Private Cardiology, Westmead, Sydney, NSW, Australia
| | - David Richards
- Westmead Private Cardiology, Westmead, Sydney, NSW, Australia
| | - Rina Hui
- Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia; The Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, NSW, Australia
| | - Mikhail Altman
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia
| | - Liza Thomas
- Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia; Westmead Clinical School, The University of Sydney, Sydney, NSW, Australia.
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2
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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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Stalikas N, Anastasiou V, Botis I, Daios S, Karagiannidis E, Zegkos T, Karamitsos T, Vassilikos V, Ziakas A, Kamperidis V, Giannakoulas G, Giannopoulos G. The prognostic impact of diastolic dysfunction after transcatheter aortic valve replacement: A systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102228. [PMID: 38043876 DOI: 10.1016/j.cpcardiol.2023.102228] [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: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Diastolic dysfunction (DD) is a long-established marker of disease progression in patients with aortic valve stenosis (AS), indicating valvular myocardial damage. Recently, substantial observational data have emerged demonstrating that worse pre-operative DD assessed using echocardiography is associated with adverse long-term clinical outcomes after transcatheter aortic valve replacement (TAVR). AIM To systematically appraise and quantitatively synthesize current evidence on the prognostic impact of echocardiographic severe DD derived by echocardiography before TAVR. METHODS A systemic literature review was undertaken in electronic databases to identify studies reporting the predictive value of severe DD in AS subjects undergoing TAVR. A random-effects meta-analysis was conducted to quantify the adjusted and unadjusted hazard ratios (HRs) for all-cause mortality and major adverse cardiovascular events (MACEs) for the presence of severe DD. RESULTS Ten studies were deemed eligible for inclusion. Of those, 9 provided appropriate quantitative data for the meta-analysis, encompassing a total of 4,619 patients. The presence of severe DD was associated with increased risk for all-cause mortality (pooled unadjusted HR=2.56 [1.46-4.48]; p<0.01; I2=76 %) and MACEs (pooled unadjusted HR=1.82 [1.29-2.58]; p<0.01; I2=86 %). When adjusted for clinically-relevant parameters, the presence of severe DD retained independent association with all-cause mortality (pooled adjusted HR=2.35 [1.26-4.37]; p<0.01; I2=79 %) and MACEs (pooled adjusted HR= 2.52 [1.72-3.65]; p<0.01; I2=0 %). In subgroup analysis there was no difference on post-TAVR risk between the use of different diastolic function grading scores. CONCLUSION Presence of severe DD assessed by echocardiography pre-TAVR is a major determinant of long-term adverse outcomes after the procedure.
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Affiliation(s)
- Nikolaos Stalikas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece.
| | - Vasileios Anastasiou
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Ioannis Botis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Stylianos Daios
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | | | - Thomas Zegkos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Theodoros Karamitsos
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vassilios Vassilikos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
| | - Antonios Ziakas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - Vasileios Kamperidis
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannakoulas
- AHEPA Hospital, Medical School, Aristotle University, St. Kiriakidi 1, Thessaloniki GR54636, Greece
| | - George Giannopoulos
- Ippokratio General Hospital, Medical School, Aristotle University, Thessaloniki, Greece
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Gao F, Tan RS, Teo LLY, Ewe SH, Koh WP, Tan KB, Koh AS. Myocardial Aging among a Population-Based Cohort Is Associated with Adverse Cardiovascular Outcomes and Sex-Specific Differences among Older Adults. Gerontology 2024; 70:368-378. [PMID: 38301609 DOI: 10.1159/000536050] [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: 07/11/2023] [Accepted: 12/28/2023] [Indexed: 02/03/2024] Open
Abstract
INTRODUCTION Despite growing calls to tackle aging-related cardiovascular disease (CVD), the role of detecting early diastolic dysfunction such as those observed in aging, prior to clinical disease, is of unclear clinical benefit. METHODS Myocardial function determined by echocardiography was examined in association with incident cardiovascular outcomes or all-cause death by Cox proportional hazards model. Sex-based differences in outcomes were included. RESULTS A total of 956 participants (mean age 63 ± 12.9 years, n = 424 males [44%]) were categorized based on mitral peak early-to-late diastolic filling velocity (E/A) ratios: E/A <0.8 (28%), E/A 0.8-1.2 (39%), E/A (29%), E/A >2.0 (4%). Incidence rate (IR) for non-fatal cardiovascular outcomes was 2.83 per 100 person-years (95% CI: 2.24-3.56) and 0.45 per 100 person-years (95% CI: 0.26-0.80) for all-cause death. Event-free survival from non-fatal cardiovascular outcomes was significantly different among E/A categories (log-rank p = 0.0269). E/A <0.8 (HR 1.80, 95% CI: 1.031, 3.14, p = 0.039) was associated with non-fatal cardiovascular outcomes. Among men, IR for cardiovascular outcomes was 3.56 per 100 person-years (95% CI: 2.62-4.84) and 0.75 per 100 person-years (95% CI: 0.39-1.44) for all-cause death. Among women, IR for cardiovascular outcomes was 2.22 per 100 person-years (95% CI: 1.56-3.16) and 0.21 per 100 person-years (95% CI: 0.067-0.64) for all-cause death. For E/A <0.8 category, women had significantly higher risks of non-fatal cardiovascular outcomes, compared to E/A 0.8-1.2 category (HR 2.49, 95% CI: 1.18, 5.23, p = 0.017). CONCLUSION Myocardial aging was an independent predictor of cardiovascular outcomes in community-dwelling older adults prior to clinical CVD. Impaired myocardial relaxation was prevalent in both sexes but associated with worse outcomes in women, suggestive of sex differences in age-related biology.
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Affiliation(s)
- Fei Gao
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Ru-San Tan
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Louis L Y Teo
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - See Hooi Ewe
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Woon-Puay Koh
- Healthy Longevity Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Singapore Institute for Clinical Sciences, Agency for Science Technology and Research (A*STAR), Singapore, Singapore
| | - Kelvin B Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Future Systems Office, IT and Data Group, Ministry of Health, Singapore, Singapore
| | - Angela S Koh
- National Heart Centre Singapore, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
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Pawar SG, Saravanan PB, Gulati S, Pati S, Joshi M, Salam A, Khan N. Study the relationship between left atrial (LA) volume and left ventricular (LV) diastolic dysfunction and LV hypertrophy: Correlate LA volume with cardiovascular risk factors. Dis Mon 2024; 70:101675. [PMID: 38262769 DOI: 10.1016/j.disamonth.2024.101675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
Heart failure (HF) with normal ejection fraction - the isolated diastolic heart failure, depicts increasing prevalence and health care burden in recent times. Having less mortality rate compared to systolic heart failure but high morbidity, it is evolving as a major cardiac concern. With increasing clinical use of Left atrial volume (LAV) quantitation in clinical settings, LAV has emerged as an important independent predictor of cardiovascular outcome in HF with normal ejection fraction. This article is intended to review the diastolic and systolic heart failure, their association with left atrial volume, in depth study of Left atrial function dynamics with determinants of various functional and structural changes.
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Affiliation(s)
| | | | | | | | - Muskan Joshi
- Tbilisi State Medical University, Tbilisi, Georgia
| | - Ajal Salam
- Government Medical College, Kottayam, Kerala, India
| | - Nida Khan
- Jinnah Sindh Medical University, Karachi, Pakistan
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Dimitroglou Y, Aggeli C, Alexopoulou A, Tsartsalis D, Patsourakos D, Koukos M, Tousoulis D, Tsioufis K. The Contemporary Role of Speckle Tracking Echocardiography in Cirrhotic Cardiomyopathy. Life (Basel) 2024; 14:179. [PMID: 38398688 PMCID: PMC10890501 DOI: 10.3390/life14020179] [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: 12/18/2023] [Revised: 01/15/2024] [Accepted: 01/22/2024] [Indexed: 02/25/2024] Open
Abstract
Cirrhotic cardiomyopathy (CCM) is characterized by elevated cardiac output at rest, an inability to further increase contractility under stress, and diastolic dysfunction. The diagnosis of CCM is crucial as it can lead to complications during liver transplantation. However, its recognition poses challenges with conventional echocardiography techniques. Speckle tracking echocardiography (STE), particularly global longitudinal strain (GLS), is a novel index that enhances the diagnostic efficacy of echocardiography for both ischemic and non-ischemic cardiomyopathies. GLS proves more sensitive in identifying early systolic dysfunction and is also influenced by advanced diastolic dysfunction. Consequently, there is an expanding scope for GLS utilization in cirrhotic cases, with newly updated diagnostic criteria for CCM incorporating GLS. Specifically, systolic dysfunction is now defined as either a left ventricular ejection fraction below 50% or an absolute GLS below 18%. However, conflicting data on GLS alterations in liver cirrhosis patients persist, as many individuals with advanced disease and a poor prognosis exhibit a hyperdynamic state with preserved or increased GLS. Consequently, the presence of CCM, according to the updated criteria, does not exhibit a significant association-in the majority of studies-with the severity of liver disease and prognosis. Furthermore, information on other indices measured with STE, such as left atrial and right ventricular strain, is promising but currently limited. This review aims to offer a critical assessment of the existing evidence concerning the application of STE in patients with liver cirrhosis.
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Affiliation(s)
- Yannis Dimitroglou
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Constantina Aggeli
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Alexandra Alexopoulou
- Second Department of Medicine & Research Laboratory, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece;
| | - Dimitrios Tsartsalis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Dimitrios Patsourakos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Markos Koukos
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Dimitris Tousoulis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
| | - Konstantinos Tsioufis
- First Department of Cardiology, Medical School, National and Kapodistrian University of Athens, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.); (D.P.); (M.K.); (K.T.)
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7
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Lee E, Ito S, Miranda WR, Lopez-Jimenez F, Kane GC, Asirvatham SJ, Noseworthy PA, Friedman PA, Carter RE, Borlaug BA, Attia ZI, Oh JK. Artificial intelligence-enabled ECG for left ventricular diastolic function and filling pressure. NPJ Digit Med 2024; 7:4. [PMID: 38182738 PMCID: PMC10770308 DOI: 10.1038/s41746-023-00993-7] [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: 07/10/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
Assessment of left ventricular diastolic function plays a major role in the diagnosis and prognosis of cardiac diseases, including heart failure with preserved ejection fraction. We aimed to develop an artificial intelligence (AI)-enabled electrocardiogram (ECG) model to identify echocardiographically determined diastolic dysfunction and increased filling pressure. We trained, validated, and tested an AI-enabled ECG in 98,736, 21,963, and 98,763 patients, respectively, who had an ECG and echocardiographic diastolic function assessment within 14 days with no exclusion criteria. It was also tested in 55,248 patients with indeterminate diastolic function by echocardiography. The model was evaluated using the area under the curve (AUC) of the receiver operating characteristic curve, and its prognostic performance was compared to echocardiography. The AUC for detecting increased filling pressure was 0.911. The AUCs to identify diastolic dysfunction grades ≥1, ≥2, and 3 were 0.847, 0.911, and 0.943, respectively. During a median follow-up of 5.9 years, 20,223 (20.5%) died. Patients with increased filling pressure predicted by AI-ECG had higher mortality than those with normal filling pressure, after adjusting for age, sex, and comorbidities in the test group (hazard ratio (HR) 1.7, 95% CI 1.645-1.757) similar to echocardiography and in the indeterminate group (HR 1.34, 95% CI 1.298-1.383). An AI-enabled ECG identifies increased filling pressure and diastolic function grades with a good prognostic value similar to echocardiography. AI-ECG is a simple and promising tool to enhance the detection of diseases associated with diastolic dysfunction and increased diastolic filling pressure.
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Affiliation(s)
- Eunjung Lee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Saki Ito
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Garvan C Kane
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | | | - Paul A Friedman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rickey E Carter
- Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Barry A Borlaug
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Zachi I Attia
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Jae K Oh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
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8
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Oldervoll LM, Gjestad R, Hilmarsen C C, Ose A, Gullikstad L, Wisløff U, Kulseng B, Grimsmo J. Diastolic function and cardiovascular risk among patients with severe obesity referred to a lifestyle-program - a pilot study. Scand Cardiovasc J Suppl 2023; 57:8-16. [PMID: 36404730 DOI: 10.1080/14017431.2022.2146185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives. Severe obesity is associated with a high risk of comorbidities and alterations of cardiac structure and function. The primary aim of the study was to investigate the proportion of diastolic dysfunction (DD) at baseline, and changes in cardiac function from baseline (T1) to 6 months follow-up (T2) among participants with severe obesity attending a lifestyle-intervention. The secondary aim was to explore changes in body mass index (BMI), physical fitness (VO2peak) and cardiovascular risk from T1 to T2 and 12 months follow-up (T3).Design. This was an open single-site prospective observational study. Patients were recruited from an obesity clinic to a lifestyle-intervention consisting of three 3-weeks intermittent stays over 12-months period. Echocardiography was performed at T1 and T2 and BMI, VO2peak and cardiovascular risk measured at T1, T2 and T3.Results. Fifty-six patients were included (mean age 45.1 years; BMI 41.9). Six of 52 patients (12%) had grade 1 DD at T1, while five subjects had DD at T2. E/A ratio (11%, p = .005) and mitral deceleration time (9%, p = .014) were improved at T2. A reduction in BMI (-1.8, p < .001) and improvement in VO2peak (1.6 mL/kg min, p = .026) were assessed at T2 and this improvement persisted at T3. The total cardiovascular risk score was not significantly changed.Conclusion. The patients with severe obesity had low prevalence of DD. For all participants, an improvement in diastolic parameters, and an important initial weight loss was observed.Clinical Trial number: NCT02826122.
