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Hirano Y, Amano M, Obokata M, Izumo M, Utsunomiya H. Practice guidance for stress echocardiography. J Echocardiogr 2024; 22:1-15. [PMID: 38358595 DOI: 10.1007/s12574-024-00643-1] [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: 11/26/2023] [Revised: 12/17/2023] [Accepted: 01/04/2024] [Indexed: 02/16/2024]
Abstract
Stress echocardiography has been one of the most promising methods for the diagnosis of ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The Japanese Society of Echocardiography produced practical guidance for the implementation of stress echocardiography in 2018. At that time, stress echocardiography was not yet widely disseminated in Japan; therefore, the 2018 practical guidance for the implementation of stress echocardiography included a report on stress echocardiography and a specific protocol to promote its use at many institutions in Japan in the future. And now, an era of renewed interest and enthusiasm surrounding the diagnosis and treatment of valvular heart disease and heart failure with preserved ejection fraction (HFpEF) has come, which are driven by emerging trans-catheter procedures and new recommended guideline-directed medical therapy. Based on the continued evidence of stress echocardiography, the new practical guideline that describes the safe and effective methodology of stress echocardiography is now created by the Guideline Development Committee of the Japanese Society of Echocardiography and is designed to expand the use of stress echocardiography for valvular heart disease and HFpEF, as well as ischemic heart disease, hypertrophic cardiomyopathy, and pulmonary hypertension. The readers are encouraged to perform stress echocardiography which will enhance the diagnosis and management of these patients.
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Affiliation(s)
- Yutaka Hirano
- Faculty of Medicine, Center for Medical Education and Clinical Training, Kindai University, 377-2 Ohnohigasi, Osakasayama, Osaka, 589-8511, Japan.
| | - Masashi Amano
- Department of Heart Failure and Transplantation, National Cerebral and Cardiovascular Center, 5‑7‑1 Fujishiro‑dai, Suita Osaka, 565‑8565, Japan
| | - Masaru Obokata
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa-Machi, Maebashi, Gunma, 371-8511, Japan
| | - Masaki Izumo
- Department of Cardiology, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-Ku, Kawasaki, Kanagawa, 216-8511, Japan
| | - Hiroto Utsunomiya
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan
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Ohte N, Ishizu T, Izumi C, Itoh H, Iwanaga S, Okura H, Otsuji Y, Sakata Y, Shibata T, Shinke T, Seo Y, Daimon M, Takeuchi M, Tanabe K, Nakatani S, Nii M, Nishigami K, Hozumi T, Yasukochi S, Yamada H, Yamamoto K, Izumo M, Inoue K, Iwano H, Okada A, Kataoka A, Kaji S, Kusunose K, Goda A, Takeda Y, Tanaka H, Dohi K, Hamaguchi H, Fukuta H, Yamada S, Watanabe N, Akaishi M, Akasaka T, Kimura T, Kosuge M, Masuyama T. JCS 2021 Guideline on the Clinical Application of Echocardiography. Circ J 2022; 86:2045-2119. [DOI: 10.1253/circj.cj-22-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Nobuyuki Ohte
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | | | - Chisato Izumi
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | - Hiroshi Itoh
- Department of Cardiovascular Medicine, Okayama University Faculty of Medicine, Dentistry and Pharmaceutical Science
| | - Shiro Iwanaga
- Department of Cardiology, Saitama Medical University International Medical Center
| | - Hiroyuki Okura
- Department of Cardiology, Gifu University Graduate School of Medicine
| | | | - Yasushi Sakata
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Toshihiko Shibata
- Department of Cardiovascular Surgery, Osaka City University Graduate School of Medicine
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine
| | - Yoshihiro Seo
- Department of Cardiology, Nagoya City University Graduate School of Medical Sciences
| | - Masao Daimon
- The Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masaaki Takeuchi
- Department of Laboratory and Transfusion Medicine, Hospital of University of Occupational and Environmental Health
| | - Kazuaki Tanabe
- The Fourth Department of Internal Medicine, Shimane University Faculty of Medicine
| | | | - Masaki Nii
- Department of Cardiology, Shizuoka Children's Hospital
| | - Kazuhiro Nishigami
- Division of Cardiovascular Medicine, Miyuki Hospital LTAC Heart Failure Center
| | - Takeshi Hozumi
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Satoshi Yasukochi
- Department of Pediatric Cardiology, Heart Center, Nagano Children’s Hospital
| | - Hirotsugu Yamada
- Department of Community Medicine for Cardiology, Tokushima University Graduate School of Biomedical Sciences
| | - Kazuhiro Yamamoto
- Department of Cardiovascular Medicine and Endocrinology and Metabolism, Faculty of Medicine, Tottori University
| | - Masaki Izumo
- Division of Cardiology, Department of Internal Medicine, St. Marianna University School of Medicine
| | - Katsuji Inoue
- Department of Cardiology, Pulmonology, Hypertension & Nephrology, Ehime University Graduate School of Medicine
| | | | - Atsushi Okada
- Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center
| | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Kenya Kusunose
- Department of Cardiovascular Medicine, Tokushima University Hospital
| | - Akiko Goda
- Department of Cardiovascular and Renal Medicine, Hyogo College of Medicine
| | - Yasuharu Takeda
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine
| | - Hidekazu Tanaka
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe University Graduate School of Medicine
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine
