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Antúnez-Montes OY, Kocica MJ, Olavarria AS, Corno AF, Millan RA, Rosales CI, Sanchez Aparicio HE. Helical structure of the ventricular myocardium. A narrative review of cardiac mechanics. Echocardiography 2023; 40:161-173. [PMID: 36610038 DOI: 10.1111/echo.15515] [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: 09/13/2022] [Revised: 11/24/2022] [Accepted: 12/03/2022] [Indexed: 01/09/2023] Open
Abstract
To date, the ventricular myocardial band is the anatomical-functional model that best explains cardiac mechanics during systolic-diastolic phenomena in the cardiac cycle. The implications of the model fundamentally affect the anatomical interpretation of the ventricular myocardium, giving meaning to the direction that muscle fibers take, turning them into an object of study with potential clinical, imaging, and surgical applications. Re-interpreting the anatomy of the ventricular muscle justifies changes in the physiological interpretation, from its functional focus as a fiber unraveling the mechanical phenomena carried out during systole and diastole. We identify the functioning of the heart from the electrical and hemodynamic point of view, but it is necessary to delve into the mechanics that originate the hemodynamic changes observed flowmetrically, and that manifested during the pathology. In this review, the mechanical phenomena that the myocardium performs in each phase of the cardiac cycle are broken down in detail, emphasizing the physical displacements that each of the muscle segments presents, as well as a vision of their alteration and in which pathologies they are mainly identified. Visually, an anatomical correlation to the echocardiogram is provided, pointing out the direction of the segmental myocardial displacement by the strain velocity vector technique.
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Affiliation(s)
| | - Mladen J Kocica
- UC Clinical Center of Serbia, Clinic for Cardiac Surgery, Belgrade, Serbia
| | | | - Antonio Francesco Corno
- Children's Heart Institute, Memorial Hermann Children's Hospital, McGovern Medical School, UTHealth in Houston, Texas, USA
| | - Rocio Aceves Millan
- Echocardiography Section, November 20 National Medical Center, ISSSTE, Mexico City, Mexico
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Strijkers GJ. Editorial for "Accelerating Cardiac Diffusion Imaging With a U-Net Based Model: Towards Single Breath-Hold". J Magn Reson Imaging 2022; 56:1705-1706. [PMID: 35416357 DOI: 10.1002/jmri.28197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Gustav J Strijkers
- Department of Biomedical Engineering and Physics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
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3
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Yacoub MH, Nagy M, Hosny H, Afifi A, Shehata N, Mahgoub A, El Sawy A, Sabry M, Abdullah H, Romeih S, Elafifi A. Right ventricular structure and function after novel repair of common arterial trunk. INTERNATIONAL JOURNAL OF CARDIOLOGY CONGENITAL HEART DISEASE 2022. [DOI: 10.1016/j.ijcchd.2022.100416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Weber L, Sokolska JM, Nadarevic T, Karolyi M, Baessler B, Fischer X, Sokolski M, von Spiczak J, Polacin M, Matziris I, Alkadhi H, Robert M. Impact of myocardial injury on regional left ventricular function in the course of acute myocarditis with preserved ejection fraction: insights from segmental feature tracking strain analysis using cine cardiac MRI. Int J Cardiovasc Imaging 2022; 38:1851-1861. [PMID: 37726513 PMCID: PMC9797452 DOI: 10.1007/s10554-022-02601-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/14/2022] [Indexed: 11/05/2022]
Abstract
The aim of this study was to provide insights into myocardial adaptation over time in myocyte injury caused by acute myocarditis with preserved ejection fraction. The effect of myocardial injury, as defined by the presence of late gadolinium enhancement (LGE), on the change of left ventricular (LV) segmental strain parameters was evaluated in a longitudinal analysis. Patients with a first episode of acute myocarditis were enrolled retrospectively. Peak radial (PRS), longitudinal (PLS) and circumferential (PCS) LV segmental strain values at baseline and at follow-up were computed using feature tracking cine cardiac magnetic resonance imaging. The change of segmental strain values in LGE positive (LGE+) and LGE negative (LGE-) segments was compared over a course of 89 ± 20 days. In 24 patients, 100 LGE+ segments and 284 LGE- segments were analysed. Between LGE+ and LGE- segments, significant differences were found for the change of segmental PCS (p < 0.001) and segmental PRS (p = 0.006). LGE + segments showed an increase in contractility, indicating recovery, and LGE- segments showed a decrease in contractility, indicating normalisation after a hypercontractile state or impairment of an initially normal contracting segment. No significant difference between LGE+ and LGE- segments was found for the change in segmental PLS. In the course of acute myocarditis with preserved ejection fraction, regional myocardial function adapts inversely in segments with and without LGE. As these effects seem to counterbalance each other, global functional parameters might be of limited use in monitoring functional recovery of these patients.
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Affiliation(s)
- L Weber
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Radiology, Cantonal Hospital Winterthur, Winterthur, Switzerland
| | - J M Sokolska
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - T Nadarevic
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Department of Radiology, University Hospital Centre Rijeka, Rijeka, Croatia
| | - M Karolyi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - B Baessler
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - X Fischer
- Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland
| | - M Sokolski
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - J von Spiczak
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - M Polacin
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland
| | - I Matziris
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - H Alkadhi
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland
| | - M Robert
- Institute of Diagnostic and Interventional Radiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland.