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Affiliation(s)
- Line M Oldervoll
- Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway.,Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, NTNU, Trondheim, Norway
| | - Rolf Gjestad
- Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | | | - Anders Ose
- Unicare Røros Rehabilitation, Røros, Norway
| | | | - Ulrik Wisløff
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.,School of Human Movement and Nutrition Science, University of Queensland, Queensland, Australia
| | - Baard Kulseng
- Centre for Obesity Research, St. Olavs Hospital, Trondheim, Norway
| | - Jostein Grimsmo
- Department of Cardiac Rehabilitation, LHL (National Organization for Heart and Lung Diseases) Hospital Gardermoen, Jessheim, Norway
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9
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Almeida ALC, Melo MDTD, Bihan DCDSL, Vieira MLC, Pena JLB, Del Castillo JM, Abensur H, Hortegal RDA, Otto MEB, Piveta RB, Dantas MR, Assef JE, Beck ALDS, Santo THCE, Silva TDO, Salemi VMC, Rocon C, Lima MSM, Barberato SH, Rodrigues AC, Rabschkowisky A, Frota DDCR, Gripp EDA, Barretto RBDM, Silva SME, Cauduro SA, Pinheiro AC, Araujo SPD, Tressino CG, Silva CES, Monaco CG, Paiva MG, Fisher CH, Alves MSL, Grau CRPDC, Santos MVCD, Guimarães ICB, Morhy SS, Leal GN, Soares AM, Cruz CBBV, Guimarães Filho FV, Assunção BMBL, Fernandes RM, Saraiva RM, Tsutsui JM, Soares FLDJ, Falcão SNDRS, Hotta VT, Armstrong ADC, Hygidio DDA, Miglioranza MH, Camarozano AC, Lopes MMU, Cerci RJ, Siqueira MEMD, Torreão JA, Rochitte CE, Felix A. Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023. Arq Bras Cardiol 2023; 120:e20230646. [PMID: 38232246 DOI: 10.36660/abc.20230646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2024] Open
Abstract
Central Illustration : Position Statement on the Use of Myocardial Strain in Cardiology Routines by the Brazilian Society of Cardiology's Department Of Cardiovascular Imaging - 2023 Proposal for including strain in the integrated diastolic function assessment algorithm, adapted from Nagueh et al.67 Am: mitral A-wave duration; Ap: reverse pulmonary A-wave duration; DD: diastolic dysfunction; LA: left atrium; LASr: LA strain reserve; LVGLS: left ventricular global longitudinal strain; TI: tricuspid insufficiency. Confirm concentric remodeling with LVGLS. In LVEF, mitral E wave deceleration time < 160 ms and pulmonary S-wave < D-wave are also parameters of increased filling pressure. This algorithm does not apply to patients with atrial fibrillation (AF), mitral annulus calcification, > mild mitral valve disease, left bundle branch block, paced rhythm, prosthetic valves, or severe primary pulmonary hypertension.
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Affiliation(s)
| | | | | | - Marcelo Luiz Campos Vieira
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - José Luiz Barros Pena
- Faculdade Ciências Médicas de Minas Gerais, Belo Horizonte, MG - Brasil
- Hospital Felicio Rocho, Belo Horizonte, MG - Brasil
| | | | - Henry Abensur
- Beneficência Portuguesa de São Paulo, São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | - Vera Maria Cury Salemi
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | - Camila Rocon
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Márcio Silva Miguel Lima
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | - Eliza de Almeida Gripp
- Hospital Pró-Cardiaco, Rio de Janeiro, RJ - Brasil
- Hospital Universitário Antônio Pedro da Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ - Brasil
| | | | | | | | | | | | | | | | | | | | | | | | | | - Maria Veronica Camara Dos Santos
- Departamento de Cardiologia Pediátrica (DCC/CP) da Sociedade Brasileira de Cardiologia (SBC), São Paulo, SP - Brasil
- Sociedade Brasileira de Oncologia Pediátrica, São Paulo, SP - Brasil
| | | | | | - Gabriela Nunes Leal
- Instituto da Criança e do Adolescente do Hospital das Clinicas Faculdade de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP - Brasil
| | | | | | | | | | | | | | | | | | | | - Viviane Tiemi Hotta
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Grupo Fleury, São Paulo, SP - Brasil
| | | | - Daniel de Andrade Hygidio
- Hospital Nossa Senhora da Conceição, Tubarão, SC - Brasil
- Universidade do Sul de Santa Catarina (UNISUL), Tubarão, SC - Brasil
| | - Marcelo Haertel Miglioranza
- EcoHaertel - Hospital Mae de Deus, Porto Alegre, RS - Brasil
- Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, RS - Brasil
| | | | | | | | | | - Jorge Andion Torreão
- Hospital Santa Izabel, Salvador, BA - Brasil
- Santa Casa da Bahia, Salvador, BA - Brasil
| | - Carlos Eduardo Rochitte
- Instituto do Coração da Faculdade de Medicina da Universidade de São Paulo (Incor/FMUSP), São Paulo, SP - Brasil
- Hospital do Coração (HCor), São Paulo, SP - Brasil
| | - Alex Felix
- Diagnósticos da América SA (DASA), São Paulo, SP - Brasil
- Instituto Nacional de Cardiologia (INC), Rio de Janeiro, RJ - Brasil
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10
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Gonzalez VL, Santos ABS, Rohde LEP, Foppa M. Left ventricular structural abnormalities in the assessment of diastolic function in the elderly: source of discrepancies between the 2009 and 2016 criteria. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:2127-2137. [PMID: 37530969 DOI: 10.1007/s10554-023-02919-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 07/13/2023] [Indexed: 08/03/2023]
Abstract
Diastolic dysfunction (DD) is routinely evaluated in echocardiography to support diagnosis, prognostication, and management of heart failure, a condition highly prevalent in elderly patients. Clinical guidelines were published in 2009, and updated in 2016, pursuing to standardize and improve DD categorization. We aimed to assess the concordance of DD between these two documents in an elderly population and to investigate how left ventricular structural abnormalities (LVSA) impact the reclassification. To evaluate this we analyzed the 308 consecutive transthoracic echocardiograms in patients older than 60 years (70.4 ± 7.7 years-old, 59% women) that fulfilled the inclusion criteria out of the 1438 echocardiograms performed in a tertiary hospital. We found that the prevalence of DD was lower according to the 2016 criteria (64% vs. 91%; p < 0.001), with 207 (67.2%) patients changing category, indicating poor agreement between the guidelines (kappa = 0.21). There were 188 (61%) patients with LVSA, which drove most of the reclassifications in 2016 Grade I DD cases. The prevalence of elevated filling pressures by Doppler halved in this elderly population using the updated recommendations (20.9% vs. 39.2%; p < 0.001). In conclusion the prevalence of DD was lower applying the 2016 guidelines, with a poor agreement with 2009 guidelines in all DD grades. The role of LVSA in reclassifications was particularly evident in Grade I DD, while Doppler parameters drove reclassifications among the more severe grades. If not properly addressed, these discrepancies may undermine the reliance on DD as a diagnostic and prognostic tool, particularly in an elderly population at a higher risk of heart failure.
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Affiliation(s)
- Vinícius Leite Gonzalez
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil
| | - Angela Barreto Santiago Santos
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil
| | - Luis Eduardo Paim Rohde
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil
| | - Murilo Foppa
- Postgraduate Program in Cardiology, School of Medicine, Universidade Federal do Rio Grande do Sul., Porto Alegre, RS, Brazil.
- Division of Cardiology, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos, 2350 Suite 2061, Porto Alegre, RS, Brazil.
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11
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Palmer C, Mazur W, Truong VT, Nagueh SF, Fowler JA, Shelton K, Joshi VM, Ness KK, Srivastava DK, Robison LL, Hudson MM, Rhea IB, Jefferies JL, Armstrong GT. Prevalence of Diastolic Dysfunction in Adult Survivors of Childhood Cancer: A Report From SJLIFE Cohort. JACC CardioOncol 2023; 5:377-388. [PMID: 37397075 PMCID: PMC10308058 DOI: 10.1016/j.jaccao.2022.12.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 12/14/2022] [Accepted: 12/22/2022] [Indexed: 07/04/2023] Open
Abstract
Background The prevalence of diastolic dysfunction has not been systematically evaluated in a large population of survivors of childhood cancer using established guidelines and standards. Objectives This study sought to assess the prevalence and progression of diastolic dysfunction in adult survivors of childhood cancer exposed to cardiotoxic therapy. Methods Comprehensive, longitudinal echocardiographic examinations of adult survivors of childhood cancer ≥18 years of age and ≥10 years from diagnosis in SJLIFE (St. Jude Lifetime Cohort Study) were performed. Diastolic dysfunction was defined based on 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines. Results Among 3,342 survivors, the median (25th-75th percentiles [quartile (Q)1-Q3]) age at diagnosis was 8.1 years (Q1-Q3: 3.6-13.7 years), 30.1 years (Q1-Q3: 24.4-37.0 years) at the baseline echocardiography evaluation (Echo 1), and 36.6 years (Q1-Q3: 30.8-43.6 years) at the last follow-up echocardiography evaluation (1,435 survivors) (Echo 2). The proportion of diastolic dysfunction was 15.2% (95% CI: 14.0%-16.4%) at Echo 1 and 15.7% (95% CI: 13.9%-17.7%) at Echo 2, largely attributable to concurrent systolic dysfunction. Less than 5% of survivors with preserved ejection fraction had diastolic dysfunction (2.2% at Echo 1, 3.7% at Echo 2). Using global longitudinal strain assessment in adult survivors with preserved ejection fraction (defined with a cutpoint worse than -15.9%), the proportion of diastolic dysfunction increased to 9.2% at baseline and 9.0% at follow-up. Conclusions The prevalence of isolated diastolic dysfunction is low among adults who received cardiotoxic therapies for childhood cancer. The inclusion of left ventricular global longitudinal strain significantly increased the identification of diastolic dysfunction.
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Affiliation(s)
- Cassady Palmer
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Wojciech Mazur
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Vien T. Truong
- Department of Cardiology, The Christ Hospital Health Network, Cincinnati, Ohio, USA
| | - Sherif F. Nagueh
- Cardiology Department, Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - James A. Fowler
- Cardiopulmonary Services, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Kyla Shelton
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Vijaya M. Joshi
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kirsten K. Ness
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Deo Kumar Srivastava
- Department of Biostatistics, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Leslie L. Robison
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Melissa M. Hudson
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
- Department of Oncology, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
| | - Isaac B. Rhea
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - John L. Jefferies
- The Cardiovascular Institute, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Gregory T. Armstrong
- Department of Epidemiology and Cancer Control, St. Jude Children’s Research Hospital, Memphis, Tennessee, USA
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12
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Lee K, Jung JH, Kwon W, Ohn C, Lee M, Kim DW, Kim TS, Park MW, Cho JS. The prognostic value of cardiopulmonary exercise testing and HFA-PEFF in patients with unexplained dyspnea and preserved left ventricular ejection fraction. Int J Cardiol 2023:S0167-5273(23)00731-3. [PMID: 37230429 DOI: 10.1016/j.ijcard.2023.05.038] [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: 01/10/2023] [Revised: 05/10/2023] [Accepted: 05/21/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND HFA-PEFF and cardiopulmonary exercise testing (CPET) are comprehensive diagnostic tools for heart failure with preserved ejection fraction (HFpEF). We aimed to investigate the incremental prognostic value of CPET for the HFA-PEFF score among patients with unexplained dyspnea with preserved ejection fraction (EF). METHODS Consecutive patients with dyspnea and preserved EF (n = 292) were enrolled between August 2019 and July 2021. All patients underwent CPET and comprehensive echocardiography, including two-dimensional speckle tracking echocardiography in the left ventricle, left atrium and right ventricle. The primary outcome was defined as a composite cardiovascular event including cardiovascular-related mortality, acute recurrent heart failure hospitalization, urgent repeat revascularization/myocardial infarction or any hospitalization due to cardiovascular events. RESULTS The mean age was 58 ± 14.5 years, and 166 (56.8%) participants were male. The study population was divided into three groups based on the HFA-PEFF score: < 2 (n = 81), 2-4 (n = 159), and ≥ 5 (n = 52). HFA-PEFF score ≥ 5, VE/VCO2 slope, peak systolic strain rate of the left atrium and resting diastolic blood pressure were independently associated with composite cardiovascular events. Furthermore, the addition of VE/VCO2 and HFA-PEFF to the base model showed incremental prognostic value for predicting composite cardiovascular events (C-statistic 0.898; integrated discrimination improvement 0.129, p = 0.032; net reclassification improvement 1.043, p ≤0.001). CONCLUSIONS CPET could be exploited for the HFA-PEFF approach in terms of incremental prognostic value and diagnosis among patients with unexplained dyspnea with preserved EF.