| | | | - Hidekatsu Fukuta
- Core Laboratory, Nagoya City University Graduate School of Medical Sciences
| | - Satoshi Yamada
- Department of Cardiology, Tokyo Medical University Hachioji Medical Center
| | - Nozomi Watanabe
- Department of Cardiology, Miyazaki Medical Association Hospital Cardiovascular Center
| | | | - Takashi Akasaka
- Department of Cardiovascular Medicine, Wakayama Medical University
| | - Takeshi Kimura
- Department of Cardiology, Kyoto University Graduate School of Medicine
| | - Masami Kosuge
- Division of Cardiology, Yokohama City University Medical Center
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Bouchahda N, Kallala MY, Zemni I, Ben Messaoud M, Boussaada M, Hasnaoui T, Haj Amor H, Sassi G, Jarraya M, Mahjoub M, Hassine M, Betbout F, Gamra H. Left atrium reservoir function is central in patients with rheumatic mitral stenosis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2022; 38:1257-1266. [PMID: 34971418 DOI: 10.1007/s10554-021-02509-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 12/24/2021] [Indexed: 11/29/2022]
Abstract
We investigated the relationship between Left Atrium strain reservoir function and symptoms and its impact on modulating Left Ventricular mechanics, diastolic filling, stroke volume, mean trans-mitral gradient and pulmonary pressure in mitral stenosis (MS) patients. We examined 195 full spectrum MS patients which were divided into two groups: Group 1 (n = 109) included patients with NYHA I & II functional class and group 2 (n = 86) included patients with NYHA III & IV functional class. LA strain reservoir function and classical echocardiographic parameters were calculated. LASr was significantly higher in group 1 versus group 2 in patients with MVA ≤ 1cm2 [8.8(6.0-12.6) vs 6.8(4.1-8.9), p = 0.03) and when 1cm2 < MVA ≤ 1.5 cm2 [10.0 (5.4-13.8) vs 6.7(4.5-9.0), p = 0.02). In patients with Pulmonary Hypertension, group 1 had significantly higher LASr than group 2 [11.1(6.6-14.8) vs 5.9(4.3-9.0), p = 0.002) By multivariate analysis, diabetes (OR = 4.11, 95%CI: 1.6-10.4), stroke (OR = 2.9, 95%CI: 1.1-7.9), LASr (OR = 0.9, 95%CI: 0.80-0.99) and LV ejection fraction (LVEF)(OR = 0.9, 95%CI: 0.91-0.99) were independently associated with NYHA functional class. LASr was significantly and positively correlated to MVA (r = 0.3, p < 10-3), stroke volume (r = 0.25, p = 10-3), mitral inflow (r = 0.4, p < 10-3) and LVEF(r = 0.14, p = 0.05). It was significantly and negatively correlated to left ventricular strain (r = -0.65, p < 10-3), LA indexed volume (r = -0.40, p < 10-3), maximum tricuspid regurgitation velocity (r = -0.25, p = 0.003), MTMG (r = -0.25, p = 10-3), and heart rate (r = -0.4, p < 10-3). We demonstrated a large range of interaction between LASr and mitral valve echocardiographic parameters. This may explain the reasons we identified LASr as an independent factor for MS functional tolerance.
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Affiliation(s)
- Nidhal Bouchahda
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia.
| | - Mohamed Yassine Kallala
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Imen Zemni
- Department of Preventive Medicine, Faculty of Medicine, University of Monastir, Rue. Avicenne, 5019, Monastir, Tunisia
| | - Mejdi Ben Messaoud
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Mehdi Boussaada
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Taha Hasnaoui
- Cardiology Department, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Hassen Haj Amor
- Cardiology Department, University Hospital Tahar Sfar, 5100, Mahdia, Tunisia
| | - Ghada Sassi
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Marwa Jarraya
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Marwen Mahjoub
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Majed Hassine
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Fethi Betbout
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
| | - Habib Gamra
- Cardiology A Department, University of Monastir, Research Laboratory LR12 SP 16 Fattouma Bourguiba University Hospital, Rue du 1er juin 1955, 5000, Monastir, Tunisia
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Kadoglou NPE, Papadopoulos CH, Papadopoulos KG, Karagiannis S, Karabinos I, Loizos S, Theodosis-Georgilas A, Aggeli K, Keramida K, Klettas D, Kounas S, Makavos G, Ninios I, Ntalas I, Ikonomidis I, Sahpekidis V, Stefanidis A, Zaglavara T, Athanasopoulos G, Karatasakis G, Kyrzopoulos S, Kouris N, Patrianakos A, Paraskevaidis I, Rallidis L, Savvatis K, Tsiapras D, Nihoyannopoulos P. Updated knowledge and practical implementations of stress echocardiography in ischemic and non-ischemic cardiac diseases: an expert consensus of the Working Group of Echocardiography of the Hellenic Society of Cardiology. Hellenic J Cardiol 2021; 64:30-57. [PMID: 34329766 DOI: 10.1016/j.hjc.2021.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/15/2021] [Indexed: 12/15/2022] Open
Abstract
Stress echocardiography (SE) is a well-established and valid technique, widely-used for the diagnostic evaluation of patients with ischemic and non-ischemic cardiac diseases. This statement of the Echocardiography Working Group of the Hellenic Society of Cardiology summarizes the consensus of the writing group regarding the applications of SE, based on the expertise of their members and on a critical review of current medical literature. The main objectives of the consensus document include a comprehensive review of SE methodology and training, focusing on the preparation, the protocols used and the analysis of the SE images and an updated, evidence-based knowledge about SE applications on ischemic and non-ischemic heart diseases, such as in cardiomyopathies, heart failure and valvular heart disease.