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5
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Yang S, Ji K, Chen X, Li F, Yang K, Yu S, Zheng Y, Song Y, Zhao K, Lu M, Wang S, Wang S, Zhao S. Left Ventricular Myocardial Remodeling and Prognostic Marker Derived from Postmyectomy Cardiac MRI Feature Tracking in Hypertrophic Obstructive Cardiomyopathy. Radiol Cardiothorac Imaging 2022; 4:e210172. [PMID: 35506138 PMCID: PMC9059098 DOI: 10.1148/ryct.210172] [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: 06/11/2021] [Revised: 01/11/2022] [Accepted: 02/16/2022] [Indexed: 11/11/2022]
Abstract
Purpose To investigate myocardial remodeling using cardiac MRI (CMR) feature tracking (FT) and to explore the relationship between CMR parameters with outcomes in hypertrophic obstructive cardiomyopathy (HOCM) after myectomy. Materials and Methods In this single-center retrospective study, patients with HOCM undergoing myectomy between 2011 and 2019 were included. Pre- and postmyectomy global and regional strains were compared. Healthy participants were included for comparison. Composite events were recorded at follow-up performed after a minimum of 12 months. The paired-samples t test was utilized to compare pre- and postmyectomy variables. Results A total of 73 patients (44 years ± 14 [SD]; 45 men) were evaluated. Compared with preoperative parameters, global circumferential strain (CS) (-17.6% ± 4.4 vs -16.7% ± 3.9, P = .02) was impaired, but global longitudinal strain (LS) was improved (-9.3% ± 2.8 vs -10.8% ± 3.3, P < .001). Septal CS (-14.2% ± 4.0 vs -11.0% ± 4.4, P < .001) and septal radial strain (RS) (16.4% ± 10.6 vs 13.7% ± 9.5, P = .007) worsened, while septal LS (-8.1% ± 3.5 vs -10.2% ± 3.4, P < .001), lateral RS (40.1% ± 16.6 vs 54.4% ± 22.6, P < .001), lateral CS (-20.2% ± 4.1 vs -23.1% ± 4.8, P < .001), and lateral LS (-5.6% ± 5.6 vs -8.4% ± 5.2, P = .001) were improved. Sixteen of 73 patients (22%) experienced composite events after median follow-up of 39.1 months. Postoperative global CS provided the highest discrimination for composite event occurrence (area under the receiver operating characteristic curve, 0.73; 95% CI: 0.61, 0.83) with a cutoff of -16.7%. Patients with postoperative global CS greater than -16.7% had reduced event-free survival compared with those with postoperative global CS less than or equal to -16.7% (log-rank P = .002). Conclusion CMR-FT analysis demonstrated longitudinal and lateral restorations, but impaired global CS, after myectomy in patients with HOCM; furthermore, increased global CS was associated with poorer outcomes.Keywords: MR Imaging, Cardiac, Outcomes Analysis, Comparative Studies, Surgery© RSNA, 2022 Supplemental material is available for this article.
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Affiliation(s)
| | | | - Xiuyu Chen
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Fei Li
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Kai Yang
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shiqin Yu
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Yucong Zheng
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Yanyan Song
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Kankan Zhao
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Minjie Lu
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shengwei Wang
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shuiyun Wang
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
| | - Shihua Zhao
- From the MR Center (S. Yang, K.J., X.C., F.L., K.Y., S. Yu, Y.S.,
M.L., S.Z.) and Department of Cardiac Surgery (Shuiyun Wang), Fuwai Hospital,
State Key Laboratory of Cardiovascular Disease, National Center for
Cardiovascular Diseases of China, Chinese Academy of Medical Sciences and Peking
Union Medical College, Beilishi Rd 167, Xicheng District, Beijing 100037, China;
Department of Radiology, Tsinghua University Hospital, Tsinghua University,
Beijing, China (Y.Z.); Paul C. Lauterbur Research Center for Biomedical Imaging,
Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences,
Shenzhen, China (K.Z.); and Department of Cardiovascular Surgery Center, Beijing
Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung
and Blood Vascular Diseases, Beijing, China (Shengwei Wang)
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Liu S, Liao Y, Zhu Z, Wang S, Li Y, Liang D, Xie Y, Zhang Z. Association between cumulative blood pressure in early adulthood and right ventricular structure and function in middle age: The CARDIA study. Clin Cardiol 2022; 45:83-90. [PMID: 34979043 PMCID: PMC8799061 DOI: 10.1002/clc.23763] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/07/2021] [Accepted: 12/13/2021] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Cumulative blood pressure (BP) exposure is a known risk factor for cardiovascular disease. This study sought to investigate the association between cumulative BP from early adulthood to middle age and right ventricular (RV) structure and function in middle age. METHODS We included 2844 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults). Cumulative BP over the 30-years follow-up was defined as the sum of the product of mean BP for each pair of consecutive examinations and the time interval between these two consecutive examinations in years. RV structure and function were assessed by echocardiography. The main analyses utilized logistic and linear regression models. RESULTS In fully adjusted models, higher cumulative systolic BP was independently associated with lower tricuspid annular plane systolic excursion (TAPSE), right ventricular peak systolic velocity (RVS'), right ventricular early diastolic velocity (RVe'), and higher pulmonary arterial systolic pressure. Higher cumulative diastolic BP was independently associated with smaller RV basal diameter, lower TAPSE, RVS', and RVe'. For categorical analyses of RV dysfunction, cumulative systolic BP was not related to systolic dysfunction. Per 1-SD increase in cumulative systolic BP was associated with a higher risk of diastolic dysfunction, while an increase in cumulative diastolic BP was associated with a higher risk of systolic dysfunction and diastolic dysfunction. CONCLUSIONS Cumulative exposure to increased BP from early adulthood to middle age was associated with incipient RV systolic and diastolic dysfunction in middle age. Exposure to higher diastolic BP levels from early adulthood to middle age was associated with a smaller RV basal diameter in middle age.
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Affiliation(s)
- Shenrong Liu
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yanfen Liao
- Department of Stomatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zongyuan Zhu
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Shushui Wang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yifan Li
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Dongpo Liang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yumei Xie
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Zhiwei Zhang
- Department of Cardiac Pediatrics, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital/Guangdong Academy of Medical Sciences, Guangzhou, China
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EVALUATION OF THE FUNCTIONAL STATE AND FEATURES OF LEFT VENTRICULAR REMODELING IN PATIENTS WITH ACUTE RHEUMATIC FEVER. WORLD OF MEDICINE AND BIOLOGY 2022. [DOI: 10.26724/2079-8334-2022-4-82-166-170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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8
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Zhang A, Pan M, Meng L, Zhang F, Zhou W, Zhang Y, Zheng R, Niu L, Zhang Y. Ultrasonic biomechanics method for vortex and wall motion of left ventricle: a phantom and in vivo study. BMC Cardiovasc Disord 2021; 21:516. [PMID: 34689730 PMCID: PMC8543879 DOI: 10.1186/s12872-021-02317-7] [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: 02/29/2020] [Accepted: 10/12/2021] [Indexed: 11/18/2022] Open
Abstract
Background The non-invasive quantitative evaluation of left ventricle (LV) function plays a critical role in clinical cardiology. This study proposes a novel ultrasonic biomechanics method by integrating both LV vortex and wall motion to fully assess and understand the LV structure and function. The purpose of this study was to validate the ultrasonic biomechanics method as a quantifiable approach to evaluate LV function. Methods Firstly, B-mode ultrasound images were acquired and processed, which were utilized to implement parameters for quantifying the LV vortex and wall motion respectively. Next, the parameters were compared in polyvinyl alcohol cryogen (PVA) phantoms with different degree of stiffness corresponding to different freezing and thawing cycles in vitro. Finally, the parameters were computed in vivo during one cardiac cycle to assess the LV function in normal and abnormal subjects in vivo. Results In vitro study, the velocity field of PVA phantom differed with stiffness (varied elasticity modulus). The peak of strain for wall motion decreases with the increase of elasticity modulus, and periodically changed values. Statistical analysis for parameters of vortex dynamics (energy dissipation index, DI; kinetic energy fluctuations, KEF; relative strength, RS; and vorticity, W) based on different elasticity (E) of phantom depicted the good viability of this algorithm. In vivo study, the results confirmed that subjects with LV dysfunction had lower vorticity and strain (S) compared to the normal group. Conclusion Ultrasonic biomechanics method can obtain the vortex and wall motion of left ventricle. The method may have potential clinical value in evaluation of LV dysfunction.