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Affiliation(s)
- Kyusup Lee
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ji-Hoon Jung
- Korea Institute of Toxicology, Daejeon, Republic of Korea
| | - Woojin Kwon
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chaeryeon Ohn
- Department of Anesthesiology and Pain Medicine, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Myunhee Lee
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dae-Won Kim
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae-Seok Kim
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Mahn-Won Park
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jung Sun Cho
- Catholic Research Institute for Intractable Cardiovascular Disease, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea; Division of Cardiology, Daejeon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
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13
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Bojer AS, Sørensen MH, Madsen SH, Broadbent DA, Plein S, Gæde P, Madsen PL. The independent association of myocardial extracellular volume and myocardial blood flow with cardiac diastolic function in patients with type 2 diabetes: a prospective cross-sectional cohort study. Cardiovasc Diabetol 2023; 22:78. [PMID: 37004049 PMCID: PMC10067250 DOI: 10.1186/s12933-023-01804-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/16/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND Diffuse myocardial fibrosis and microvascular dysfunction are suggested to underlie cardiac dysfunction in patients with type 2 diabetes, but studies investigating their relative impact are lacking. We aimed to study imaging biomarkers of these and hypothesized that fibrosis and microvascular dysfunction would affect different phases of left ventricular (LV) diastole. METHODS In this cross-sectional study myocardial blood flow (MBF) at rest and adenosine-stress and perfusion reserve (MPR), as well as extracellular volume fraction (ECV), were determined with cardiovascular magnetic resonance (CMR) imaging in 205 patients with type 2 diabetes and 25 controls. Diastolic parameters included echocardiography-determined lateral e' and average E/e', and CMR-determined (rest and chronotropic-stress) LV early peak filling rate (ePFR), LV peak diastolic strain rate (PDSR), and left atrial (LA) volume changes. RESULTS In multivariable analysis adjusted for possible confounders including each other (ECV for blood flow and vice versa), a 10% increase of ECV was independently associated with ePFR/EDV (rest: β = - 4.0%, stress: β = - 7.9%), LAmax /BSA (rest: β = 4.8%, stress: β = 5.8%), and circumferential (β = - 4.1%) and radial PDSR (β = 0.07%/sec). A 10% stress MBF increase was associated with lateral e' (β = 1.4%) and average E/e' (β = - 1.4%) and a 10% MPR increase to lateral e' (β = 2.7%), and average E/e' (β = - 2.8%). For all the above, p < 0.05. No associations were found with longitudinal PDSR or left atrial total emptying fraction. CONCLUSION In patients with type 2 diabetes, imaging biomarkers of microvascular dysfunction and diffuse fibrosis impacts diastolic dysfunction independently of each other. Microvascular dysfunction primarily affects early left ventricular relaxation. Diffuse fibrosis primarily affects diastasis. Trial registration https://www. CLINICALTRIALS gov . Unique identifier: NCT02684331. Date of registration: February 18, 2016.
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Affiliation(s)
- Annemie S Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, Region Zealand, 4200, Slagelse, Denmark.
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern, Odense, Denmark.
| | - Martin H Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, Region Zealand, 4200, Slagelse, Denmark
| | - Stine H Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Capital Region of Denmark, Hellerup, Denmark
| | - David A Broadbent
- Department of Medical Physics and Engineering, Leeds Teaching Hospitals NHS Trust, Leeds, UK
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sven Plein
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Peter Gæde
- Department of Cardiology and Endocrinology, Slagelse Hospital, Ingemannsvej 32, Region Zealand, 4200, Slagelse, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern, Odense, Denmark
| | - Per L Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Capital Region of Denmark, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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14
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Left atrial strain evaluation to assess left ventricle diastolic dysfunction and heart failure with preserved ejection fraction: a guide to clinical practice : Left atrial strain and diastolic function. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1083-1096. [PMID: 36826616 DOI: 10.1007/s10554-023-02816-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 02/11/2023] [Indexed: 02/25/2023]
Abstract
Although frequently unrecognized, left atrium (LA) function plays a key role in global cardiac performance as it modulates left ventricle (LV) filling through three main functions: the LA reservoir, conduit and booster pump. Given the interdependence between the LA and the LV, it is known that LA dimension and/or LA function can be used as a surrogate for LV diastolic function.Recently, LA deformation analysis using 2-dimensional (2D) speckle tracking echocardiography (STE) strain emerged as a promising non-invasive technique that can help to estimate LV filling pressures (LVFP) and diagnose heart failure with preserved ejection fraction (HFpEF), as recently proposed in the recent 2022 European Association of Cardiovascular Imaging (EACVI) consensus which included LA reservoir strain as an additive parameter to estimate LVFP.This article aims to review the latest evidence regarding the role of LA strain in the assessment and management of LV diastolic dysfunction (LVDD) and HFpEF, providing a clinical guide with tips and tricks to use LA strain as a new technique to help to estimate LVFP.
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15
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Bertacchini F, Agabiti Rosei C, Buso G, Cappellini S, Stassaldi D, Aggiusti C, Salvetti M, Paini A, De Ciuceis C, Muiesan ML. Subclinical HMOD in Hypertension: Left Ventricular Diastolic Dysfunction. High Blood Press Cardiovasc Prev 2022; 29:585-593. [PMID: 36352335 PMCID: PMC9708770 DOI: 10.1007/s40292-022-00548-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 10/25/2022] [Indexed: 06/16/2023] Open
Abstract
Arterial hypertension represents an important risk factor for the development of cardiac, vascular and renal events, predisposing to heart failure, acute coronary syndromes, peripheral artery disease, stroke, and chronic renal disease. Arterial hypertension leads to the development of subclinical hypertension mediated organ damage (HMOD) which has prognostic relevance and may influence the choice of treatment options. Alterations of cardiac structure and function represent the more widely assessed form of HMOD. This manuscript will focus on the diagnostic opportunities, prognostic significance and treatment of diastolic dysfunction alterations.
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Affiliation(s)
- Fabio Bertacchini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Claudia Agabiti Rosei
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Giacomo Buso
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Sara Cappellini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Deborah Stassaldi
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carlo Aggiusti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Massimo Salvetti
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Anna Paini
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Carolina De Ciuceis
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy
| | - Maria Lorenza Muiesan
- Department of Clinical and Experimental Sciences, 2a Medicina-ASST Spedali Civili Brescia, University of Brescia, 25100, Brescia, Italy.
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16
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Ikemura N, Nakanishi K, Spertus JA, Lam CSP, Kimura T, Katsumata Y, Fujisawa T, Ueda I, Ohki T, Fukuda K, Takatsuki S, Kohsaka S. Left Ventricular Diastolic Indices and Their Impact on Outcomes in Patients with Recently Diagnosed Atrial Fibrillation. J Clin Med 2022; 11:jcm11195732. [PMID: 36233600 PMCID: PMC9571305 DOI: 10.3390/jcm11195732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Revised: 09/20/2022] [Accepted: 09/25/2022] [Indexed: 11/25/2022] Open
Abstract
Background: Early identification of atrial fibrillation (AF) patients at risk for heart failure (HF) remains critical for improving their outcomes. We aimed to investigate whether indices of left ventricular diastolic dysfunction (LVDD) can stratify AF patients without clinical history of HF. Methods: We extracted 1775 patients’ data from a prospective cohort that consecutively recruited recently recognized AF patients with ejection fraction ≥50%. We categorized patients as LVDD grade 0 (none) to 3 (severe) based on mitral deceleration time and E/e’ per the American Society of Echocardiography recommendation. The primary outcome was a composite of all-cause death, stroke, and HF hospitalization during the 2-year follow-up. We also investigated the Atrial Fibrillation Effects on QualiTy-of-Life (AFEQT) scores. Results: Overall, 857 (48.3%) had mild or higher LVDD. Incidence of primary outcomes increased in parallel with LVDD grading (1.8%, 2.8%, 6.5%, and 8.1% for grades 0−3, respectively, p < 0.001), and the presence of grade 3 LVDD was an independent predictor of the primary outcome (adjusted HR 2.28 (vs. grade 0), 95%CI 1.13−4.60). Furthermore, patients with LVDD had lower AFEQT scores at the enrollment and 1-year follow-up. Conclusions: LVDD indices were associated with adverse clinical outcomes and patients’ perceived health status in a recently diagnosed AF cohort without HF.
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Affiliation(s)
- Nobuhiro Ikemura
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
- Kansas City Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, University of Missouri, Kansas City, MO 64111, USA
| | - Koki Nakanishi
- Department of Cardiovascular Medicine, The University of Tokyo, Tokyo 113-8654, Japan
| | - John A. Spertus
- Kansas City Healthcare Institute for Innovations in Quality and Saint Luke’s Mid America Heart Institute, University of Missouri, Kansas City, MO 64111, USA
| | - Carolyn S. P. Lam
- Department of Cardiology, National Heart Center Singapore, Singapore 169609, Singapore
| | - Takehiro Kimura
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yoshinori Katsumata
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Taishi Fujisawa
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Ikuko Ueda
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Takahiro Ohki
- Department of Cardiology, Tokyo Dental College Ichikawa General Hospital, Ichikawa 272-8513, Japan
| | - Keiichi Fukuda
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Seiji Takatsuki
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo 160-8582, Japan
- Correspondence: ; Tel.: +81-3-3353-1211; Fax: +81-3-5363-3875
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17
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Arvidsson PM, Nelsson A, Edlund J, Smith JG, Magnusson M, Jin N, Heiberg E, Carlsson M, Steding-Ehrenborg K, Arheden H. Kinetic energy of left ventricular blood flow across heart failure phenotypes and in subclinical diastolic dysfunction. J Appl Physiol (1985) 2022; 133:697-709. [PMID: 36037442 DOI: 10.1152/japplphysiol.00257.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Kinetic energy (KE) of intracardiac blood flow reflects myocardial work spent on accelerating blood and provides a mechanistic window into diastolic filling dynamics. Diastolic dysfunction may represent an early stage in the development of heart failure (HF). Here we evaluated the hemodynamic effects of impaired diastolic function in subjects with and without HF, testing the hypothesis that left ventricular KE differs between controls, subjects with subclinical diastolic dysfunction (SDD), and HF patients. METHODS We studied 77 subjects (16 controls, 20 subjects with SDD, 16 HFpEF, 9 HFmrEF, and 16 HFrEF patients, age- and sex-matched at the group level). Cardiac magnetic resonance at 1.5T included intracardiac 4D flow and cine imaging. Left ventricular KE was calculated as 0.5*m*v2. RESULTS Systolic KE was similar between groups (p>0.4), also after indexing to stroke volume (p=0.25), and was primarily driven by ventricular emptying rate (p<0.0001, R2=0.52). Diastolic KE was higher in heart failure patients than controls (p<0.05) but similar between SDD and HFpEF (p>0.18), correlating with inflow conditions (E-wave velocity, p<0.0001, R2=0.24) and end-diastolic volume (p=0.0003, R2=0.17) but not with average e' (p=0.07). CONCLUSIONS Diastolic KE differs between controls and heart failure, suggesting more work is spent filling the failing ventricle, while systolic KE does not differentiate between well-matched groups with normal ejection fraction even in the presence of relaxation abnormalities and heart failure. Mechanistically, KE reflects the acceleration imparted on the blood and is driven by variations in ventricular emptying and filling rates, volumes, and heart rate, regardless of underlying pathology.
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Affiliation(s)
- Per Martin Arvidsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Anders Nelsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonathan Edlund
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - J Gustav Smith
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Martin Magnusson
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Malmö, Sweden.,Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Ning Jin
- Cardiovascular MR R&D, Siemens Medical Solutions USA, Inc., Cleveland, Ohio, United States
| | - Einar Heiberg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.,Wallenberg Center for Molecular Medicine, Lund University, Lund, Sweden
| | - Marcus Carlsson
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Katarina Steding-Ehrenborg
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Håkan Arheden
- Clinical Physiology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Ashkir Z, Myerson S, Neubauer S, Carlhäll CJ, Ebbers T, Raman B. Four-dimensional flow cardiac magnetic resonance assessment of left ventricular diastolic function. Front Cardiovasc Med 2022; 9:866131. [PMID: 35935619 PMCID: PMC9355735 DOI: 10.3389/fcvm.2022.866131] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 06/30/2022] [Indexed: 11/13/2022] Open
Abstract
Left ventricular diastolic dysfunction is a major cause of heart failure and carries a poor prognosis. Assessment of left ventricular diastolic function however remains challenging for both echocardiography and conventional phase contrast cardiac magnetic resonance. Amongst other limitations, both are restricted to measuring velocity in a single direction or plane, thereby compromising their ability to capture complex diastolic hemodynamics in health and disease. Time-resolved three-dimensional phase contrast cardiac magnetic resonance imaging with three-directional velocity encoding known as '4D flow CMR' is an emerging technology which allows retrospective measurement of velocity and by extension flow at any point in the acquired 3D data volume. With 4D flow CMR, complex aspects of blood flow and ventricular function can be studied throughout the cardiac cycle. 4D flow CMR can facilitate the visualization of functional blood flow components and flow vortices as well as the quantification of novel hemodynamic and functional parameters such as kinetic energy, relative pressure, energy loss and vorticity. In this review, we examine key concepts and novel markers of diastolic function obtained by flow pattern analysis using 4D flow CMR. We consolidate the existing evidence base to highlight the strengths and limitations of 4D flow CMR techniques in the surveillance and diagnosis of left ventricular diastolic dysfunction.