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Affiliation(s)
- Nikolaos P E Kadoglou
- Medical School, University of Cyprus, Nicosia, Cyprus; Second Cardiology Department, "Hippokration" Hospital, Aristotle University ofThessaloniki, Greece.
| | | | | | | | | | | | | | - Konstantina Aggeli
- 1st Cardiology Department, Hippokration University Hospital, Athens, Greece
| | - Kalliopi Keramida
- 2nd Cardiology Department, Attikon University Hospital, Athens, Greece
| | | | | | - George Makavos
- 3rd Cardiology Department, Sotiria University Hospital, Athens, Greece
| | - Ilias Ninios
- 2nd Cardiology Department, Interbalkan Center, Thessaloniki, Greece
| | | | | | | | | | | | | | - George Karatasakis
- 1st Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | | | - Nikos Kouris
- Cardiology Department, Thriasio Hospital, Elefsina, Greece
| | | | | | | | | | - Dimitrios Tsiapras
- 2nd Cardiology Department, Onassis Cardiosurgical Center, Piraeus, Greece
| | - Petros Nihoyannopoulos
- Metropolitan Hospital Center, Piraeus, Greece; Imperial College London, Hammersmith Hospital, London, UK
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2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Thorac Cardiovasc Surg 2021; 162:e183-e353. [PMID: 33972115 DOI: 10.1016/j.jtcvs.2021.04.002] [Citation(s) in RCA: 90] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Valle FH, Mohammed B, Wright SP, Bentley R, Fam NP, Mak S. Exercise Right Heart Catheterisation in Cardiovascular Diseases: A Guide to Interpretation and Considerations in the Management of Valvular Heart Disease. ACTA ACUST UNITED AC 2021; 16:e01. [PMID: 33664800 PMCID: PMC7903588 DOI: 10.15420/icr.2020.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 09/01/2020] [Indexed: 12/19/2022]
Abstract
The use of exercise right heart catheterisation for the assessment of cardiovascular diseases has regained attention recently. Understanding physiologic haemodynamic exercise responses is key for the identification of abnormal haemodynamic patterns. Exercise total pulmonary resistance >3 Wood units identifies a deranged haemodynamic response and when total pulmonary resistance exceeds 3 Wood units, an exercise pulmonary artery wedge pressures/cardiac output slope >2 mmHg/l/min indicates the presence of underlying exercise-induced pulmonary hypertension related to left heart disease. In the evolving field of transcatheter interventions for valvular heart disease, exercise right heart catheterisation may objectively unmask symptoms and underlying haemodynamic abnormalities. Further studies are needed on the use of the procedure to inform the selection of patients who might receive the most benefit from transcatheter interventions for valvular heart diseases.
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Affiliation(s)
- Felipe H Valle
- Division of Cardiology, Mount Sinai Hospital/University Health Network Toronto, Canada.,Division of Cardiology, St Michael's Hospital/University of Toronto Toronto, Canada
| | - Basma Mohammed
- Division of Internal Medicine, University of Toronto Toronto, Canada
| | - Stephen P Wright
- Division of Cardiology, Mount Sinai Hospital/University Health Network Toronto, Canada
| | - Robert Bentley
- Division of Cardiology, Mount Sinai Hospital/University Health Network Toronto, Canada.,Faculty of Kinesiology and Physical Education, University of Toronto Toronto, Canada
| | - Neil P Fam
- Division of Cardiology, St Michael's Hospital/University of Toronto Toronto, Canada
| | - Susanna Mak
- Division of Cardiology, Mount Sinai Hospital/University Health Network Toronto, Canada
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e72-e227. [PMID: 33332150 DOI: 10.1161/cir.0000000000000923] [Citation(s) in RCA: 548] [Impact Index Per Article: 182.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2021; 143:e35-e71. [PMID: 33332149 DOI: 10.1161/cir.0000000000000932] [Citation(s) in RCA: 345] [Impact Index Per Article: 115.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIM This executive summary of the valvular heart disease guideline provides recommendations for clinicians to diagnose and manage valvular heart disease as well as supporting documentation to encourage their use. METHODS A comprehensive literature search was conducted from January 1, 2010, to March 1, 2020, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, Cochrane, Agency for Healthcare Research and Quality Reports, and other selected database relevant to this guideline. Structure: Many recommendations from the earlier valvular heart disease guidelines have been updated with new evidence and provides newer options for diagnosis and treatment of valvular heart disease. This summary includes only the recommendations from the full guideline which focus on diagnostic work-up, the timing and choice of surgical and catheter interventions, and recommendations for medical therapy. The reader is referred to the full guideline for graphical flow charts, text, and tables with additional details about the rationale for and implementation of each recommendation, and the evidence tables detailing the data considered in developing these guidelines.