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Affiliation(s)
- Aohua Zhang
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Tianhe District, China
| | - Min Pan
- Department of Ultrasound, Shenzhen Hospital (Futian) of Guangzhou University of Chinese Medicine, Shenzhen, China.,Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Long Meng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Fengshu Zhang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China.,Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China
| | - Wei Zhou
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yaonan Zhang
- Sino-Dutch Biomedical and Information Engineering School, Northeastern University, Shenyang, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Tianhe District, China
| | - Lili Niu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yanling Zhang
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-Sen University, 600 Tianhe Road, Guangzhou, 510630, Tianhe District, China.
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9
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Allen BS. Myocardial protection: a forgotten modality. Eur J Cardiothorac Surg 2021; 57:263-270. [PMID: 31364690 DOI: 10.1093/ejcts/ezz215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 06/20/2019] [Accepted: 06/28/2019] [Indexed: 12/25/2022] Open
Abstract
The goals of a cardiac surgical procedure are both technical excellence and complete protection of cardiac function. Cardioplegia is used almost universally to protect the heart and provide a quiet bloodless field for surgical accuracy. Yet, despite the importance of myocardial protection in cardiac surgery, manuscripts or dedicated sessions at major meetings on this subject have become relatively rare, as though contemporary techniques now make them unnecessary. Nevertheless, septal dysfunction and haemodynamic support (inotropes, intra-aortic balloon pump, assist devices) are common in postoperative patients, indicating that myocardial damage following cardiac surgery is still prevalent with current cardioplegic techniques and solutions. This article first describes why cardiac enzymes and septal function are the ideal markers for determining the adequacy of myocardial protection. It also describes the underappreciated consequences of postoperative cardiac enzyme release or septal dysfunction (which currently occurs in 40-80% of patients) from inadequate protection, and how they directly correlate with early and especially late mortality. Finally, it reviews the various myocardial protection techniques available to provide a detailed understanding of the cardioplegic methods that can be utilized to protect the heart. This will allow surgeons to critically assess their current method of protection and, if needed, make necessary changes to provide their patients with optimal protection.
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Affiliation(s)
- Bradley S Allen
- Division of Acute Care Surgery, Department of Surgery, USC Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, CA, USA
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10
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Montero P, Flandes-Iparraguirre M, Musquiz S, Pérez Araluce M, Plano D, Sanmartín C, Orive G, Gavira JJ, Prosper F, Mazo MM. Cells, Materials, and Fabrication Processes for Cardiac Tissue Engineering. Front Bioeng Biotechnol 2020; 8:955. [PMID: 32850768 PMCID: PMC7431658 DOI: 10.3389/fbioe.2020.00955] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/23/2020] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular disease is the number one killer worldwide, with myocardial infarction (MI) responsible for approximately 1 in 6 deaths. The lack of endogenous regenerative capacity, added to the deleterious remodelling programme set into motion by myocardial necrosis, turns MI into a progressively debilitating disease, which current pharmacological therapy cannot halt. The advent of Regenerative Therapies over 2 decades ago kick-started a whole new scientific field whose aim was to prevent or even reverse the pathological processes of MI. As a highly dynamic organ, the heart displays a tight association between 3D structure and function, with the non-cellular components, mainly the cardiac extracellular matrix (ECM), playing both fundamental active and passive roles. Tissue engineering aims to reproduce this tissue architecture and function in order to fabricate replicas able to mimic or even substitute damaged organs. Recent advances in cell reprogramming and refinement of methods for additive manufacturing have played a critical role in the development of clinically relevant engineered cardiovascular tissues. This review focuses on the generation of human cardiac tissues for therapy, paying special attention to human pluripotent stem cells and their derivatives. We provide a perspective on progress in regenerative medicine from the early stages of cell therapy to the present day, as well as an overview of cellular processes, materials and fabrication strategies currently under investigation. Finally, we summarise current clinical applications and reflect on the most urgent needs and gaps to be filled for efficient translation to the clinical arena.
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Affiliation(s)
- Pilar Montero
- Regenerative Medicine Program, Cima Universidad de Navarra, Foundation for Applied Medical Research, Pamplona, Spain
| | - María Flandes-Iparraguirre
- Regenerative Medicine Program, Cima Universidad de Navarra, Foundation for Applied Medical Research, Pamplona, Spain
| | - Saioa Musquiz
- Regenerative Medicine Program, Cima Universidad de Navarra, Foundation for Applied Medical Research, Pamplona, Spain
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country – UPV/EHU, Vitoria-Gasteiz, Spain
| | - María Pérez Araluce
- Regenerative Medicine Program, Cima Universidad de Navarra, Foundation for Applied Medical Research, Pamplona, Spain
- Department of Pharmaceutical Technology and Chemistry, University of Navarra, Pamplona, Spain
| | - Daniel Plano
- Department of Pharmaceutical Technology and Chemistry, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Carmen Sanmartín
- Department of Pharmaceutical Technology and Chemistry, University of Navarra, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
| | - Gorka Orive
- NanoBioCel Group, Laboratory of Pharmaceutics, School of Pharmacy, University of the Basque Country – UPV/EHU, Vitoria-Gasteiz, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- University Institute for Regenerative Medicine and Oral Implantology – UIRMI (UPV/EHU – Fundación Eduardo Anitua), Vitoria-Gasteiz, Spain
- Singapore Eye Research Institute, Singapore, Singapore
| | - Juan José Gavira
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Cardiology Department, Clínica Universidad de Navarra, Pamplona, Spain
| | - Felipe Prosper
- Regenerative Medicine Program, Cima Universidad de Navarra, Foundation for Applied Medical Research, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Hematology and Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
| | - Manuel M. Mazo
- Regenerative Medicine Program, Cima Universidad de Navarra, Foundation for Applied Medical Research, Pamplona, Spain
- IdiSNA, Navarra Institute for Health Research, Pamplona, Spain
- Hematology and Cell Therapy Area, Clínica Universidad de Navarra, Pamplona, Spain
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11
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Sakata T, Mogi K, Sakurai M, Tani K, Hashimoto M, Shiko Y, Kawasaki Y, Matsumiya G, Takahara Y. Impact of tricuspid annuloplasty on postoperative changes in the right ventricular systolic and diastolic function: A retrospective cohort study. J Card Surg 2020; 35:1464-1470. [DOI: 10.1111/jocs.14611] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Tomoki Sakata
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
- Department of Cardiovascular Surgery Chiba University Hospital Chiba Japan
| | - Kenji Mogi
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Manabu Sakurai
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Kengo Tani
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Masafumi Hashimoto
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
| | - Yuki Shiko
- Biostatistics Section, Clinical Research Center Chiba University Hospital Chiba Japan
| | - Yohei Kawasaki
- Biostatistics Section, Clinical Research Center Chiba University Hospital Chiba Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery Chiba University Hospital Chiba Japan
| | - Yoshiharu Takahara
- Division of Cardiovascular Surgery Funabashi Municipal Medical Center Heart and Vascular Institute Funabashi Japan
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12
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Ball K, Kinne R, Aguirre A. Analysis of Congenital Heart Defects in Mouse Embryos Using Qualitative and Quantitative Histological Methods. J Vis Exp 2020. [PMID: 32225147 DOI: 10.3791/60926] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Congenital heart defects (CHD) are the most common type of birth defect in humans, affecting up to 1% of all live births. However, the underlying causes for CHD are still poorly understood. The developing mouse constitutes a valuable model for the study of CHD, because cardiac developmental programs between mice and humans are highly conserved. The protocol describes in detail how to produce mouse embryos of the desired gestational stage, methods to isolate and preserve the heart for downstream processing, quantitative methods to identify common types of CHD by histology (e.g., ventricular septal defects, atrial septal defects, patent ductus arteriosus), and quantitative histomorphometry methods to measure common muscular compaction phenotypes. These methods articulate all the steps involved in sample preparation, collection, and analysis, allowing scientists to correctly and reproducibly measure CHD.