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Affiliation(s)
- Zakariye Ashkir
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Saul Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Carl-Johan Carlhäll
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
- Department of Clinical Physiology in Linköping, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Tino Ebbers
- Division of Diagnostics and Specialist Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Center for Medical Image Science and Visualization (CMIV), Linköping University, Linköping, Sweden
| | - Betty Raman
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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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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Kahl U, Schirren L, Yu Y, Lezius S, Fischer M, Menke M, Sinning C, Nierhaus A, Vens M, Zöllner C, Kluge S, Goepfert MS, Roeher K. Left Ventricular Diastolic Dysfunction Is Not Associated With Pulmonary Edema in Septic Patients. A Prospective Observational Cohort Study. Front Cardiovasc Med 2022; 9:900850. [PMID: 35845063 PMCID: PMC9283750 DOI: 10.3389/fcvm.2022.900850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Purpose We aimed to investigate whether left ventricular diastolic dysfunction (LVDD) is associated with pulmonary edema in septic patients. Methods We conducted a prospective cohort study in adult septic patients between October 2018 and May 2019. We performed repeated echocardiography and lung ultrasound examinations within the first 7 days after diagnosis of sepsis. We defined LVDD according to the 2016 recommendations of the American Society of Echocardiography and—for sensitivity analysis—according to an algorithm which has been validated in septic patients. We quantified pulmonary edema using the lung ultrasound score (LUSS), counting B-lines in four intercostal spaces. Results We included 54 patients. LVDD was present in 51 (42%) of 122 echocardiography examinations. The mean (±SD) LUSS was 11 ± 6. There was no clinically meaningful association of LVDD with LUSS (B = 0.55 [95%CI: −1.38; 2.47]; p = 0.571). Pneumonia was significantly associated with higher LUSS (B = 4.42 [95%CI: 0.38; 8.5]; p = 0.033). Conclusion The lack of a clinically meaningful association of LVDD with LUSS suggests that LVDD is not a major contributor to pulmonary edema in septic patients. Trial Registration NCT03768752, ClinicalTrials.gov, November 30th, 2018 - retrospectively registered.
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Affiliation(s)
- Ursula Kahl
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- *Correspondence: Ursula Kahl ; orcid.org/0000-0003-2096-9647
| | - Leah Schirren
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Yuanyuan Yu
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Susanne Lezius
- Institut für Medizinische Biometrie und Epidemiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Marlene Fischer
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Klinik für Intensivmedizin Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maja Menke
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Sinning
- Klinik und Poliklinik für Kardiologie Universitäres Herz- und Gefäßzentrum Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Axel Nierhaus
- Klinik für Intensivmedizin Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Maren Vens
- Institut für Medizinische Biometrie und Epidemiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Institut für Medizinische Biometrie und Statistik Universität zu Lübeck, Universitätsklinikum Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Christian Zöllner
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Stefan Kluge
- Klinik für Intensivmedizin Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - Matthias S. Goepfert
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
- Klinik für Anästhesie und Intensivmedizin Alexianer St. Hedwigkliniken Berlin, Berlin, Germany
| | - Katharina Roeher
- Klinik und Poliklinik für Anästhesiologie Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
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Fernandes LP, Almeida MDCCD, Matos SAD, Campos ACP, Câmara EJN, Foppa M, Ribeiro ALP, Barreto SM, Aras R. Parâmetros Ecocardiográficos Simples são Fortes Preditores de Risco Cardiovascular em Indivíduos Assintomáticos: Coorte Elsa-Brasil. Arq Bras Cardiol 2022; 118:916-924. [PMID: 35613191 PMCID: PMC9368872 DOI: 10.36660/abc.20210101] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/28/2021] [Indexed: 01/19/2023] Open
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Hinze AM, Perin J, Woods A, Hummers LK, Wigley FM, Mukherjee M, Shah AA. Diastolic Dysfunction in Systemic Sclerosis: Risk Factors and Impact on Mortality. Arthritis Rheumatol 2022; 74:849-859. [PMID: 34927390 PMCID: PMC9050815 DOI: 10.1002/art.42054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 09/04/2021] [Accepted: 12/16/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine the independent risk factors for diastolic dysfunction (DD) in patients with systemic sclerosis (SSc) and to evaluate the impact of DD on mortality. METHODS SSc patients enrolled in the Johns Hopkins Scleroderma Center Cohort between November 1, 2006 and November 1, 2017 with ≥1 analyzable 2-dimensional (2-D) echocardiogram in our system were included (n = 806). DD risk factors and SSc disease characteristics were prospectively obtained, and the presence or absence of DD was determined using the most recent 2-D echocardiogram. Logistic regression models examined associations between clinical risk factors and DD, and Cox proportional hazards models were used to assess survival. RESULTS DD was present in 18.6% of participants. The majority of participants were female (84%) with a median age of 58.4 years (interquartile range 48.8-68.1). Older age (odds ratio [OR] 1.12 [95% confidence interval (95% CI) 1.09-1.15], P < 0.001), coronary artery disease (OR 3.69 [95% CI 1.52-8.97], P = 0.004), obesity (OR 4.74 [95% CI 2.57-8.74], P < 0.001), longer SSc disease duration (OR 1.04 [95% CI 1.01-1.06], P = 0.004), diffusing capacity for carbon monoxide ≤60% of predicted (OR 2.41 [95% CI 1.40-4.16], P = 0.002), and history of scleroderma renal crisis (OR 3.18 [95% CI 1.12-9.07], P = 0.031) were all independently associated with an increased risk of DD. Anti-Scl-70 positivity (OR 0.49 [95% CI 0.26-0.93], P = 0.03) and severe gastrointestinal disease (OR 0.48 [95% CI 0.30-0.79], P = 0.004) were associated with a reduced risk of DD. The presence of DD was independently associated with an increase in the risk of mortality (hazard ratio 1.69 [95% CI 1.07-2.68], P = 0.027). CONCLUSION DD is independently associated with an increased risk of mortality in patients with SSc. Potentially modifiable risk factors, including coronary artery disease and obesity, should be addressed in patients with SSc to reduce mortality risk.
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Affiliation(s)
- Alicia M. Hinze
- Department of Medicine, Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jamie Perin
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Adrianne Woods
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Laura K. Hummers
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Fredrick M. Wigley
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Monica Mukherjee
- Department of Medicine, Division of Cardiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Ami A. Shah
- Department of Medicine, Division of Clinical and Molecular Rheumatology, Johns Hopkins University, Baltimore, Maryland, USA
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Strachinaru M, Bosch JG. Automated algorithms in diastology: how to move forward? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:975-977. [PMID: 35132500 DOI: 10.1007/s10554-021-02505-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 12/24/2021] [Indexed: 11/24/2022]
Affiliation(s)
- Mihai Strachinaru
- Department of Cardiology, Erasmus University Medical Center, Postbus 2040, 3000 CA, Rotterdam, The Netherlands.
- Biomedical Engineering, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Johan G Bosch
- Biomedical Engineering, Erasmus University Medical Center, Rotterdam, The Netherlands
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Singh A, Sun D, Mor-Avi V, Addetia K, Patel AR, DeCara JM, Ward RP, Lang RM. Can echocardiographic assessment of diastolic function be automated? THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:965-974. [PMID: 34882301 DOI: 10.1007/s10554-021-02488-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
Echocardiographic evaluation of left ventricular diastolic function relies on a multi-pronged algorithm, which incorporates Doppler-based and volumetric parameters. Integration of clinical data in diastolic assessment is recommended, though not clearly outlined. We sought to develop an automated tool for diastolic function, compare its performance to human-generated diagnoses and identify the common sources of error. Our software tool is based on the 2016 diastolic guidelines algorithm, which uses 8 parameters as input, with 10 conditions as the logic and 5 possible outputs as final diagnoses. Initially, we prospectively studied 563 patients whose diastolic function was independently evaluated by an expert echocardiographer and by the automated tool. Incongruent cases were further analyzed, after which features of myocardial disease were integrated into a refined version of the software that was tested in an independent cohort of 1106 patients. In the initial analysis, 202/563 grades (36%) were incongruent between the automated and human reads, with the highest rate of discordance for mild and indeterminate categories. In 17% of cases, human diagnoses differed from that dictated by the algorithm due to integration of clinical factors. Follow-up analysis using the refined automated tool did not improve the discordance rate (440/1106; 40%). There was more discordance in cases of: age > 40 years, impaired mitral inflow patterns (E/A < 0.8) and reduced mitral e' values. Further analysis revealed differences in how readers interpreted the interaction between these factors and diastolic function, which could not be incorporated into the automated tool. In conclusion, although assessment of diastolic function relies on an algorithm that can be automated, this algorithm does not include clear guidance on how to incorporate age, or age-related changes in Doppler-based parameters, often resulting in discordant diagnoses. Standardized interpretation of these factors is needed to improve the reproducibility of diastolic function grading by human readers and the accuracy of the automated classification.
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Affiliation(s)
- Amita Singh
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA.
| | - Deyu Sun
- Philips Healthcare, Cambridge, MA, USA
| | - Victor Mor-Avi
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Karima Addetia
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Amit R Patel
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Jeanne M DeCara
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - R Parker Ward
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
| | - Roberto M Lang
- Department of Medicine, University of Chicago Medical Center, 5758 S. Maryland Ave., MC 9067, DCAM 5512, Chicago, IL, 60637, USA
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Han S, Park J, Hong SH, Park CS, Choi J, Chae MS. Cardiovascular manifestation of end-stage liver disease and perioperative echocardiography for liver transplantation: anesthesiologist’s view. Anesth Pain Med (Seoul) 2022; 17:132-144. [PMID: 35538654 PMCID: PMC9091670 DOI: 10.17085/apm.22132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Accepted: 03/30/2022] [Indexed: 11/19/2022] Open
Abstract
Liver transplantation (LT) is the curative therapy for decompensated cirrhosis. However, anesthesiologists can find it challenging to manage patients undergoing LT due to the underlying pathologic conditions of patients with end-stage liver disease and the high invasiveness of the procedure, which is frequently accompanied by massive blood loss. Echocardiography is a non-invasive or semi-invasive imaging tool that provides real-time information about the structural and functional status of the heart and is considered to be able to improve outcomes by enabling accurate and detailed assessments. This article reviews the pathophysiologic changes of the heart accompanied by cirrhosis that mainly affect hemodynamics. We also present a comparative review of the diagnostic criteria for cirrhotic cardiomyopathy published by the World Congress of Gastroenterology in 2005 and the Cirrhotic Cardiomyopathy Consortium in 2019. This article discusses the conditions that could affect hemodynamic stability and postoperative outcomes, such as coronary artery disease, left ventricular outflow tract obstruction, portopulmonary hypertension, hepatopulmonary syndrome, pericardial effusion, cardiac tamponade, patent foramen ovale, and ascites. Finally, we cover a number of intraoperative factors that should be considered, including intraoperative blood loss, rapid reaccumulation of ascites, manipulation of the inferior vena cava, post-reperfusion syndrome, and adverse effects of excessive fluid infusion and transfusion. This article aimed to summarize the cardiovascular manifestations of cirrhosis that can affect hemodynamics and can be evaluated using perioperative echocardiography. We hope that this article will provide information about the hemodynamic characteristics of LT recipients and stimulate more active use of perioperative echocardiography.
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Affiliation(s)
- Sangbin Han
- Department of Emergency Medicine, Cheongyang Health Center County Hospital, Cheongyang, Korea
| | - Jaesik Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sang Hyun Hong
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chul Soo Park
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jongho Choi
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Min Suk Chae
- Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- Corresponding author Min Suk Chae, M.D., Ph.D. Department of Anesthesiology and Pain Medicine, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea Tel: 82-2-2258-6150 Fax: 82-2-537-1951 E-mail:
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Wenzel JP, Kellen RBD, Magnussen C, Blankenberg S, Schrage B, Schnabel R, Nikorowitsch J. Diastolic dysfunction in individuals with and without heart failure with preserved ejection fraction. Clin Res Cardiol 2022; 111:416-427. [PMID: 34269862 PMCID: PMC8971165 DOI: 10.1007/s00392-021-01907-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/07/2021] [Indexed: 12/01/2022]
Abstract
AIM Left ventricular diastolic dysfunction (DD), a common finding in the general population, is considered to be associated with heart failure with preserved ejection faction (HFpEF). Here we evaluate the prevalence and correlates of DD in subjects with and without HFpEF in a middle-aged sample of the general population. METHODS AND RESULTS From the first 10,000 participants of the population-based Hamburg City Health Study (HCHS), 5913 subjects (mean age 64.4 ± 8.3 years, 51.3% females), qualified for the current analysis. Diastolic dysfunction (DD) was identified in 753 (12.7%) participants. Of those, 11.2% showed DD without HFpEF (ALVDD) while 1.3% suffered from DD with HFpEF (DDwHFpEF). In multivariable regression analysis adjusted for major cardiovascular risk factors, ALVDD was associated with arterial hypertension (OR 2.0, p < 0.001) and HbA1c (OR 1.2, p = 0.007). Associations of both ALVDD and DDwHFpEF were: age (OR 1.7, p < 0.001; OR 2.7, p < 0.001), BMI (OR 1.2, p < 0.001; OR 1.6, p = 0.001), and left ventricular mass index (LVMI). In contrast, female sex (OR 2.5, p = 0.006), atrial fibrillation (OR 2.6, p = 0.024), CAD (OR 7.2, p < 0.001) COPD (OR 3.9, p < 0.001), and QRS duration (OR 1.4, p = 0.005) were strongly associated with DDwHFpEF but not with ALVDD. CONCLUSION The prevalence of DD in a sample from the first 10,000 participants of the population-based HCHS was 12.7% of whom 1.3% suffered from HFpEF. DD with and without HFpEF showed significant associations with different major cardiovascular risk factors and comorbidities warranting further research for their possible role in the formation of both ALVDD and DDwHFpEF.