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O'Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2021; 77:e25-e197. [PMID: 33342586 DOI: 10.1016/j.jacc.2020.11.018] [Citation(s) in RCA: 782] [Impact Index Per Article: 260.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, Jneid H, Krieger EV, Mack M, McLeod C, O’Gara PT, Rigolin VH, Sundt TM, Thompson A, Toly C. 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary. J Am Coll Cardiol 2021; 77:450-500. [DOI: 10.1016/j.jacc.2020.11.035] [Citation(s) in RCA: 272] [Impact Index Per Article: 90.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Cristina de Castro Faria S, Costa HS, Hung J, Gorle de Miranda Chaves A, Paes de Oliveira FA, Padilha da Silva JL, Esteves WAM, Tan TC, Levine RA, Pereira Nunes MC. Pulmonary Artery Systolic Pressure Response to Exercise in Patients with Rheumatic Mitral Stenosis: Determinants and Prognostic Value. J Am Soc Echocardiogr 2020; 33:550-558. [PMID: 32127221 DOI: 10.1016/j.echo.2019.11.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/23/2019] [Accepted: 11/27/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pulmonary hypertension in response to exercise is a marker of the hemodynamic severity of mitral stenosis (MS). However, the factors related to elevated pulmonary pressure with exercise are not well defined. The aim of this study was to assess the parameters associated with the pulmonary pressure response to exercise in patients with pure rheumatic MS. An additional aim was to determine the impact of exercise-induced pulmonary hypertension on clinical outcome. METHODS One hundred thirty patients with MS (94% women; mean age, 45 ± 11 years) underwent exercise echocardiography. A range of echocardiographic parameters were obtained at rest and at peak exercise. Symptom-limited graded ramp bicycle exercise was performed in the supine position. The primary end point was mitral valve intervention, either percutaneous or surgical. RESULTS In the overall population, systolic pulmonary artery pressure (SPAP) increased from 38.3 ± 13.4 mm Hg at rest to 65.8 ± 20.7 mm Hg during exercise. Increases in mean mitral gradient, right ventricular function, left atrial volume, and net atrioventricular compliance were independently associated with SPAP at peak exercise, after adjusting for changes in heart rate. During the follow-up period (median, 17 months; range, 1-45 months), 46 adverse clinical events were observed. By multivariate Cox proportional-hazards analysis adjusted for age and sex, SPAP achieved at peak exercise was an important predictor of adverse outcome (adjusted hazard ratio, 1.025; 95% CI, 1.010-1.040; P = .001). New York Heart Association functional class (adjusted hazard ratio, 2.459; 95% CI, 1.509-4.006; P < .001) and the interaction between valve area and net atrioventricular compliance (P = .001) were also significant predictors of adverse events. Time-dependent areas under the receiver operating characteristic curve for the model with SPAP during exercise were better than for the model with SPAP at rest, with a significant improvement from 3 years onward. CONCLUSIONS In patients with MS, the pulmonary artery pressure response to exercise is determined by a combination of factors, including transmitral mean gradient at exercise, net atrioventricular compliance, left atrial volume, and right ventricular function. Pulmonary artery pressure at peak exercise is a predictor of clinical outcomes and adds incremental prognostic value beyond that provided by standard resting measurements, including valve area.
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Affiliation(s)
- Sanny Cristina de Castro Faria
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Henrique Silveira Costa
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Judy Hung
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | - William Antonio M Esteves
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Timothy C Tan
- Department of Cardiology, Blacktown Hospital, University of Western Sydney, Sydney, Australia
| | - Robert A Levine
- Cardiac Ultrasound Lab, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Maria Carmo Pereira Nunes
- Postgraduate Course of Infectious Diseases and Tropical Medicine, School of Medicine, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil; Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil.