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Affiliation(s)
- Kristen Ball
- Department of Biomedical Engineering, Michigan State University; Institute for Quantitative Health Sciences and Engineering, Michigan State University
| | - Renee Kinne
- Institute for Quantitative Health Sciences and Engineering, Michigan State University
| | - Aitor Aguirre
- Department of Biomedical Engineering, Michigan State University; Institute for Quantitative Health Sciences and Engineering, Michigan State University;
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13
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Kinova E, Somleva-Todorova D, Goudev A. Left Ventricular Strain and Rotation in Patients with Dilated Cardiomyopathy and Severe Systolic Dysfunction. Cardiology 2019; 145:1-12. [PMID: 31715595 DOI: 10.1159/000503682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 09/25/2019] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In dilated cardiomyopathy (DCM) left ventricular (LV) strain and twist are significantly decreased. However, the rate of attenuation has not been investigated well in patients with varying degrees of systolic dysfunction. AIM The present study aimed to investigate the relationship between LV deformational and rotational mechanics and conventional and tissue Doppler imaging (TDI) parameters, and to search for a constellation of findings distinguishing patients with severe systolic dysfunction (SSD) in DCM. METHODS Fifty-two patients with heart failure NYHA class III-IV and ejection fraction (EF) ≤45% were prospectively enrolled (mean age 61.8 ± 13.4 years; 36 males, 69%). Severe systolic LV dysfunction was considered as EF <30%. Echocardiography with 2D-speckle tracking analysis was performed. RESULTS The relationships of global longitudinal strain (GLS) with EF, circumferential strain at mid-level (CSmid), and systolic medial mitral annulus velocity were strong (r = -0.53, 0.67, and -0.56, respectively, p < 0.0001 for all). A good correlation was found between CSmid and EF (r = -0.50, p < 0.0001). There were weak correlations between basal endocardial rotation (BRendo) and EF and CSmid. Multiple regression analysis found GLS (p < 0.0001) and BRendo (p = 0.04) to be predictors of the change of EF. In ROC curve analysis, the cut-off values of GLS -7.2% (AUC 0.81, p < 0.0001), CSmid -7.5% (AUC 0.76, p = 0.002), and BRendo -2.43° (AUC 0.68, p = 0.03) identified SSD. CONCLUSIONS Parameters of LV mechanics were related to conventional and TDI systolic parameters in patients with DCM. The degree of alterations of LV longitudinal and circumferential deformation and basal rotation may identify patients with SSD and a higher risk, and may help in therapeutic decision making.
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Affiliation(s)
- Elena Kinova
- Department of Cardiology, University Hospital "Tsaritsa Yoanna - ISUL," Medical University Sofia, Sofia, Bulgaria,
| | - Desislava Somleva-Todorova
- Department of Cardiology, University Hospital "Tsaritsa Yoanna - ISUL," Medical University Sofia, Sofia, Bulgaria
| | - Assen Goudev
- Department of Cardiology, University Hospital "Tsaritsa Yoanna - ISUL," Medical University Sofia, Sofia, Bulgaria
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14
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Anderson RH, Niederer PF, Sanchez‐Quintana D, Stephenson RS, Agger P. How are the cardiomyocytes aggregated together within the walls of the left ventricular cone? J Anat 2019; 235:697-705. [PMID: 31206661 PMCID: PMC6742897 DOI: 10.1111/joa.13027] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2019] [Indexed: 12/28/2022] Open
Abstract
The manner of packing together of the cardiomyocytes within the walls of the cardiac ventricles has now been investigated for over half a millennium. In 1669, Lower dissected the ventricular mass, likening the arrangement to skeletal musculature, in the form of a myocardial band extending between the right and left atrioventricular junctions. Pettigrew subsequently showed obvious helical arrangements to be evident within the ventricular walls, but emphasised that the cardiomyocytes were attached to each other, and could not justifiably be compared with skeletal cardiomyocytes. Torrent-Guasp then reactivated the notion that the ventricular mass was formed of a solitary band. Unlike Lower, he dissected the band as extending between the pulmonary to the aortic roots. Multiple investigations conducted using gross dissection and histology, and more recently diffusion tensor magnetic resonance imaging and computed tomographic analysis, have shown an absence of any anatomical boundaries within the walls that might permit the mass uniformly to be dissected so as to reveal the band. A response to a recent letter to the Journal, nonetheless, claimed that the dissections had been validated by clinicians interpreting the findings so as to provide an explanation for ventricular cardiodynamics, arguing that the findings provided a suitable anatomical model for this purpose. Anatomical models, however, are of no value unless they are anatomically correct. In this review, therefore, we summarise the evidence showing that the cardiomyocytes making up the ventricular walls, rather than forming a ventricular myocardial band, are instead aggregated together to form a three-dimensional myocardial mesh.