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Affiliation(s)
- Jan-Per Wenzel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- Epidemiological Study Center, Hamburg, Germany
| | | | - Christina Magnussen
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Stefan Blankenberg
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
- Epidemiological Study Center, Hamburg, Germany
| | - Benedikt Schrage
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Renate Schnabel
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Luebeck, Hamburg, Germany
| | - Julius Nikorowitsch
- Department of Cardiology, University Heart and Vascular Center Hamburg, Hamburg, Germany
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Kuznetsova T, Cauwenberghs N, Sabovčik F, Kobayashi Y, Haddad F. Evaluation of diastole by echocardiography for detecting early cardiac dysfunction: an outcome study. ESC Heart Fail 2022; 9:1775-1783. [PMID: 35238176 PMCID: PMC9065821 DOI: 10.1002/ehf2.13863] [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] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 01/03/2022] [Accepted: 02/13/2022] [Indexed: 11/22/2022] Open
Abstract
Aims Timely detection of subclinical left ventricular diastolic dysfunction (LVDDF) is of importance for precise risk stratification of asymptomatic subjects. Here, we evaluated the prevalence of LVDDF and its prognostic significance in the general population using two grading approaches: the 2016 ASE/EACVI recommendations and population‐derived, age‐specific criteria. Methods and results We randomly recruited 1407 community‐dwelling participants (mean age, 51.2 years; 51.1% women; 53.5% with cardiovascular risk factors). We measured left heart dimensions, strain, tricuspid regurgitation, transmitral blood flow, and mitral annular tissue velocities using conventional echocardiography and Doppler imaging. We utilized these measurements to grade of LVDDF according to the 2016 recommendations and population‐derived, age‐specific approach. According to the 2016 recommendations, 26 subjects (1.85%) were classified as having the advanced stage (Grade 2), whereas in 109 participants (7.75%) diastolic function was indeterminate. When applying the population‐derived criteria, the prevalence of advanced LVDDF was 17.9% (n = 252). During the follow‐up period (8.4 years), 100 participants experienced adverse cardiac events. After full adjustment, we did not observe any significant differences in the risk of events between subjects with indeterminate or any grade of LVDDF and subjects with normal diastolic function when classified according to the 2016 recommendation (P ≥ 0.25). In contrast, the adjusted risks of adverse cardiac events (HR = 1.28; P = 0.0045) were significantly elevated in participants with LVDDF when classified according to the population‐derived criteria. Conclusions Our study underscored the importance of considering age‐ and population‐derived thresholds in LVDDF grading in subjects at high cardiovascular risk which led to a better risk stratification and outcome prediction.
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Affiliation(s)
- Tatiana Kuznetsova
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 7, box 7001, Leuven, B-3000, Belgium
| | - Nicholas Cauwenberghs
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 7, box 7001, Leuven, B-3000, Belgium
| | - František Sabovčik
- Research Unit Hypertension and Cardiovascular Epidemiology, Department of Cardiovascular Sciences, University of Leuven, Campus Sint Rafaël, Kapucijnenvoer 7, box 7001, Leuven, B-3000, Belgium
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Romand X, Adeline F, Dalecky M, Pflimlin A, Bellier A, Barone-Rochette G, Wendling D, Gaudin P, Claudepierre P, Dougados M, Baillet A. Systematic assessment of heart valves and cardiac function by echocardiography in axial spondyloarthritis: a systematic review and meta-analysis. Joint Bone Spine 2022; 89:105375. [DOI: 10.1016/j.jbspin.2022.105375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 02/17/2022] [Accepted: 02/22/2022] [Indexed: 11/30/2022]
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Alonso Gómez AM, Sierra LT, Mora MN, Toledo E, Alonso A, Uriarte MG, Sanchez CS, Portillo MP, Rodriguez LL, Arellano EE, Schröder H, Salas-Salvadó J. Left atrial strain improves echocardiographic classification of diastolic function in patients with metabolic syndrome and overweight-obesity. Int J Cardiol 2022; 348:169-174. [PMID: 34890763 PMCID: PMC8980725 DOI: 10.1016/j.ijcard.2021.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current recommendations for echocardiographic assessment of diastolic function (2016 guidelines of the American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) in patients with metabolic syndrome and overweight/obesity result in a significant number of patients with indeterminate diastolic dysfunction (LVDD). The aim of this article is to study whether the use of the left atrial strain criterion (LALS) reduces the number of indeterminate patients. METHODS 229 patients were studied with a complete echocardiographic study that included left ventricular longitudinal strain (LVLS) analysis, LALS and a maximal ergospirometry test with assessment of oxygen uptake (VO2max). RESULTS The mean age was 65 ± 5 years, 153 (67%) males, with a mean EF of 60 ± 5%. The mean LVLS was -19.4 ± 2% and the LALS Reservoir was 23.8 ± 7%. There were 140 patients who did not meet LVDD criteria and 82 who did meet the indeterminate LVDD criterion. When the left atrial volume index (LAVI) >34 ml/m2 criterion was replaced in the 2016 ASE/EACVI algorithm by LALS Reservoir ≤20%, the number of indeterminate patients was reduced from 36% to 23% (p < 0.001) at the expense of increasing normal studies (61% and 74%). Adding the LALS Reservoir criterion ≤23% in the 82 patients of the indeterminate group resulted in two groups with a different VO2max (11.6 ± 3 and 18 ± 5 ml/kg/min, p:0.081). CONCLUSIONS This study confirms the low prevalence of diastolic dysfunction in overweight/obese patients with metabolic syndrome. Adding left atrial strain criterion to the current recommendations significantly reduces the number of indeterminate patients by reclassifying them as normal.
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Affiliation(s)
- Angel M Alonso Gómez
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Lucas Tojal Sierra
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - Marta Noris Mora
- Balearic Islands Health Research Institute. Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | - Estefanía Toledo
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Navarre Institute for Health Research (IdiSNA), Pamplona, Navarre, Spain,Department of Preventive Medicine and Public Health, University of Navarra, Pamplona, Navarra, Spain
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - María Garrido Uriarte
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain
| | - Carolina Sorto Sanchez
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain
| | - María P Portillo
- Bioaraba Health Research Institute; Osakidetza Basque Health Service, Araba University Hospital; University of the Basque Country UPV/EHU; Vitoria-Gasteiz, Spain.,CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Nutrition and Obesity Group, Dept. Pharmacy and Food Science, Faculty of Pharmacy, University of the Basque Country (UPV/EHU) and Lucio Lascaray Research Centre, Vitoria, Spain
| | - Luis López Rodriguez
- Balearic Islands Health Research Institute. Cardiology Department, Son Espases University Hospital, Palma de Mallorca, Balearic Islands, Spain
| | | | - Helmut Schröder
- Cardiovascular Risk and Nutrition Research Group (CARIN). Hospital del Mar. Barcelona. Spain.,Medical Research Institute (IMIM), Barcelona, Spain.,CIBER Epidemiology and Public Health (CIBERESP), Carlos III Health Institute, Madrid, Spain
| | - Jordi Salas-Salvadó
- CIBER Physiopathology of Obesity and Nutrition (CIBEROBN). Carlos III Health Institute (ISCIII), Madrid, Spain.,Human Nutrition Unit, Department of Biochemistry and Biotechnology, Faculty of Medicine and Health Sciences, Sant Joan de Reus University Hospital, IISPV, Rovira i Virgili University, c/Sant Llorenç 21, 43201 Reus, Spain
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Yagi K, Imamura T, Tada H, Liu J, Miyamoto Y, Ohbatake A, Ito N, Shikata M, Enkaku A, Takikawa A, Honoki H, Fujisaka S, Chujo D, Origasa H, Kinugawa K, Tobe K. Fragmented QRS on electrocardiography as a predictor for diastolic cardiac dysfunction in type 2 diabetes. J Diabetes Investig 2022; 13:1052-1061. [PMID: 35092353 PMCID: PMC9153843 DOI: 10.1111/jdi.13759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 11/28/2022] Open
Abstract
Aims/Introduction Diastolic cardiac dysfunction in type 2 diabetes (DD2D) is a critical risk of heart failure with preserved ejection fraction. However, there is no established biomarker to detect DD2D. We aimed to investigate the predictive impact of fragmented QRS (fQRS) on electrocardiography on the existence of DD2D. Materials and Methods We included in‐hospital patients with type 2 diabetes without heart failure symptoms who were admitted to our institution for glycemic management between November 2017 and April 2021. An fQRS was defined as an additional R′ wave or notching/splitting of the S wave in two contiguous electrocardiography leads. DD2D was diagnosed according to the latest guidelines of the American Society of Echocardiography. Results Of 320 participants, 122 patients (38.1%) had fQRS. DD2D was diagnosed in 82 (25.6%). An fQRS was significantly associated with the existence of DD2D (odds ratio 4.37, 95% confidence interval 2.33–8.20; p < 0.0001) adjusted for seven potential confounders. The correlation between DD2D and diabetic microvascular disease was significant only among those with fQRS. Classification and regression tree analysis showed that fQRS was the most relevant optimum split for DD2D. Conclusions An fQRS might be a simple and promising predictor of the existence of DD2D. The findings should be validated in a larger‐scale cohort.
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Affiliation(s)
- Kunimasa Yagi
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
- 2nd Department of Internal Medicine Kanazawa University Graduate School of Medical Science 13‐1 Takaramachi Kanazawa 920‐0934 Japan
| | - Teruhiko Imamura
- 2nd Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
| | - Hayato Tada
- 2nd Department of Internal Medicine Kanazawa University Graduate School of Medical Science 13‐1 Takaramachi Kanazawa 920‐0934 Japan
| | - Jianhui Liu
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
- 2nd Department of Internal Medicine Kanazawa University Graduate School of Medical Science 13‐1 Takaramachi Kanazawa 920‐0934 Japan
| | - Yukiko Miyamoto
- 2nd Department of Internal Medicine Kanazawa University Graduate School of Medical Science 13‐1 Takaramachi Kanazawa 920‐0934 Japan
| | - Azusa Ohbatake
- 2nd Department of Internal Medicine Kanazawa University Graduate School of Medical Science 13‐1 Takaramachi Kanazawa 920‐0934 Japan
| | - Naoko Ito
- 2nd Department of Internal Medicine Kanazawa University Graduate School of Medical Science 13‐1 Takaramachi Kanazawa 920‐0934 Japan
| | - Masataka Shikata
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
| | - Asako Enkaku
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
| | - Akiko Takikawa
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
| | - Hisae Honoki
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
| | - Shiho Fujisaka
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
| | - Daisuke Chujo
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
- 2nd Department of Internal Medicine Kanazawa University Graduate School of Medical Science 13‐1 Takaramachi Kanazawa 920‐0934 Japan
| | - Hideki Origasa
- Biostatistics and Clinical Epidemiology University of Toyama Graduate School of Medicine and Pharmaceutical Sciences 2630 Sugitani Toyama 934‐0194 Japan
| | - Koichiro Kinugawa
- 2nd Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
| | - Kazuyuki Tobe
- 1st Department of Internal Medicine University of Toyama 2630 Sugitani Toyama 934‐0194 Japan
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31
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Samiei N, Abbasi F, Shojaeifard M, Parsaee M, Hosseini S, Rezaei Y, Naderi N. The Role of Left Atrial Strain in Detecting Left Ventricular Diastolic Dysfunction: Comparison between the 2009 and 2016 Recommendations. J Tehran Heart Cent 2022; 16:58-67. [PMID: 35082873 PMCID: PMC8742863 DOI: 10.18502/jthc.v16i2.7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The frequency of left ventricular diastolic dysfunction (DD) is overestimated by earlier recommendations. We compared the 2009 and 2016 guidelines regarding the detection of DD and explored the potential of adding left atrial (LA) strain to the current guideline. Methods: Consecutive patients with heart failure were enrolled. All the patients were examined using 2-dimensional speckle-tracking echocardiography (2D-STE) and tissue Doppler imaging. DD was evaluated in terms of E/eʹ, eʹ velocity, E, A, tricuspid regurgitation velocity, LA volume, and LA strain. Results: This study evaluated 147 patients (101 males, 68.7%) at a mean age of 54.73±14.42 years. LA strain decreased with increasing grades of DD in both guidelines. The rate of reclassification between the 2 guidelines was 41%. The detection rate of normal diastolic function increased after the implementation of the 2016 guideline. LA strain discriminated individuals with normal diastolic function from those with DD more accurately than did LA volume index (area under the curve [AUC] =0.816 vs AUC=0.759, respectively). When LA strain <23% was incorporated into the 2016 guideline, 2 out of 4 patients with indeterminate diastolic function were reclassified as normal and 2 patients as grade I DD. The rate of reclassification was 4.1% after the addition of LA strain to the current guideline (κ=0.939, P<0.001). Conclusion: This study showed that the current guideline detected lower rates of DD than did the earlier recommendations. Furthermore, the incorporation of LA strain into the current guideline resulted in lower rates of indeterminate diastolic function.