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Gurbuz AS, Ozturk S, Alsancak Y, Saklı B, Duzenli MA. Prolonged pulmonary pulse transit time is associated with symptoms in patients with significant mitral stenosis and sinus rhythm. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:38-44. [PMID: 31297841 DOI: 10.1002/jcu.22758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/23/2019] [Accepted: 07/02/2019] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Pulmonary pulse transit time (pPTT) is a novel noninvasive echocardiographic measure to assess pulmonary arterial hemodynamics. It has been shown to be shorter in precapillary pulmonary hypertension (PHT). Mitral stenosis (MS) is one of the causes of postcapillary PHT. We aimed to investigate pPTT in patients with MS and its relationship with symptoms. METHODS We included 51 patients with MS (25 were asymptomatic, NYHA I, and 26 were symptomatic, NHYA II or III), and 50 controls, and evaluated their demographic characteristics and echocardiographic variables, including pPTT. RESULTS Baseline characteristics, including age, sex, body mass index, and cardiovascular risk factors, were similar between the MS and the control group. The pPTT was longer in the MS group than in the control group (0.21 ± 0.08 vs 0.15 ± 0.05, P < .001). Patients with symptomatic MS had longer pPTT than asymptomatic patients (P = .005). The pPTT was positively correlated with left atrial volume index and systolic pulmonary artery pressure, and negatively with tricuspid annular plane systolic excursion (r = .432; P < .001, r = .319; P = .001, r = -.293; and P = .003, respectively). CONCLUSION The measurement of pPTT appears clinically relevant in patients with PHT. Further studies evaluating whether it is useful in distinguishing precapillary from postcapillary PHT are required.
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Affiliation(s)
- Ahmet S Gurbuz
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
| | - Semi Ozturk
- Department of Cardiology, Haseki Education and Research Hospital, Istanbul, Turkey
| | - Yakup Alsancak
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
| | - Beyza Saklı
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
| | - Mehmet A Duzenli
- Department of Cardiology, Necmettin Erbakan University Meram Medicine Faculty, Konya, Turkey
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13
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Lloyd G, Badiani S, Costa M, Armado K, Bhattacharyya S. Mitral stenosis in 2019: changing approaches for changing times. Expert Rev Cardiovasc Ther 2019; 17:473-477. [PMID: 31195847 DOI: 10.1080/14779072.2019.1632190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Guy Lloyd
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,c William Harvey Research Institute , Queen Mary & Westfield, University of London , London , UK.,d Institute of Cardiovascular Sciences , UCL , London , UK
| | - Sveeta Badiani
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Marta Costa
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Karen Armado
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Sanjeev Bhattacharyya
- a Echocardiography Laboratory, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,c William Harvey Research Institute , Queen Mary & Westfield, University of London , London , UK.,d Institute of Cardiovascular Sciences , UCL , London , UK
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Badiani S, Waddingham P, Lloyd G, Bhattacharyya S. Stress echocardiography in valvular heart disease. Expert Rev Cardiovasc Ther 2018; 16:795-804. [PMID: 30286667 DOI: 10.1080/14779072.2018.1532791] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The management of patients with heart valve disease can be complex. Patients may have symptoms disproportionate to the severity or the severity may be unclear. In addition, the optimal timing of intervention in patients with severe disease may be controversial. Areas covered: This article examines the role of stress echocardiography for assessment of patients with low-flow, low-gradient aortic stenosis, asymptomatic severe valve disease and patients where symptoms are discordant to the resting severity of valve disease. Expert commentary: Stress echocardiography helps clinicians determine the true severity of valve disease and may identify the cause of symptoms in patients with only mild/moderate disease. The data provided by stress echocardiography will help determine the appropriate management strategy and the correct timing of intervention.
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Affiliation(s)
- Sveeta Badiani
- a Echocardiography Laboratory , Barts Heart Centre, St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Peter Waddingham
- a Echocardiography Laboratory , Barts Heart Centre, St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK
| | - Guy Lloyd
- a Echocardiography Laboratory , Barts Heart Centre, St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,c William Harvey Research Institute, Queen Mary & Westfield , University of London , London , UK.,d Institute of Cardiovascular Sciences, UCL , London , UK
| | - Sanjeev Bhattacharyya
- a Echocardiography Laboratory , Barts Heart Centre, St Bartholomew's Hospital , London , UK.,b Heart Valve Clinic, Barts Heart Centre , St Bartholomew's Hospital , London , UK.,c William Harvey Research Institute, Queen Mary & Westfield , University of London , London , UK.,d Institute of Cardiovascular Sciences, UCL , London , UK
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Affiliation(s)
- John B Chambers
- Cardiology Department, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Lancellotti P, Dulgheru R, Go YY, Sugimoto T, Marchetta S, Oury C, Garbi M. Stress echocardiography in patients with native valvular heart disease. Heart 2017; 104:807-813. [DOI: 10.1136/heartjnl-2017-311682] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 10/30/2017] [Accepted: 11/15/2017] [Indexed: 12/20/2022] Open
Abstract
Valve stress echocardiography (VSE) can be performed as exercise stress echocardiography (ESE) or dobutamine stress echocardiography (DSE) depending on the patient’s clinical status, severity and type of valve disease. ESE combines exercise testing with two-dimensional grey scale and Doppler echocardiography during exercise. Thus, it provides objective assessment of symptomatic status (exercise test), as well as exercise-induced changes of a series of echocardiographic parameters (different depending on the valve disease type), which yield prognostic information in individual patients and help in a better treatment planning. DSE is useful in symptomatic patients with low-gradient aortic stenosis. It clarifies its severity and helps in assessing surgical risk in patients with severe disease and systolic dysfunction. It can be also used to test valve haemodynamics in asymptomatic patients with significant mitral stenosis unable to perform an exercise test or to test the left ventricle response, namely to test viability, in patients with ischaemic secondary mitral regurgitation. VSE has taught us that history taking, clinical examination and resting echocardiography give an ‘incomplete picture’ of the disease in patients presenting with a severe valve disease. Therefore, its use should be encouraged in such patients.