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Affiliation(s)
| | | | - Damian Sanchez‐Quintana
- Department of Anatomy and Cell BiologyFaculty of MedicineUniversity of ExtremaduraBadajozSpain
| | - Robert S. Stephenson
- Institute of Clinical SciencesCollege of Medical and Dental SciencesThe University of BirminghamBirminghamUK
- Comparative Medicine LaboratoryInstitute of Clinical MedicineAarhus UniversityAarhusDenmark
| | - Peter Agger
- Comparative Medicine LaboratoryInstitute of Clinical MedicineAarhus UniversityAarhusDenmark
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15
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In Memoriam. CIRUGIA CARDIOVASCULAR 2019. [DOI: 10.1016/j.circv.2019.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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16
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Right ventricular dysfunction in arterial hypertension: still terra incognita? J Hum Hypertens 2019; 33:491-498. [PMID: 31076653 DOI: 10.1038/s41371-019-0206-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/24/2019] [Accepted: 04/01/2019] [Indexed: 11/08/2022]
Abstract
The effects of systemic hypertension on left ventricular function have been well described, as has been the response of the resulting alterations to antihypertensive treatment. However, hypertension effects on the right ventricle (RV) have not been sufficiently investigated; only in recent years, with the development of new imaging modalities, has its importance become widely recognized. Indeed, evidence from clinical trials suggestive of RV functional and structural impairment early in the course of arterial hypertension continues to accumulate. Newer imaging techniques, especially speckle-tracking-derived myocardial deformation imaging, have provided new insights into the effect of systemic hypertension on this previously neglected cardiac chamber. Two- and three-dimensional echocardiography, along with cardiac magnetic resonance imaging, forms the cornerstone of RV structural and functional assessment. This article provides an overview of the effect of longstanding hypertension on RV structure and function, the respective underlying mechanisms, and the potential therapeutic implications. It summarizes the available options for RV structural and functional assessment, and evaluates the existing evidence with respect to RV alterations in hypertensive disease, aiming to assess the current limits of scientific knowledge about a heart chamber that has only recently become the focus of greater interest.
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17
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Athanasuleas CL, Stanley AWH, Buckberg GD. Mitral regurgitation: anatomy is destiny. Eur J Cardiothorac Surg 2018; 54:627-634. [PMID: 29718159 DOI: 10.1093/ejcts/ezy174] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 03/18/2018] [Indexed: 11/13/2022] Open
Abstract
Mitral regurgitation (MR) occurs when any of the valve and ventricular mitral apparatus components are disturbed. As MR progresses, left ventricular remodelling occurs, ultimately causing heart failure when the enlarging left ventricle (LV) loses its conical shape and becomes globular. Heart failure and lethal ventricular arrhythmias may develop if the left ventricular end-systolic volume index exceeds 55 ml/m2. These adverse changes persist despite satisfactory correction of the annular component of MR. Our goal was to describe this process and summarize evolving interventions that reduce the volume of the left ventricle and rebuild its elliptical shape. This 'valve/ventricle' approach addresses the spherical ventricular culprit and offsets the limits of treating MR by correcting only its annular component.
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Affiliation(s)
- Constantine L Athanasuleas
- Section of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Gerald D Buckberg
- Department of Cardiothoracic Surgery, University of California Los Angeles, Los Angeles, CA, USA
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18
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MacIver DH, Partridge JB, Agger P, Stephenson RS, Boukens BJD, Omann C, Jarvis JC, Zhang H. The end of the unique myocardial band: Part II. Clinical and functional considerations. Eur J Cardiothorac Surg 2018; 53:120-128. [PMID: 29029119 DOI: 10.1093/ejcts/ezx335] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 08/20/2017] [Indexed: 12/25/2022] Open
Abstract
Two of the leading concepts of mural ventricular architecture are the unique myocardial band and the myocardial mesh model. We have described, in an accompanying article published in this journal, how the anatomical, histological and high-resolution computed tomographic studies strongly favour the latter concept. We now extend the argument to describe the linkage between mural architecture and ventricular function in both health and disease. We show that clinical imaging by echocardiography and magnetic resonance imaging, and electrophysiological studies, all support the myocardial mesh model. We also provide evidence that the unique myocardial band model is not compatible with much of scientific research.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton and Somerset Hospital, Musgrove Park, Taunton, UK.,Medical Education, University of Bristol, Senate House, Bristol, UK.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - John B Partridge
- Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology & Environment, Batemans Bay, NSW, Australia
| | - Peter Agger
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark.,Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bastiaan J D Boukens
- Department of Medical Biology, Academic Medical Centre, Amsterdam University, Amsterdam, Netherlands
| | - Camilla Omann
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - Jonathan C Jarvis
- School of Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Henggui Zhang
- Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
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19
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MacIver DH, Stephenson RS, Jensen B, Agger P, Sánchez-Quintana D, Jarvis JC, Partridge JB, Anderson RH. The end of the unique myocardial band: Part I. Anatomical considerations. Eur J Cardiothorac Surg 2018; 53:112-119. [PMID: 28958005 DOI: 10.1093/ejcts/ezx290] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 07/18/2017] [Indexed: 01/04/2023] Open
Abstract
The concept of the 'unique myocardial band', which proposes that the ventricular myocardial cone is arranged like skeletal muscle, provides an attractive framework for understanding haemodynamics. The original idea was developed by Francisco Torrent-Guasp. Using boiled hearts and blunt dissection, Torrent-Guasp created a single band of ventricular myocardium extending from the pulmonary trunk to the aortic root, with the band thus constructed encircling both ventricular cavities. Cooked hearts can, however, be dissected in many ways. In this review, we show that the band does not exist as an anatomical entity with defined borders. On the contrary, the ventricular cardiomyocytes are aggregated end to end and by their branching produce an intricate meshwork. Across the thickness of the left ventricular wall, the chains of cardiomyocytes exhibit a gradually changing helical angle, with a circumferential zone formed in the middle. There is no abrupt change in helical angle, as could be expected if the wall was constructed of opposing limbs of a single wrapped band, nor does the long axis of the cardiomyocytes consistently match with the long axis of the unique myocardial band. There are, furthermore, no connective tissue structures that could be considered to demarcate its purported boundaries. The unique myocardial band should be consistent with evolution, and although the ventricular wall of fish and reptiles has one or several distinct layers, a single band is not found. In 1965, Lev and Simpkins cautioned that the ventricular muscle mass of a cooked heart can be dissected almost at the whim of the anatomist. We suggest that the unique myocardial band should have ended there.