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Affiliation(s)
- Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abbasi
- Department of Cardiology, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Shojaeifard
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Parsaee
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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32
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Smiseth OA, Morris DA, Cardim N, Cikes M, Delgado V, Donal E, Flachskampf FA, Galderisi M, Gerber BL, Gimelli A, Klein AL, Knuuti J, Lancellotti P, Mascherbauer J, Milicic D, Seferovic P, Solomon S, Edvardsen T, Popescu BA. Multimodality imaging in patients with heart failure and preserved ejection fraction: an expert consensus document of the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 2022; 23:e34-e61. [PMID: 34729586 DOI: 10.1093/ehjci/jeab154] [Citation(s) in RCA: 139] [Impact Index Per Article: 69.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 08/10/2021] [Indexed: 12/27/2022] Open
Abstract
Nearly half of all patients with heart failure (HF) have a normal left ventricular (LV) ejection fraction (EF) and the condition is termed heart failure with preserved ejection fraction (HFpEF). It is assumed that in these patients HF is due primarily to LV diastolic dysfunction. The prognosis in HFpEF is almost as severe as in HF with reduced EF (HFrEF). In contrast to HFrEF where drugs and devices are proven to reduce mortality, in HFpEF there has been limited therapy available with documented effects on prognosis. This may reflect that HFpEF encompasses a wide range of different pathological processes, which multimodality imaging is well placed to differentiate. Progress in developing therapies for HFpEF has been hampered by a lack of uniform diagnostic criteria. The present expert consensus document from the European Association of Cardiovascular Imaging (EACVI) provides recommendations regarding how to determine elevated LV filling pressure in the setting of suspected HFpEF and how to use multimodality imaging to determine specific aetiologies in patients with HFpEF.
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Affiliation(s)
- Otto A Smiseth
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Daniel A Morris
- Department of Internal Medicine and Cardiology, Campus Virchow Klinikum, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Nuno Cardim
- Cardiology Department, Hospital da Luz, Av. Lusíada, N° 100, Lisbon, Portugal
| | - Maja Cikes
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Albinusdreef 2, Leiden 2300 RC, The Netherlands
| | - Erwan Donal
- Service de Cardiologie Et Maladies Vasculaires Et CIC-IT 1414, CHU Rennes, 35000 Rennes, France.,Université de Rennes 1, LTSI, 35000 Rennes, France
| | - Frank A Flachskampf
- Department of Medical Sciences, Clinical Physiology and Cardiology, Uppsala University Hospital, Uppsala, Sweden
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Bernhard L Gerber
- Division of Cardiology, Department of Cardiovascular Diseases, Cliniques Universitaires St. Luc, Pôle de Recherche Cardiovasculaire (CARD), Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Av Hippocrate, 10/2806 Brussels, Belgium
| | - Alessia Gimelli
- Fondazione Toscana Gabriele Monasterio, Via Moruzzi, 1, Pisa 56124, Italy
| | - Allan L Klein
- Section of Cardiovascular Imaging, Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juhani Knuuti
- Turku PET Centre, University of Turku, and Turku University Hospital, Turku, Finland
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, Domaine Universitaire du Sart Tilman, Liège B4000, Belgium.,Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
| | - Julia Mascherbauer
- Department of Internal Medicine 3, Karl Landsteiner University of Health Sciences, University Hospital St. Pölten, Krems, Austria
| | - Davor Milicic
- Department of Cardiovascular Diseases, University of Zagreb School of Medicine and University Hospital Center Zagreb, Zagreb, Croatia
| | - Petar Seferovic
- Department of Cardiology, Clinical Center of Serbia, Belgrade, Serbia.,Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Scott Solomon
- Division of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute for Surgical Research, Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Bogdan A Popescu
- Department of Cardiology, University of Medicine and Pharmacy "Carol Davila", Euroecolab, Emergency Institute for Cardiovascular Diseases "Prof. Dr. C. C. Iliescu", Sos. Fundeni 258, sector 2, 022328 Bucharest, Romania
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33
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Kameshima H, Uejima T, Fraser AG, Takahashi L, Cho J, Suzuki S, Kato Y, Yajima J, Yamashita T. A Phenotyping of Diastolic Function by Machine Learning Improves Prediction of Clinical Outcomes in Heart Failure. Front Cardiovasc Med 2022; 8:755109. [PMID: 35004877 PMCID: PMC8733156 DOI: 10.3389/fcvm.2021.755109] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Accepted: 11/10/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Discriminating between different patterns of diastolic dysfunction in heart failure (HF) is still challenging. We tested the hypothesis that an unsupervised machine learning algorithm would detect heterogeneity in diastolic function and improve risk stratification compared with recommended consensus criteria. Methods: This study included 279 consecutive patients aged 24–97 years old with clinically stable HF referred for echocardiographic assessment, in whom diastolic variables were measured according to the current guidelines. Cluster analysis was undertaken to identify homogeneous groups of patients with similar profiles of the variables. Sequential Cox models were used to compare cluster-based classification with guidelines-based classification for predicting clinical outcomes. The primary endpoint was hospitalization for worsening HF. Results: The analysis identified three clusters with distinct properties of diastolic function that shared similarities with guidelines-based classification. The clusters were associated with brain natriuretic peptide level (p < 0.001), hemoglobin concentration (p = 0.017) and estimated glomerular filtration rate (p = 0.001). During a mean follow-up period of 2.6 ± 2.0 years, 62 patients (22%) experienced the primary endpoint. Cluster-based classification predicted events with a hazard ratio 1.68 (p = 0.019) that was independent from and incremental to the Meta-analysis Global Group in Chronic Heart Failure (MAGGIC) risk score for HF, and from left ventricular end-diastolic volume and global longitudinal strain, whereas guidelines-based classification did not retain its independent prognostic value (hazard ratio = 1.25, p = 0.202). Conclusion: Machine learning can identify patterns of diastolic function that better stratify the risk for decompensation than the current consensus recommendations in HF. Integrating this data-driven phenotyping may help in refining prognostication and optimizing treatment.
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Affiliation(s)
| | | | - Alan G Fraser
- School of Medicine, Cardiff University, Cardiff, United Kingdom
| | | | - Junyi Cho
- The Cardiovascular Institute Hospital, Tokyo, Japan
| | | | - Yuko Kato
- The Cardiovascular Institute Hospital, Tokyo, Japan
| | - Junji Yajima
- The Cardiovascular Institute Hospital, Tokyo, Japan
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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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Carter-Storch R, Mortensen NSB, Ali M, Laursen K, Pellikka PA, Møller JE, Dahl JS. Assessment of diastolic function in aortic stenosis: A comparison between 2009 and 2016 guidelines. Echocardiography 2021; 38:2006-2015. [PMID: 34921437 DOI: 10.1111/echo.15230] [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: 03/10/2021] [Revised: 09/17/2021] [Accepted: 10/04/2021] [Indexed: 12/01/2022] Open
Abstract
AIMS New diastolic dysfunction (DD) guidelines were introduced in 2016 to replace the 2009 guidelines, but have not yet been evaluated in aortic stenosis (AS). We aimed to compare the 2009 and 2016 DD guidelines in severe AS patients in terms of association with left ventricular (LV) and left atrial (LA) remodeling, with pulmonary capillary wedge pressure (PCWP) at rest and exercise, and with prognosis. METHODS AND RESULTS We included 212 patients with severe AS (112 undergoing AVR, 100 asymptomatic). Echocardiography, magnetic resonance imaging, and brain natriuretic peptides (BNP) were performed/measured. Thirty-nine asymptomatic patients had PCWP measured during rest and maximal exertion. Asymptomatic patients were followed for 3.1 years for the combined endpoint of death, AVR or admission with heart failure. The 2009 and 2016 DD guidelines agreed poorly with each other (Cohens' κ = .15). 2009 guidelines showed many ambiguous DD findings. With the 2016 guidelines, 20% of patients had indeterminate DD. DD grade 2 according to 2016 guidelines showed stronger association with symptom status, BNP, global longitudinal strain (GLS) and peak exercise PCWP than 2009 guidelines. For indeterminate DD patients according to 2009 guidelines, GLS above the median was associated with event-free survival (HR .11 (95% CI .02-.53)). For neither guideline was DD associated with the combined endpoint in asymptomatic patients. CONCLUSION The 2016 guidelines show a stronger association with BNP, GLS, and exercise PCWP than the 2009 guidelines. The 2016 guidelines result in 20% of patients with indeterminate DD; however, these patients may possibly be stratified according to GLS.
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Affiliation(s)
- Rasmus Carter-Storch
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense, Denmark
| | | | - Mulham Ali
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Kristian Laursen
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Patricia A Pellikka
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jacob E Møller
- Department of Cardiology, Odense University Hospital, Odense, Denmark.,OPEN Odense Patient data Explorative Network, Odense, Denmark
| | - Jordi S Dahl
- Department of Cardiology, Odense University Hospital, Odense, Denmark
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Saito C, Minami Y, Haruki S, Arai K, Ashihara K, Hagiwara N. Prognostic Relevance of a Score for Identifying Diastolic Dysfunction According to the 2016 ASE/EACVI Recommendations in Patients with Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2021; 35:469-476. [PMID: 34933117 DOI: 10.1016/j.echo.2021.12.006] [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: 12/25/2020] [Revised: 12/09/2021] [Accepted: 12/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In hypertrophic cardiomyopathy (HCM), one of the main pathophysiological features is diastolic dysfunction. According to the 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) recommendations, diastolic function is assessed with echocardiographic variables. However, the association between ASE/EACVI recommendations and the outcome in patients with HCM remains unclear. We evaluated the prognostic implications of ASE/EACVI recommendations in patients with HCM. METHODS This study included 290 patients with HCM. We evaluated 4 variables for identifying diastolic dysfunction using the following abnormal cutoff values: septal e' <7 cm/s, septal E/e' ratio >15, left atrial volume index >34 mL/m2, and peak tricuspid regurgitation velocity >2.8 m/s. A score was developed in which 1 point was designated for each abnormal echo parameter of diastolic function. We divided patients into 2 groups with an ASE/EACVI score of 3 as the cutoff value. The primary endpoint was the combination of HCM-related adverse outcomes (combination of sudden death or potentially lethal arrhythmic events, heart failure-related death, and heart failure hospitalization). RESULTS The prevalence of an ASE/EACVI score ≥3 was 37.2%. Over a median follow up of 9.7 (6.9-12.9) years, 26 (24.1%) patients with an ASE/EACVI score ≥3 and 25 (13.7%) patients with an ASE/EACVI score <3 experienced a combination of HCM-related adverse outcomes. Patients with an ASE/EACVI score ≥3 had a significantly higher incidence of the combined endpoint than those with an ASE/EACVI score <3 (log-rank, P=0.010). An ASE/EACVI score ≥3 was an independent determinant of the combined endpoint in multivariate analysis (adjusted hazard ratio 1.92; 95% confidence interval 1.05-3.49; P=0.033). CONCLUSION The score for identifying diastolic dysfunction by following ASE/EACVI recommendations may be associated with an adverse outcome in patients with HCM.
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Affiliation(s)
- Chihiro Saito
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan.
| | - Shintaro Haruki
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kotaro Arai
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Kyomi Ashihara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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37
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Ribeiro J. Diastolic dysfunction and type 1 diabetes: A sweet link? Rev Port Cardiol 2021; 40:767-769. [PMID: 34857115 DOI: 10.1016/j.repce.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Affiliation(s)
- José Ribeiro
- Cardiology Department, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
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38
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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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Paolisso P, Gallinoro E, Mileva N, Moya A, Fabbricatore D, Esposito G, De Colle C, Beles M, Spapen J, Heggermont W, Collet C, Van Camp G, Vanderheyden M, Barbato E, Bartunek J, Penicka M. Performance of non-invasive myocardial work to predict the first hospitalization for de novo heart failure with preserved ejection fraction. ESC Heart Fail 2021; 9:373-384. [PMID: 34821061 PMCID: PMC8788027 DOI: 10.1002/ehf2.13740] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 01/08/2023] Open
Abstract
AIMS Non-invasive myocardial work (MW) is a validated index of left ventricular (LV) systolic performance, incorporating afterload and myocardial metabolism. The role of MW in predicting the first hospitalization for de novo heart failure with preserved ejection fraction (HFpEF) is still unknown. We aim to investigate the diagnostic performance of MW to predict the first de novo HFpEF hospitalization in ambulatory individuals with preserved LV ejection fraction. METHODS AND RESULTS Twenty-nine patients with transthoracic echocardiography performed at least 6 months before the first HFpEF hospitalization were compared with 29 matched controls. MW was derived as the area of pressure-strain loop using speckle-tracking and brachial artery blood pressure. Global work index, global constructive work, global wasted work (GWW), and global work efficiency (GWE) were collected. First HFpEF hospitalization and its combination with cardiovascular death [major adverse cardiovascular events (MACE)] and all-cause of death [major adverse events (MAE)] were assessed. At baseline, future HFpEF patients showed lower global work index, global constructive work, GWE, and higher GWW than controls (all P < 0.05). At admission vs. baseline, GWE significantly decreased, and GWW increased in the HFpEF group (P < 0.05), whereas no significant difference was observed in the controls over time. GWW, with a cut-off of 170 mmHg%, showed the largest area under the curve (AUC) to predict first HFpEF hospitalization [AUC = 0.80, 95% confidence interval (CI) 0.69-0.91, P < 0.001], MACE (AUC = 0.80, 95% CI 0.66-0.90, P < 0.001), and MAE (AUC = 0.79, 95% CI 0.62-0.88, P = 0.001). GWW > 170 mmHg% was associated with a 4-fold increase of MACE (HR = 4.5, 95% CI 1.59-13.12, P = 0.005) and a 3-fold higher risk of MAE (HR = 2.9, 95% CI 1.24-6.6, P = 0.014). CONCLUSIONS In ambulatory patients with preserved LV ejection fraction and risk factors, GWW showed high accuracy to predict the first HFpEF hospitalization and its combination with mortality. The GWW routine assessment may be clinically helpful in patients with dyspnoea.