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Jung MH, Jung HO, Lee JW, Youn HJ. Decreases in left atrial compliance during early-stage exercise are related to exercise intolerance in asymptomatic significant mitral stenosis. Echocardiography 2017; 34:1633-1639. [PMID: 28833495 DOI: 10.1111/echo.13666] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Doppler-driven net atrioventricular compliance (Cn ), which represents left atrial (LA) compliance, is an important determinant of pulmonary hypertension in mitral stenosis (MS). HYPOTHESIS We hypothesized that decreases in Cn during early-stage exercise underlie exercise intolerance in patients with MS. METHODS Thirty-three asymptomatic patients with significant MS (valve area 1.24 ± 0.16 cm2 ) underwent resting and bicycle exercise echocardiography. LA compliance and conventional parameters were assessed at each workload. The patients were classified into two groups based on whether they developed dyspnea during exercise: an exercise-intolerance group (n = 22) and an exercise-tolerance group (n = 11). Moreover, "50 W" was defined as an early exercise stage. RESULTS Although the groups had similar resting characteristics, there were striking differences in their echocardiographic parameters from the early stages of exercise. The relative Cn decrease at 50 W (expressed as a percentage of the resting Cn ) was significantly greater in the exercise-intolerance group (70.3 ± 15.4% vs 49.7 ± 9.7%, P < .001). The overall decrease in relative Cn was significantly greater in the exercise-intolerance group (P = .0005). Furthermore, differences in the trends in this parameter were observed between the two groups (P < .0001 for interaction). Multivariate analysis revealed that the relative Cn decrease at 50 W was an independent predictor of exercise intolerance (adjusted OR 1.105, 95% CI 1.030-1.184) after adjustment for other conventional parameters. CONCLUSIONS Decreases in Cn during early-stage exercise are an important mechanism underlying exercise intolerance in MS.
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Affiliation(s)
- Mi-Hyang Jung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hae Ok Jung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jung-Won Lee
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Ho-Joong Youn
- Division of Cardiology, Department of Internal Medicine, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The Clinical Use of Stress Echocardiography in Non-Ischaemic Heart Disease: Recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. J Am Soc Echocardiogr 2017; 30:101-138. [DOI: 10.1016/j.echo.2016.10.016] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Lancellotti P, Pellikka PA, Budts W, Chaudhry FA, Donal E, Dulgheru R, Edvardsen T, Garbi M, Ha JW, Kane GC, Kreeger J, Mertens L, Pibarot P, Picano E, Ryan T, Tsutsui JM, Varga A. The clinical use of stress echocardiography in non-ischaemic heart disease: recommendations from the European Association of Cardiovascular Imaging and the American Society of Echocardiography. Eur Heart J Cardiovasc Imaging 2016; 17:1191-1229. [DOI: 10.1093/ehjci/jew190] [Citation(s) in RCA: 206] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 08/12/2016] [Indexed: 12/20/2022] Open
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Tweet MS, Arruda-Olson AM, Anavekar NS, Pellikka PA. Stress echocardiography: what is new and how does it compare with myocardial perfusion imaging and other modalities? Curr Cardiol Rep 2016; 17:43. [PMID: 25911442 DOI: 10.1007/s11886-015-0600-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cardiovascular disease is a leading cause of morbidity and mortality, and noninvasive strategies to diagnose and risk stratify patients remain paramount in the evaluative process. Stress echocardiography is a well-established, versatile, real-time imaging modality with advantages including lack of radiation exposure, portability, and affordability. Innovative techniques in stress echocardiography include myocardial contrast echocardiography, deformation imaging, three-dimensional (3D) echocardiography, and assessment of coronary flow reserve. Myocardial perfusion imaging with single-photon emission computed tomography (SPECT) or positron emission tomography (PET) are imaging alternatives, and stress cardiac magnetic resonance imaging and coronary computed tomography (CT) angiography, including CT perfusion imaging, are emerging as newer approaches. This review will discuss recent and upcoming developments in the field of stress testing, with an emphasis on stress echocardiography while highlighting comparisons with other modalities.