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Affiliation(s)
- David H MacIver
- Department of Cardiology, Taunton and Somerset Hospital, Musgrove Park, Taunton, UK.,Medical Education, University of Bristol, Senate House, Tyndall Avenue, Bristol, UK.,Biological Physics Group, School of Physics and Astronomy, University of Manchester, Manchester, UK
| | - Robert S Stephenson
- Comparative Medicine Lab, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Bjarke Jensen
- Department of Medical Biology, Academic Medical Center, Amsterdam University, Netherlands
| | - Peter Agger
- Department of Paediatrics, Aarhus University Hospital, Denmark
| | - Damián Sánchez-Quintana
- Department of Anatomy and Cell Biology, Faculty of Medicine, University of Extremadura, Badajoz, Spain
| | - Jonathan C Jarvis
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - John B Partridge
- Eurobodalla Unit, Rural Clinical School of the ANU College of Medicine, Biology and Environment, Batemans Bay, NSW, Australia
| | - Robert H Anderson
- Institute of Genetic Medicine, Newcastle University, Newcastle Upon Tyne, UK
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20
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Hoffman JIE. Will the real ventricular architecture please stand up? Physiol Rep 2018; 5:5/18/e13404. [PMID: 28947592 PMCID: PMC5617926 DOI: 10.14814/phy2.13404] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 07/23/2017] [Indexed: 12/28/2022] Open
Abstract
Ventricular twisting, essential for cardiac function, is attributed to the contraction of myocardial helical fibers. The exact relationship between ventricular anatomy and function remains to be determined, but one commonly used explanatory model is the helical ventricular myocardial band (HVMB) model of Torrent‐Guasp. This model has been successful in explaining many aspects of ventricular function, (Torrent‐Guasp et al. Eur. J. Cardiothorac. Surg., 25, 376, 2004; Buckberg et al. Eur. J. Cardiothorac. Surg., 47, 587, 2015; Buckberg et al. Eur. J. Cardiothorac. Surg. 47, 778, 2015) but the model ignores important aspects of ventricular anatomy and should probably be replaced. The purpose of this review is to compare the HVMB model with a different model (nested layers). A complication when interpreting experimental observations that relate anatomy to function is that, in the myocardium, shortening does not always imply activation and lengthening does not always imply inactivation.
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Affiliation(s)
- Julien I E Hoffman
- Department of Pediatrics, University of California, San Francisco, California
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21
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What Is the Heart? Anatomy, Function, Pathophysiology, and Misconceptions. J Cardiovasc Dev Dis 2018; 5:jcdd5020033. [PMID: 29867011 PMCID: PMC6023278 DOI: 10.3390/jcdd5020033] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 05/10/2018] [Accepted: 05/23/2018] [Indexed: 01/08/2023] Open
Abstract
Cardiac dynamics are traditionally linked to a left ventricle, right ventricle, and septum morphology, a topography that differs from the heart's five-century-old anatomic description of containing a helix and circumferential wrap architectural configuration. Torrent Guasp's helical ventricular myocardial band (HVMB) defines this anatomy and its structure, and explains why the heart's six dynamic actions of narrowing, shortening, lengthening, widening, twisting, and uncoiling happen. The described structural findings will raise questions about deductions guiding "accepted cardiac mechanics", and their functional aspects will challenge and overturn them. These suppositions include the LV, RV, and septum description, timing of mitral valve opening, isovolumic relaxation period, reasons for torsion/twisting, untwisting, reasons for longitudinal and circumferential strain, echocardiographic sub segmentation, resynchronization, RV function dynamics, diastolic dysfunction's cause, and unrecognized septum impairment. Torrent Guasp's revolutionary contributions may alter future understanding of the diagnosis and treatment of cardiac disease.
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22
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Stephenson A, Adams JW, Vaccarezza M. Rebuttal letter in response to Professor R.H. Anderson's letter 'Evolution of the vertebrate heart'. J Anat 2018; 232:888-889. [PMID: 29488220 DOI: 10.1111/joa.12788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
| | - Justin W Adams
- School of Biomedical Sciences, Monash University, Clayton, VIC, Australia
| | - Mauro Vaccarezza
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
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23
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Clancy DJ, Mclean A, Slama M, Orde SR. Paradoxical septal motion: A diagnostic approach and clinical relevance. Australas J Ultrasound Med 2018; 21:79-86. [PMID: 34760507 DOI: 10.1002/ajum.12086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Abnormal septal motion (commonly referred to as septal bounce) is a common echocardiographic finding that occurs with several conditions, including the following: mitral stenosis, left bundle branch block, pericardial syndromes and severe pulmonary hypertension. We explore the subtle changes that occur on M-mode imaging of the septum, other associated echocardiographic features, the impact of inspiratory effort on septal motion and relevant clinical findings. Finally, we discuss the impact of abnormal septal motion on cardiac form and function, proposing there is a clinically significant impact on biventricular filling and ejection.
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Affiliation(s)
- David J Clancy
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
| | - Anthony Mclean
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
| | - Michel Slama
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
| | - Sam R Orde
- Intensive Care Unit Nepean Hospital Kingswood Sydney 2747 New South Wales Australia
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24
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Dal Lin C, Tona F, Osto E. The Heart as a Psychoneuroendocrine and Immunoregulatory Organ. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2018; 1065:225-239. [PMID: 30051388 DOI: 10.1007/978-3-319-77932-4_15] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The heart can be viewed not just as muscle pump but also as an important checkpoint for a complex network of nervous, endocrine, and immune signals. The heart is able to process neurological signals independently from the brain and to crosstalk with the endocrine and immune systems. The heart communicates with the psyche through the neuro-endocrine-immune system in a highly integrated way, in order to maintain the homeostasis of the whole body with peculiarities specific to males and females.
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Affiliation(s)
- Carlo Dal Lin
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Elena Osto
- Laboratory of Translational Nutrition Biology, Federal Institute of Technology Zurich ETHZ, Zurich, Switzerland. .,Center for Molecular Cardiology, University of Zurich and University Heart Center, Cardiology, University Hospital Zurich, Zurich, Switzerland.
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25
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Hoffman JIE. The helical ventricular myocardial band-or what's in a name? Echocardiography 2017; 33:1448-1449. [PMID: 27783872 DOI: 10.1111/echo.13332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- Julien I E Hoffman
- Professor Emeritus, Department of Pediatrics, University of California, San Francisco, CA, USA.