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Affiliation(s)
- Pasquale Paolisso
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Emanuele Gallinoro
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Niya Mileva
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Cardiology Clinic, 'Alexandrovska' University Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Ana Moya
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Davide Fabbricatore
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Esposito
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Cristina De Colle
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Monika Beles
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Jerrold Spapen
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Ward Heggermont
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Carlos Collet
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Guy Van Camp
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Marc Vanderheyden
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Emanuele Barbato
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium.,Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Jozef Bartunek
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
| | - Martin Penicka
- Cardiovascular Center Aalst, OLV-Clinic, Moorselbaan n. 164, Aalst, 9300, Belgium
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Bojer AS, Sørensen MH, Bjerre J, Gaede P, Vejlstrup N, Madsen PL. Metabolic improvement with short-term, glucagon-like peptide-1 receptor agonist treatment does not improve cardiac diastolic dysfunction in patients with type 2 diabetes: A randomized, double-blind, placebo-controlled trial. Diabetes Obes Metab 2021; 23:2374-2384. [PMID: 34189832 DOI: 10.1111/dom.14480] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/14/2021] [Accepted: 06/27/2021] [Indexed: 01/16/2023]
Abstract
AIM To investigate if short-term treatment with liraglutide, a glucagon-like peptide-1 receptor agonist, improves left ventricular diastolic function. MATERIALS AND METHODS An investigator-initiated, double-blind, randomized, placebo-controlled trial on the effect of 18 weeks of treatment with liraglutide on diastolic function was assessed in patients with type 2 diabetes with signs of diastolic dysfunction (echo-Doppler determined E/e' ≥ 9 and/or lateral e' ≤ 10 cm/s). Primary outcomes were improved left ventricle filling (the early peak filling rate [ePFR]) and left atrium ease of emptying (the passive emptying fraction [LAPEF ]), assessed by cardiac magnetic resonance imaging at rest and during chronotropic stress. Secondary outcomes included left ventricular and left atrial volumes and systolic function, measures of aortic stiffness and echocardiographic diastolic variables. RESULTS Forty patients were randomized to liraglutide subcutaneously 1.8 mg/day (n = 20) or placebo (n = 20). Liraglutide reduced HbA1c (-0.47%, 95% CI [-0.88% to -0.06%] [-5.1, 95% CI {-9.7 to -0.62} mmol/mol]) and weight (-2.9, 95% CI [-4.6 to -1.2] kg); both P < .03. Liraglutide did not change ePFR at rest (-24 ± 60 vs. -6 ± 46 mL/s), during stress (2 ± 58 vs. -2 ± 38 mL/s), or the changes from rest to stress (12.9 ± 72.5 vs. 4.7 ± 104.0; all P > .05). LAPEF decreased with liraglutide during stress (-3.1% [-9.0%, 1.1%] vs. 1.0% [-2.9%, 6.1%]; P = .049), but no changes were evident at rest (-4.3% [-7.9%, 1.9%] vs. -0.6% [-3.1%, 2.2%]; P = .19), or for the changes from rest to stress (-1.7 ± 8.4 vs. 0.8 ± 8.2; P = .4). Secondary outcomes were unchanged by liraglutide. CONCLUSIONS Short-term treatment with liraglutide did not improve left ventricular diastolic function, suggesting the cardioprotective effect is not exerted through the improvement in diastolic dysfunction.
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Affiliation(s)
- Annemie Stege Bojer
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Martin Heyn Sørensen
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
| | - Jenny Bjerre
- Department of Cardiology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Peter Gaede
- Department of Cardiology and Endocrinology, Slagelse Hospital, Slagelse, Denmark
- Institute of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Niels Vejlstrup
- Department of Cardiology, Rigshospitalet, Copenhagen, Denmark
| | - Per Lav Madsen
- Department of Cardiology, Copenhagen University Hospital Herlev-Gentofte, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Bae S, Yoon HJ, Kim KH, Kim HY, Park H, Cho JY, Kim MC, Kim Y, Ahn Y, Cho JG, Jeong MH. Usefulness of Diastolic Function Score as a Predictor of Long-Term Prognosis in Patients With Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:730872. [PMID: 34568464 PMCID: PMC8460859 DOI: 10.3389/fcvm.2021.730872] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 08/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Left ventricular diastolic function (LVDF) evaluation using a combination of several echocardiographic parameters is an important predictor of adverse events in patients with acute myocardial infarction (AMI). To date, the clinical impact of each individual LVDF marker is well-known, but the clinical significance of the sum of the abnormal diastolic function markers and the long-term clinical outcome are not well-known. This study aimed to investigate the usefulness of LVDF score in predicting clinical outcomes of patients with AMI. Methods: LVDF scores were measured in a 2,030 patients with AMI who underwent successful percutaneous coronary intervention from 2012 to 2015. Four LVDF parameters (septal e' ≥ 7 cm/s, septal E/e' ≤ 15, TR velocity ≤ 2.8 m/s, and LAVI ≤ 34 ml/m2) were used for LVDF scoring. The presence of each abnormal LVDF parameter was scored as 1, and the total LVDF score ranged from 0 to 4. Mortality and hospitalization due to heart failure (HHF) in relation to LVDF score were evaluated. To compare the predictive ability of LVDF scores and left ventricular ejection fraction (LVEF) for mortality and HHF, receiver operating characteristic (ROC) curve and landmark analyses were performed. Results: Over the 3-year clinical follow-up, all-cause mortality occurred in 278 patients (13.7%), while 91 patients (4.5%) developed HHF. All-cause mortality and HHF significantly increased as LVDF scores increased (all-cause mortality-LVDF score 0: 2.3%, score 1: 8.8%, score 2: 16.7%, score 3: 31.8%, and score 4: 44.5%, p < 0.001; HHF-LVDF score 0: 0.6%, score 1: 1.8%, score 2: 6.3%, score 3: 10.3%, and score 4: 18.2%, p < 0.001). In multivariate analysis, a higher LVDF score was associated with significantly higher adjusted hazard ratios for all-cause mortality and HHF. In landmark analysis, LVDF score was a better predictor of long-term mortality than LVEF (area under the ROC curve: 0.739 vs. 0.640, p < 0.001). Conclusion: The present study demonstrated that LVDF score was a significant predictor of mortality and HHF in patients with AMI. LVDF scores are useful for risk stratification of patients with AMI; therefore, careful monitoring and management should be performed for patients with AMI with higher LVDF scores.
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Affiliation(s)
- SungA Bae
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Hyun Ju Yoon
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Kye Hun Kim
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyung Yoon Kim
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Hyukjin Park
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jae Yeong Cho
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Min Chul Kim
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Yongcheol Kim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine and Cardiovascular Center, Yongin Severance Hospital, Yongin, South Korea
| | - Youngkeun Ahn
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Jeong Gwan Cho
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
| | - Myung Ho Jeong
- Division of Cardiology, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, South Korea
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Kobayashi M, Huttin O, Magnusson M, Ferreira JP, Bozec E, Huby AC, Preud'homme G, Duarte K, Lamiral Z, Dalleau K, Bresso E, Smaïl-Tabbone M, Devignes MD, Nilsson PM, Leosdottir M, Boivin JM, Zannad F, Rossignol P, Girerd N. Machine Learning-Derived Echocardiographic Phenotypes Predict Heart Failure Incidence in Asymptomatic Individuals. JACC Cardiovasc Imaging 2021; 15:193-208. [PMID: 34538625 DOI: 10.1016/j.jcmg.2021.07.004] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/01/2021] [Accepted: 07/01/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES This study sought to identify homogenous echocardiographic phenotypes in community-based cohorts and assess their association with outcomes. BACKGROUND Asymptomatic cardiac dysfunction leads to a high risk of long-term cardiovascular morbidity and mortality; however, better echocardiographic classification of asymptomatic individuals remains a challenge. METHODS Echocardiographic phenotypes were identified using K-means clustering in the first generation of the STANISLAS (Yearly non-invasive follow-up of Health status of Lorraine insured inhabitants) cohort (N = 827; mean age: 60 ± 5 years; men: 48%), and their associations with vascular function and circulating biomarkers were also assessed. These phenotypes were externally validated in the Malmö Preventive Project cohort (N = 1,394; mean age: 67 ± 6 years; men: 70%), and their associations with the composite of cardiovascular mortality (CVM) or heart failure hospitalization (HFH) were assessed as well. RESULTS Three echocardiographic phenotypes were identified as "mostly normal (MN)" (n = 334), "diastolic changes (D)" (n = 323), and "diastolic changes with structural remodeling (D/S)" (n = 170). The D and D/S phenotypes had similar ages, body mass indices, cardiovascular risk factors, vascular impairments, and diastolic function changes. The D phenotype consisted mainly of women and featured increased levels of inflammatory biomarkers, whereas the D/S phenotype, consisted predominantly of men, displayed the highest values of left ventricular mass, volume, and remodeling biomarkers. The phenotypes were predicted based on a simple algorithm including e', left ventricular mass and volume (e'VM algorithm). In the Malmö cohort, subgroups derived from e'VM algorithm were significantly associated with a higher risk of CVM and HFH (adjusted HR in the D phenotype = 1.87; 95% CI: 1.04 to 3.37; adjusted HR in the D/S phenotype = 3.02; 95% CI: 1.71 to 5.34). CONCLUSIONS Among asymptomatic, middle-aged individuals, echocardiographic data-driven classification based on the simple e'VM algorithm identified profiles with different long-term HF risk. (4th Visit at 17 Years of Cohort STANISLAS-Stanislas Ancillary Study ESCIF [STANISLASV4]; NCT01391442).
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Affiliation(s)
- Masatake Kobayashi
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Olivier Huttin
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Martin Magnusson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden; Wallenberg Centre for Molecular Medicine, Lund University, Sweden
| | - João Pedro Ferreira
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Erwan Bozec
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Anne-Cecile Huby
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Gregoire Preud'homme
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Kevin Duarte
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Zohra Lamiral
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Kevin Dalleau
- Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Emmanuel Bresso
- Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Malika Smaïl-Tabbone
- French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France; Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Marie-Dominique Devignes
- French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France; Laboratoire lorrain de Recherche en Informatique et ses Applications, Unité Mixte de Recherche 7503, Université de Lorraine, Vandoeuvre-lès-Nancy, France
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Internal Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Margret Leosdottir
- Department of Clinical Sciences, Lund University, Malmö, Sweden; Department of Cardiology, Skåne University Hospital, Malmö, Sweden
| | - Jean-Marc Boivin
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Faiez Zannad
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Patrick Rossignol
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique 1433, Université de Lorraine, Institut national de la santé et de la recherche médicale 1116, Centre Hospitalier Universitaire Régional de Nancy, France; French Clinical Research Infrastructure Network "Investigation" Network Initiative - Cardiovascular and Renal Clinical Trialists" Cardiovascular and Renal Clinical Trialists Network, France.
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Pillai AA, Thiyagarajan M, Sharma DK, Pant BP, Keerti Priya SB, Keepanasseril A. Maternal cardiovascular dysfunction in women with early onset preeclampsia: a cross-sectional study. J Matern Fetal Neonatal Med 2021; 35:8394-8399. [PMID: 34486496 DOI: 10.1080/14767058.2021.1974834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Cardiac remodeling and diastolic dysfunction may occur, in women with early-onset preeclampsia, following raised total vascular resistance in response to the impaired placentation. These changes can increase the risk of premature cardiac morbidity and mortality later in life. According to updated guidelines by the American and European Societies of Echocardiography (ASE/ESE) to diagnose diastolic dysfunction, using a simpler criterion is not yet used in pregnant women. OBJECTIVE To compare the maternal cardiovascular changes and the variation in the diastolic dysfunction using the 2009 and 2016 criteria by ASE/ESE among women with early onset preeclampsia and gestational age-matched normotensive controls. METHODS A prospective matched cross-sectional study conducted in a tertiary hospital in South India, involving 40 women with early and 40 women with gestational age-matched normotensive controls. Cardiac function and remodeling were assessed by conventional 2D, M-mode, and Doppler echocardiography. RESULTS Compared to the controls, women with early-onset preeclampsia had significantly higher. Total vascular resistance index (2867.6 vs. 2277.2 dynes/s/cm5/m2, p = .035) and median end-systolic stress index (5.2 vs. 9.2 dyne/cm2/m2), suggesting a higher afterload. Cases had a significant rate of left ventricular diastolic dysfunction using the 2009 criteria (grade II/III: 21 (52%) vs. 0 (0%), p<.001) whereas the rates were much lower when the updated 2016 guidelines were used (grade II/III: 9 (22.5%) vs. 1 (2.5%), p<.001). CONCLUSIONS In women with early-onset preeclampsia, cardiovascular adaption occurs to minimize wall stress and myocardial oxygenation. The prevalence of diastolic dysfunction was observed to be lower with the 2016 criteria. Further studies involving pregnant women are required to assess the impact of newer guidelines on association with short- and long-term cardiovascular outcomes in high-risk women.