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Affiliation(s)
- Marysia S Tweet
- Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA,
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Garbi M, Chambers J, Vannan MA, Lancellotti P. Valve Stress Echocardiography. JACC Cardiovasc Imaging 2015; 8:724-36. [DOI: 10.1016/j.jcmg.2015.02.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Revised: 01/22/2015] [Accepted: 02/12/2015] [Indexed: 11/29/2022]
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Naji P, Patel K, Griffin BP, Desai MY. Stress echocardiography in valvular heart disease: a current appraisal. Expert Rev Cardiovasc Ther 2015; 13:249-62. [DOI: 10.1586/14779072.2015.1013940] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD, Anderson JL, Halperin JL, Albert NM, Bozkurt B, Brindis RG, Creager MA, Curtis LH, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Pressler SJ, Sellke FW, Shen WK, Stevenson WG, Yancy CW. 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Thorac Cardiovasc Surg 2014; 148:e1-e132. [DOI: 10.1016/j.jtcvs.2014.05.014] [Citation(s) in RCA: 631] [Impact Index Per Article: 63.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O'Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2014; 129:e521-643. [PMID: 24589853 DOI: 10.1161/cir.0000000000000031] [Citation(s) in RCA: 883] [Impact Index Per Article: 88.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Roshdy HS, Meshrif AM, El-Dosouky II. Value of the Mitral Valve Resistance in Evaluation of Symptomatic Patients with Mild and Moderate Mitral Stenosis - A Dobutamine Stress Echocardiographic Study. Echocardiography 2013; 31:347-52. [DOI: 10.1111/echo.12363] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Hisham S. Roshdy
- Cardiology Department; Faculty of Medicine; Zagazig University; Zagazig Egypt
| | - Amir M. Meshrif
- Cardiology Department; Health Affairs Directorate; Dakahlia Egypt
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Bhattacharyya S, Kamperidis V, Shah BN, Roussin I, Chahal N, Li W, Khattar R, Senior R. Clinical Utility and Prognostic Value of Appropriateness Criteria in Stress Echocardiography for the Evaluation of Valvular Heart Disease. JACC Cardiovasc Imaging 2013; 6:987-92. [DOI: 10.1016/j.jcmg.2013.04.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2012] [Revised: 02/21/2013] [Accepted: 04/03/2013] [Indexed: 10/26/2022]
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Jin Y, Wang HS, Wang ZW, Li XM, Yin ZT, Zhu Y. Risk factors for midterm cardiac function deterioration after valve replacement surgery in patients with rheumatic mitral stenosis. J Card Fail 2013; 19:565-70. [PMID: 23910586 DOI: 10.1016/j.cardfail.2013.06.001] [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: 02/06/2013] [Revised: 04/17/2013] [Accepted: 06/03/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND A symptomatic reduction in left ventricular ejection fraction (LVEF) is the main reason for postoperative heart failure after valve replacement surgery. However, postoperative heart failure occurs in patients with normal preoperative LVEF. Therefore, we examined clinical and echocardiographic data of patients with rheumatic heart disease to determine additional risk factors for low LVEF in the postoperative period. METHODS AND RESULTS Ninety-seven patients with rheumatic heart disease (RHD) who underwent mitral valve replacement for severe mitral valve stenosis were included retrospectively in this study. All patients had normal LVEF before surgery. Patients were divided into 2 groups based on postoperative LVEF 6 months after surgery. Groups A had normal postoperative LVEF (82 cases, 84.5%), and group B had low postoperative LVEF (15 cases, 15.5%). Clinical and electrocardiographic data were collected to determine risk factors for deterioration in cardiac function. Multivariate analysis revealed that preoperative low systolic peak velocities at the lateral tricuspid annulus (St) and no or mild aortic stenosis were independent risk factors for cardiac deterioration in patients with normal preoperative LVEF. Individuals with preoperative St ≤ 4.8 cm/s were more likely to develop lower LVEF at follow-up (χ(2) = 7.54; P = .006; odds ratio 5.03, 95% confidence interval 1.31-20.82). All 15 patients who had normal preoperative LVEF but abnormal postoperative LVEF had no or only mild aortic valve stenosis. CONCLUSIONS Decreased right ventricular function and no or mild aortic stenosis were independent risk factors for low LVEF at follow-up in patients with RHD who had normal preoperative LVEF. The velocity of the tricuspid valve ring should be included in preoperative evaluations to improve the accuracy of postsurgical prognosis and clinical decision making.
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Affiliation(s)
- Yan Jin
- Cardiovascular Institute and Shenyang Northern Hospital, Shenyang City, China.
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Bhattacharyya S, Khattar R, Chahal N, Moat N, Senior R. Dynamic Assessment of Stenotic Valvular Heart Disease by Stress Echocardiography. Circ Cardiovasc Imaging 2013; 6:583-9. [DOI: 10.1161/circimaging.113.000201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sanjeev Bhattacharyya
- From the Department of Cardiology and Echocardiography Laboratory (S.B., R.K., N.C., R.S.), Department of Cardiovascular Surgery (N.M.), Royal Brompton Hospital, London, United Kingdom; and Biomedical Research Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom (R.S.)
| | - Rajdeep Khattar
- From the Department of Cardiology and Echocardiography Laboratory (S.B., R.K., N.C., R.S.), Department of Cardiovascular Surgery (N.M.), Royal Brompton Hospital, London, United Kingdom; and Biomedical Research Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom (R.S.)