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26
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Sveric KM, Ulbrich S, Rady M, Ruf T, Kvakan H, Strasser RH, Jellinghaus S. Three-Dimensional Left Ventricular Torsion in Patients With Dilated Cardiomyopathy - A Marker of Disease Severity. Circ J 2017; 81:529-536. [PMID: 28123150 DOI: 10.1253/circj.cj-16-0965] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND LV twist has a key role in maintaining left ventricular (LV) contractility during exercise. The purpose of this study was to investigate LV torsion instead of twist as a surrogate marker of peak oxygen uptake (peak V̇O2) assessed by cardiopulmonary exercise testing (CPET) in patients with non-ischemic dilated cardiomyopathy (DCM).Methods and Results:We evaluated 45 outpatients with DCM (50±12 years, 24% females) with 3D speckle-tracking electrocardiography prior to CPET. LV torsion, LV ejection fraction (EF), LV diastolic function, LV global longitudinal (GLS) and circumferential (GCS) strain were quantified. A reduced functional capacity (FC) was defined as a peak V̇O2<20 mL/kg/min. LV torsion correlated most strongly with peak V̇O2(r=0.76, P<0.001). LV torsion instead of twist was an independent predictor of peak V̇O2(B: 0.59 to 0.71, P<0.001) in multivariable analyses. Impaired LV torsion <0.61 degrees/cm was able to predict a reduced FC with higher sensitivity and specificity (0.91 and 0.81; area under the curve (AUC): 0.88, P<0.001) than LV EF, GLS or GCS (AUC 0.64, 0.63 and 0.66; P<0.05 for differences in AUC). CONCLUSIONS Peak V̇O2correlated more strongly with LV torsion than with LV diastolic function, LV EF, GLS or GCS. LV torsion had high accuracy in identifying patients with a reduced FC.
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Isomura T, Fukada Y, Miyazaki T, Yoshida M, Morisaki A, Endo M. Posterior ventricular restoration treatment for heart failure: a review, past, present and future aspects. Gen Thorac Cardiovasc Surg 2017; 65:137-143. [PMID: 28161770 DOI: 10.1007/s11748-017-0750-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022]
Abstract
Congestive heart failure (CHF) is one of the major causes of death and occurs in more than 15,000,000 patients worldwide. The incidence is expected to increase in parallel with the aging population. Most current therapies for CHF are medications, and biventricular pacing implantation as appropriated by cardiologists, or surgical interventions. The heart transplantation for indicated patients is still gold standard surgery although the 10-year survival rate is approximately 60% based on the worldwide data. However, the cardiac transplantation remains epidemiologically insignificant because of donor pool limitations. New strategies for treating CHF are needed. In addition to conventional cardiac surgery, surgical ventricular restoration was reported as a promising surgical therapy in 1990s. After the first report of partial left ventriculectomy in which posterior wall was widely resected for dilated heart, many controversial clinical and animal research studies have been reported. In this review, the principles of posterior cardiac restoration therapy will be discussed. An overview of posterior cardiac restoration, structure, and torsion are presented. By understanding the structure of cardiac muscle, shape, and torsion of left ventricle for surgical restoration, the procedure can be performed based on appropriate indication and this knowledge can be used to optimize and improve its efficacy. The use of mechanical support devices has recently become commonplace in many centers, and the use of implantable ventricular assist devices as destination therapy will increase. Surgeons will be able to select several options of the treatment for CHF by understanding the advantages and disadvantages of those surgical treatments.
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Affiliation(s)
- Tadashi Isomura
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan.
| | - Yasuhisa Fukada
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Takuya Miyazaki
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Minoru Yoshida
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Akimasa Morisaki
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
| | - Masahiro Endo
- Cardiovascular Surgery, Tokyo Heart Center, 5-4-12, Kita-shinagawa, Shinagawa, Tokyo, 141-0001, Japan
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Buckberg GD. Echogenic zone in mid-septum: its structure/function relationship. Echocardiography 2016; 33:1450-1456. [PMID: 27783875 DOI: 10.1111/echo.13342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Gerald D Buckberg
- Department of Cardiothoracic Surgery, University of California Los Angeles, Los Angeles, CA, USA.
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29
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Stöhr EJ, Shave RE, Baggish AL, Weiner RB. Left ventricular twist mechanics in the context of normal physiology and cardiovascular disease: a review of studies using speckle tracking echocardiography. Am J Physiol Heart Circ Physiol 2016; 311:H633-44. [DOI: 10.1152/ajpheart.00104.2016] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 07/03/2016] [Indexed: 11/22/2022]
Abstract
The anatomy of the adult human left ventricle (LV) is the result of its complex interaction with its environment. From the fetal to the neonatal to the adult form, the human LV undergoes an anatomical transformation that finally results in the most complex of the four cardiac chambers. In its adult form, the human LV consists of two muscular helixes that surround the midventricular circumferential layer of muscle fibers. Contraction of these endocardial and epicardial helixes results in a twisting motion that is thought to minimize the transmural stress of the LV muscle. In the healthy myocardium, the LV twist response to stimuli that alter preload, afterload, or contractility has been described and is deemed relatively consistent and predictable. Conversely, the LV twist response in patient populations appears to be a little more variable and less predictable, yet it has revealed important insight into the effect of cardiovascular disease on LV mechanical function. This review discusses important methodological aspects of assessing LV twist and evaluates the LV twist responses to the main physiological and pathophysiological states. It is concluded that correct assessment of LV twist mechanics holds significant potential to advance our understanding of LV function in human health and cardiovascular disease.
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Affiliation(s)
- Eric J. Stöhr
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Rob E. Shave
- Discipline of Physiology and Health, Cardiff School of Sport, Cardiff Metropolitan University, Cardiff, United Kingdom; and
| | - Aaron L. Baggish
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rory B. Weiner
- Cardiovascular Performance Program, Division of Cardiology, Massachusetts General Hospital, Boston, Massachusetts
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Affiliation(s)
- Daniel Burkhoff
- Cardiovascular Research Foundation and Columbia University, New York, New York
| | - Julius Guccione
- University of California San Francisco, Department of Surgery, San Francisco, California
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31
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Buckberg GD. Physiologic left ventricular reconstruction: Shape, function, and time recaptured. J Thorac Cardiovasc Surg 2016; 152:392-3. [PMID: 27209016 DOI: 10.1016/j.jtcvs.2016.03.068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 03/30/2016] [Indexed: 10/22/2022]
Affiliation(s)
- Gerald D Buckberg
- Department of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, Calif.