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Affiliation(s)
- Ajith Ananthakrishna Pillai
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Monica Thiyagarajan
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Devendra Kishanlal Sharma
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Bhagwati Prasad Pant
- Department of Cardiology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - S B Keerti Priya
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
| | - Anish Keepanasseril
- Department of Obstetrics & Gynaecology, Jawaharlal Institute of Post-graduate Medical Education & Research (JIPMER), Puducherry, India
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44
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Ribeiro J. Diastolic dysfunction and type 1 diabetes: A sweet link? Rev Port Cardiol 2021; 40:S0870-2551(21)00350-4. [PMID: 34462171 DOI: 10.1016/j.repc.2021.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- José Ribeiro
- Cardiology Department, Gaia/Espinho Hospital Center, Vila Nova de Gaia, Portugal.
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45
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Fletcher AJ, Lapidaire W, Leeson P. Machine Learning Augmented Echocardiography for Diastolic Function Assessment. Front Cardiovasc Med 2021; 8:711611. [PMID: 34422935 PMCID: PMC8371749 DOI: 10.3389/fcvm.2021.711611] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/13/2021] [Indexed: 12/18/2022] Open
Abstract
Cardiac diastolic dysfunction is prevalent and is a diagnostic criterion for heart failure with preserved ejection fraction—a burgeoning global health issue. As gold-standard invasive haemodynamic assessment of diastolic function is not routinely performed, clinical guidelines advise using echocardiography measures to determine the grade of diastolic function. However, the current process has suboptimal accuracy, regular indeterminate classifications and is susceptible to confounding from comorbidities. Advances in artificial intelligence in recent years have created revolutionary ways to evaluate and integrate large quantities of cardiology data. Imaging is an area of particular strength for the sub-field of machine-learning, with evidence that trained algorithms can accurately discern cardiac structures, reliably estimate chamber volumes, and output systolic function metrics from echocardiographic images. In this review, we present the emerging field of machine-learning based echocardiographic diastolic function assessment. We summarise how machine-learning has made use of diastolic parameters to accurately differentiate pathology, to identify novel phenotypes within diastolic disease, and to grade diastolic function. Perspectives are given about how these innovations could be used to augment clinical practice, whilst areas for future investigation are identified.
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Affiliation(s)
- Andrew J Fletcher
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom.,Department of Cardiac Physiology, Royal Papworth Hospital National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Winok Lapidaire
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Paul Leeson
- Oxford Cardiovascular Clinical Research Facility, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, United Kingdom
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Playford D, Strange G, Celermajer DS, Evans G, Scalia GM, Stewart S, Prior D. Diastolic dysfunction and mortality in 436 360 men and women: the National Echo Database Australia (NEDA). Eur Heart J Cardiovasc Imaging 2021; 22:505-515. [PMID: 33245344 PMCID: PMC8081414 DOI: 10.1093/ehjci/jeaa253] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 08/19/2020] [Indexed: 12/11/2022] Open
Abstract
Aims To examine the characteristics/prognostic impact of diastolic dysfunction (DD) according to 2016 American Society of Echocardiography (ASE) and European Society of Cardiovascular Imaging (ESCVI) guidelines, and individual parameters of DD. Methods and results Data were derived from a large multicentre mortality-linked echocardiographic registry comprising 436 360 adults with ≥1 diastolic function measurement linked to 100 597 deaths during 2.2 million person-years follow-up. ASE/European Association of Cardiovascular Imaging (EACVI) algorithms could be applied in 392 009 (89.8%) cases; comprising 11.4% of cases with ‘reduced’ left ventricular ejection fraction (LVEF < 50%) and 88.6% with ‘preserved’ LVEF (≥50%). Diastolic function was indeterminate in 21.5% and 62.2% of ‘preserved’ and ‘reduced’ LVEF cases, respectively. Among preserved LVEF cases, the risk of adjusted 5-year cardiovascular-related mortality was elevated in both DD [odds ratio (OR) 1.31, 95% confidence interval (CI) 1.22–1.42; P < 0.001] and indeterminate status cases (OR 1.11, 95% CI 1.04–1.18; P < 0.001) vs. no DD. Among impaired LVEF cases, the equivalent risk of cardiovascular-related mortality was 1.51 (95% CI 1.15–1.98, P < 0.001) for increased filling pressure vs. 1.25 (95% CI 0.96–1.64, P = 0.06) for indeterminate status. Mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi all correlated with mortality. On adjusted basis, pivot-points of increased risk for cardiovascular-related mortality occurred at 90 cm/s for E wave velocity, 9 cm/s for septal e’ velocity, an E:e’ ratio of 9, and an LAVi of 32 mL/m2. Conclusion ASE/EACVI-classified DD is correlated with increased mortality. However, many cases remain ‘indeterminate’. Importantly, when analysed individually, mitral E velocity, septal e’ velocity, E:e’ ratio, and LAVi revealed clear pivot-points of increased risk of cardiovascular-related mortality.
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Affiliation(s)
- David Playford
- The University of Notre Dame, Henry Street, Fremantle 6160, Australia
| | - Geoff Strange
- The University of Notre Dame, Henry Street, Fremantle 6160, Australia
| | | | - Geoffrey Evans
- Charles Clinic, 287 Charles St, Launceston TAS 7250, Tasmania, Australia
| | - Gregory M Scalia
- The Prince Charles Hospital, 627 Rode Rd, Chermside QLD 4032, Brisbane, Australia
| | - Simon Stewart
- Torrens University, 88 Wakefield St, Adelaide SA 5000, Australia.,University of Glasgow, Glasgow G12 8QQ, UK
| | - David Prior
- St Vincent's Hospital, 41 Victoria Parade, Fitzroy VIC 3065, Australia.,University of Melbourne, Parkville VIC 3010, Australia
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Genovese D, Muraru D, Marra MP, Carrer A, Previtero M, Palermo C, Tarantini G, Parati G, Iliceto S, Badano LP. Left Atrial Expansion Index for Noninvasive Estimation of Pulmonary Capillary Wedge Pressure: A Cardiac Catheterization Validation Study. J Am Soc Echocardiogr 2021; 34:1242-1252. [PMID: 34311063 DOI: 10.1016/j.echo.2021.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/11/2021] [Accepted: 07/13/2021] [Indexed: 01/28/2023]
Abstract
BACKGROUND Pulmonary capillary wedge pressure (PCWP) plays a pivotal role in cardiac disease diagnosis and management. Right heart catheterization (RHC) invasively provides accurate PCWP measurement, but it is impractical for widespread use in all patients. The left atrial expansion index (LAEI), measured on transthoracic echocardiography, describes the relative left atrial volume increase during the left atrial reservoir phase. The aim of this study was to validate LAEI as a noninvasive parameter for PCWP estimation. METHODS A total of 649 chronic cardiac patients (mean age, 66 ± 14 years; mean PCWP, 14 ± 7.6 mm Hg; mean left ventricular ejection fraction, 50 ± 15%) who underwent both clinically indicated RHC and transthoracic echocardiography within 24 hours were retrospectively enrolled. Patients were randomly divided into derivation (n = 509) and validation (n = 140) cohorts. PCWP was measured during RHC and defined as elevated when >12 mm Hg. Transthoracic echocardiographic parameters and LAEI were measured offline, blinded to RHC results. RESULTS In the derivation cohort, LAEI correlated logarithmically with PCWP, and the log-transformed LAEI (lnLAEI) correlated linearly with PCWP (r = -0.73, P < .001). lnLAEI showed an independent and additive predictive role for PCWP estimation over clinical and diastolic dysfunction (DD) parameters. The diagnostic accuracy of lnLAEI for elevated PCWP identification (area under the curve = 0.875, P < .001; optimal lnLAEI cutoff < 4.02) was higher than either the single DD parameters or their combination. In the validation cohort, lnLAEI cutoff < 4.02 showed higher accuracy than the 2016 DD algorithm (88% vs 74%) for elevated PCWP identification. Finally, the equation PCWP = 38.3 - 6.2 × lnLAEI, obtained from the derivation cohort, predicted invasively measured PCWP in the validation cohort. CONCLUSIONS In a cohort of patients with various chronic cardiac diseases, lnLAEI performed better than DD parameters and the 2016 DD algorithm for PCWP estimation. lnLAEI might be a useful echocardiographic parameter for noninvasive PCWP estimation.
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Affiliation(s)
- Davide Genovese
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy.
| | - Denisa Muraru
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy; Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Martina Perazzolo Marra
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Anna Carrer
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Marco Previtero
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Chiara Palermo
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giuseppe Tarantini
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Gianfranco Parati
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy; Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
| | - Sabino Iliceto
- Cardiology Unit, Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Luigi P Badano
- Department of Medicine and Surgery, University Milano-Bicocca, Milan, Italy; Department of Cardiac, Neural and Metabolic Sciences, Istituto Auxologico Italiano, IRCCS, Milan, Italy
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48
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Left atrial ejection fraction is an indicator of left ventricular diastolic function. Int J Cardiovasc Imaging 2021; 38:33-39. [PMID: 34292434 DOI: 10.1007/s10554-021-02357-2] [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: 04/20/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
Left atrial ejection fraction (LAEF) has been previously shown to accurately distinguish between patients with and without clearly defined left ventricle diastolic dysfunction (LVDD) by ASE/EACVI criteria, but indeterminate cases were excluded. We sought to determine if LAEF could accurately distinguish between normal, indeterminate and LVDD patients. A retrospective cohort of 125 patients who underwent transthoracic echocardiography was studied. Comprehensive echocardiographic study was performed with measurement of validated diastolic parameters. Subjects were assigned LVDF ASE/EACVI categories. ANOVA test was used to compare means between groups and binary logistic regression and ROC curves to assess diagnostic accuracy. Mean LAEF was statistically different between groups (p < 0.001): 56.3% ± 4.5 for normal patients, 50.2% ± 5.5 for indeterminate patients and 44% ± 8.5 for patients with LVDD. LAEF distinguished LVDD from patients without diastolic dysfunction (OR = 0.73, 95% CI 0.63-0.65, p < 0.001) and ROC curve reveals excellent discriminative power (AUC 0.91, 95% CI 0.84-0.97, p < 0.001). LAEF also distinguished indeterminate patients from LVDD (OR = 0.9, 95% CI 0.83-0.95, p < 0.001) and ROC curve revealed good discriminative power (AUC 0.72, 95% CI 0.62-0.82, p < 0.001). LAEF can accurately differentiate between normal, indeterminate and LVDD patients and could be considered as an additional parameter in the study of diastolic function.
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Harvey R, Chellappa V, Mofidi S, Scovotti J, Neelankavil JP, Saddic L. Intraoperative diastolic function assessed by TEE does not agree with preoperative diastolic function grade in CABG patients. Echocardiography 2021; 38:1282-1289. [PMID: 34255390 DOI: 10.1111/echo.15137] [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: 01/05/2021] [Revised: 03/26/2021] [Accepted: 05/31/2021] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To compare the agreement of the 2016 ASE/EACVI guidelines for grading diastolic dysfunction (DD) with the most commonly used intraoperative transesophageal echocardiography (TEE)-based diastolic function grading algorithm in cardiac surgical patients, and to describe the contribution of the echocardiographic variables used in the algorithms to any observed differences. DESIGN Retrospective data analysis. SETTING University tertiary medical center. PARTICIPANTS Hundred and one patients undergoing coronary artery bypass grafting (CABG) at a single institution from June 2017 to February 2019. INTERVENTIONS Preoperative transthoracic echocardiography (TTE) diastolic function grade determined by the 2016 American Society of Echocardiography (ASE)/European Association of Cardiovascular Imaging (EACVI) guidelines was compared to intraoperative diastolic function grade obtained by TEE. MEASUREMENTS AND MAIN RESULTS Incidence of DD on preoperative TTE was only 19.8%, while 62.3% of patients were graded as having DD on the intraoperative TEE exam. There was grade agreement between TTE and TEE in only 47/101 patients (46.5%). The McNemar test showed poor agreement between the two algorithms (OR for disagreement = 15.33, CI = 4.77-49.30; p < 0.0001). Despite the low incidence of DD on preoperative TTE, mean lateral e' values were significantly lower on TTE compared to TEE (7.7 cm/s vs 9.5 cm/s; p = < 0.0001). CONCLUSIONS There is strong disagreement between TTE and TEE-based DD grading algorithms. Due to the different echocardiographic variables used in each and the unique clinical settings in which they are applied, they produce fundamentally different results.
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Affiliation(s)
- Reed Harvey
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vivek Chellappa
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Sean Mofidi
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jennifer Scovotti
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jacques P Neelankavil
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Louis Saddic
- Department of Anesthesiology and Perioperative Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Vannan MA, Argulian E, Lancellotti P. Phenogrouping Diastolic Dysfunction by Artificial Intelligence: Learning From What We Teach the Machines. JACC Cardiovasc Imaging 2021; 14:1901-1903. [PMID: 34274266 DOI: 10.1016/j.jcmg.2021.05.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 05/13/2021] [Indexed: 11/18/2022]
Affiliation(s)
- Mani A Vannan
- Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA.
| | - Edgar Argulian
- Mount Sinai Morningside Heart, Mount Sinai Heart, New York, New York, USA
| | - Patrizio Lancellotti
- Centre Hospitalier Universitaire Sart Tilman, GIGA Cardiovascular Sciences, University of Liège Hospital, Liege, Belgium; Gruppo Villa Maria Care and Research, Maria Cecilia Hospital, Cotignola, and Anthea Hospital, Bari, Italy
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