| | - Nav Chahal
- From the Department of Cardiology and Echocardiography Laboratory (S.B., R.K., N.C., R.S.), Department of Cardiovascular Surgery (N.M.), Royal Brompton Hospital, London, United Kingdom; and Biomedical Research Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom (R.S.)
| | - Neil Moat
- From the Department of Cardiology and Echocardiography Laboratory (S.B., R.K., N.C., R.S.), Department of Cardiovascular Surgery (N.M.), Royal Brompton Hospital, London, United Kingdom; and Biomedical Research Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom (R.S.)
| | - Roxy Senior
- From the Department of Cardiology and Echocardiography Laboratory (S.B., R.K., N.C., R.S.), Department of Cardiovascular Surgery (N.M.), Royal Brompton Hospital, London, United Kingdom; and Biomedical Research Unit, National Heart and Lung Institute, Imperial College London, London, United Kingdom (R.S.)
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Mahfouz RA, Elawady W, Hossein E, Yosri A. Impact of Atrioventricular Compliance on Clinical Outcome of Patients Undergoing Successful Percutaneous Balloon Mitral Valvuloplasty. Echocardiography 2013; 30:1187-93. [DOI: 10.1111/echo.12256] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ragab A Mahfouz
- Cardiology Department; Zagazig University Hospital; Zagazig Egypt
| | - Waled Elawady
- Cardiology Department; Zagazig University Hospital; Zagazig Egypt
| | - Ekhlas Hossein
- Cardiology Department; Zagazig University Hospital; Zagazig Egypt
| | - Ahmad Yosri
- Cardiology Department; Zagazig University Hospital; Zagazig Egypt
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Plein S, Knuuti J, Edvardsen T, Saraste A, Piérard LA, Maurer G, Lancellotti P. The year 2012 in the European Heart Journal-Cardiovascular Imaging. Part II. Eur Heart J Cardiovasc Imaging 2013; 14:613-7. [PMID: 23729757 DOI: 10.1093/ehjci/jet084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The part II of the best of the European Heart Journal - Cardiovascular Imaging in 2012 specifically focuses on studies of valvular heart diseases, heart failure, cardiomyopathies, and congenital heart diseases.
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Current world literature. Curr Opin Cardiol 2013; 28:259-68. [PMID: 23381096 DOI: 10.1097/hco.0b013e32835ec472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Farkhooy A, Flachskampf FA. The most important publications of the past year in echocardiography. Herz 2013; 38:10-7. [PMID: 23324912 DOI: 10.1007/s00059-012-3742-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We review the published literature on clinical echocardiography of the past year. Key topics were valvular heart disease, in particular aortic stenosis, and the imaging requirements for transcatheter aortic valve implantation. Three-dimensional echocardiography and deformation imaging have yielded important new insights in valvular heart disease. Other key fields have been assessment of heart failure, in particular heart failure with preserved ejection fraction, and the relationship of this condition with diastolic dysfunction and left atrial function. Functional imaging of cardiomyopathies was also an important topic.
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Affiliation(s)
- A Farkhooy
- Institut för Medicinska Vetenskaper, Uppsala Universitet, Uppsala, Sweden.
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Dimitrova NA, Dimitrov GV, Bonow RO, Carabello BA, Erwin JP, Guyton RA, O’Gara PT, Ruiz CE, Skubas NJ, Sorajja P, Sundt TM, Thomas JD. Effect of electrical stimulus parameters on the development and propagation of action potentials in short excitable fibres. J Am Coll Cardiol 1988; 63:e57-185. [PMID: 2460319 DOI: 10.1016/j.jacc.2014.02.536] [Citation(s) in RCA: 1842] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Intracellular action potentials (IAPs) produced by short fibres in response to their electrical stimulation were analysed. IAPs were calculated on the basis of the Hodgkin-Huxley (1952) model by the method described by Joyner et al. (1978). Principal differences were found in processes of activation of short (semilength L less than 5 lambda) and long fibres under near-threshold stimulation. The shorter the fibre, the lower was the threshold value (Ithr). Dependence of the latency on the stimulus strength (Ist) was substantially non-linear and was affected by the fibre length. Both fibre length and stimulus strength influenced the IAP amplitude, the instantaneous propagation velocity (IPV) and the site of the first origin of the IAP (and, consequently, excitability of the short fibre membrane). With L less than or equal to 2 lambda and Ithr less than or equal to Ist less than or equal to 1.1Ithr, IPV could reach either very high values (so that all the fibre membrane fired practically simultaneously) or even negative values. The latter corresponded to the first origin of the propagated IAP, not at the site of stimulation but at the fibre termination or at a midpoint. The characters of all the above dependencies were unchanged irrespective of the manner of approaching threshold (variation of stimulus duration or its strength). Reasons for differences in processes of activation of short and long fibres are discussed in terms of electrical load and latency. Applications of the results to explain an increased jitter, velocity recovery function and velocity-diameter relationship are also discussed.
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Affiliation(s)
- N A Dimitrova
- CLBA, Centre of Biology, Bulgarian Academy of Sciences, Sofia
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