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32
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Buckberg GD. Surgical ventricular restoration after flawed STICH trial: results when guidelines followed. Eur J Cardiothorac Surg 2016; 50:702-703. [DOI: 10.1093/ejcts/ezw133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tadic M, Cuspidi C, Ivanovic B, Vukomanovic V, Djelic M, Celic V, Kocijancic V. The Impact of White-Coat Hypertension on Cardiac Mechanics. J Clin Hypertens (Greenwich) 2016; 18:617-22. [DOI: 10.1111/jch.12826] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 12/21/2015] [Accepted: 12/28/2015] [Indexed: 01/17/2023]
Affiliation(s)
- Marijana Tadic
- Cardiology Department; University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje,”; Belgrade Serbia
- Faculty of Medicine; Belgrade Serbia
| | - Cesare Cuspidi
- Clinical Research Unit; University of Milan-Bicocca and Istituto Auxologico Italiano; Meda Italy
| | | | - Vladan Vukomanovic
- Cardiology Department; University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje,”; Belgrade Serbia
| | | | - Vera Celic
- Cardiology Department; University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje,”; Belgrade Serbia
- Faculty of Medicine; Belgrade Serbia
| | - Vesna Kocijancic
- Cardiology Department; University Clinical Hospital Center “Dr. Dragisa Misovic - Dedinje,”; Belgrade Serbia
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Cirillo M, Campana M, Brunelli F, Dalla Tomba M, Mhagna Z, Messina A, Villa E, Natalini G, Troise G. Time series analysis of physiologic left ventricular reconstruction in ischemic cardiomyopathy. J Thorac Cardiovasc Surg 2016; 152:382-91. [PMID: 27167021 DOI: 10.1016/j.jtcvs.2016.03.087] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 01/07/2023]
Abstract
OBJECTIVE The history of left ventricular reconstruction has demonstrated that the full spectrum of recoverable physiologic parameters is essential for a good functional result. We report the long-term outcome of a new surgical technique that arranges myocardial fibers in a near-normal disposition, also recovering left ventricular twisting. METHODS Between May 2006 and October 2013, 29 consecutive patients with previous anterior myocardial infarction and heart failure symptoms underwent physiologic left ventricular reconstruction surgery and coronary revascularization. Patients were examined by means of standard echocardiography and 2-dimensional speckle tracking at 8 time steps until 7 years after surgery. Ten geometric and functional parameters were evaluated at each step and analyzed by the linear mixed model test. RESULTS Hospital mortality was 0%. The mean percentage of indexed end-diastolic and end-systolic volume reduction was 45.7% and 50.9%, respectively. Ejection fraction and all of the volumes were significantly different in the postoperative period with a steady correction during time. Diastolic parameters were not worsened by surgical reconstruction. Ejection fraction and deceleration time showed a significant improvement during time. Left ventricular torsion increased immediately after the surgical correction from 2.8 ± 4.4 degrees to 8.7 ± 3.9 degrees (P = .02) and was still present 4 years after surgery. CONCLUSIONS Surgical conduction of ventricular reconstruction should be standardized to achieve the full spectrum of recoverable physiologic parameters. The renewal of ventricular torsion should be pursued as an adjunctive element of ventricular efficiency, mainly in ventricles that work at a critical level in the Frank-Starling relationship and pressure-volume loop.
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Affiliation(s)
- Marco Cirillo
- Heart Failure Surgery Unit, Poliambulanza Foundation Hospital, Brescia, Italy.
| | - Marco Campana
- Echocardiography Laboratory, Cardiology Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Federico Brunelli
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Margherita Dalla Tomba
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Zean Mhagna
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Antonio Messina
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Emmanuel Villa
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giuseppe Natalini
- Intensive Care Unit, Emergency Department, Poliambulanza Foundation Hospital, Brescia, Italy
| | - Giovanni Troise
- Cardiac Surgery Unit, Cardiovascular Department, Poliambulanza Foundation Hospital, Brescia, Italy
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Azevedo PS, Polegato BF, Minicucci MF, Paiva SAR, Zornoff LAM. Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arq Bras Cardiol 2015; 106:62-9. [PMID: 26647721 PMCID: PMC4728597 DOI: 10.5935/abc.20160005] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Accepted: 09/15/2015] [Indexed: 02/06/2023] Open
Abstract
Cardiac remodeling is defined as a group of molecular, cellular and interstitial changes that manifest clinically as changes in size, mass, geometry and function of the heart after injury. The process results in poor prognosis because of its association with ventricular dysfunction and malignant arrhythmias. Here, we discuss the concepts and clinical implications of cardiac remodeling, and the pathophysiological role of different factors, including cell death, energy metabolism, oxidative stress, inflammation, collagen, contractile proteins, calcium transport, geometry and neurohormonal activation. Finally, the article describes the pharmacological treatment of cardiac remodeling, which can be divided into three different stages of strategies: consolidated, promising and potential strategies.
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Bloechlinger S, Berger D, Bryner J, Roost E, Jakob S, Dünser MW, Takala J. Changes in Left Ventricular Torsion Early Postoperatively After Aortic Valve Replacement and at Long-Term Follow-up. J Cardiothorac Vasc Anesth 2015; 29:860-7. [DOI: 10.1053/j.jvca.2015.01.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Indexed: 12/16/2022]
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Kerkhof PLM. Characterizing heart failure in the ventricular volume domain. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2015; 9:11-31. [PMID: 25780344 PMCID: PMC4345934 DOI: 10.4137/cmc.s18744] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 01/11/2015] [Accepted: 01/17/2015] [Indexed: 12/13/2022]
Abstract
Heart failure (HF) may be accompanied by considerable alterations of left ventricular (LV) volume, depending on the particular phenotype. Two major types of HF have been identified, although heterogeneity within each category may be considerable. All variants of HF show substantially elevated LV filling pressures, which tend to induce changes in LV size and shape. Yet, one type of HF is characterized by near-normal values for LV end-diastolic volume (EDV) and even a smaller end-systolic volume (ESV) than in matched groups of persons without cardiac disease. Furthermore, accumulating evidence indicates that, both in terms of shape and size, in men and women, the heart reacts differently to adaptive stimuli as well as to certain pharmacological interventions. Adjustments of ESV and EDV such as in HF patients are associated with (reverse) remodeling mechanisms. Therefore, it is logical to analyze HF subtypes in a graphical representation that relates ESV to EDV. Following this route, one may expect that the two major phenotypes of HF are identified as distinct entities localized in different areas of the LV volume domain. The precise coordinates of this position imply unique characteristics in terms of the actual operating point for LV volume regulation. Evidently, ejection fraction (EF; equal to 1 minus the ratio of ESV and EDV) carries little information within the LV volume representation. Thus far, classification of HF is based on information regarding EF combined with EDV. Our analysis shows that ESV in the two HF groups follows different patterns in dependency of EDV. This observation suggests that a superior HF classification system should primarily be founded on information embodied by ESV.
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Affiliation(s)
- Peter LM Kerkhof
- Department of Physics and Medical Technology, VU University Medical Center, Amsterdam, The Netherlands
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