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Mattesi G, Pergola V, Bariani R, Martini M, Motta R, Perazzolo Marra M, Rigato I, Bauce B. Multimodality imaging in arrhythmogenic cardiomyopathy - From diagnosis to management. Int J Cardiol 2024; 407:132023. [PMID: 38583594 DOI: 10.1016/j.ijcard.2024.132023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 03/03/2024] [Accepted: 04/04/2024] [Indexed: 04/09/2024]
Abstract
Arrhythmogenic Cardiomyopathy (AC), an inherited cardiac disorder characterized by myocardial fibrofatty replacement, carries a significant risk of sudden cardiac death (SCD) due to ventricular arrhythmias. A comprehensive multimodality imaging approach, including echocardiography, cardiac magnetic resonance imaging (CMR), and cardiac computed tomography (CCT), allows for accurate diagnosis, effective risk stratification, vigilant monitoring, and appropriate intervention, leading to improved patient outcomes and the prevention of SCD. Echocardiography is primary tool ventricular morphology and function assessment, CMR provides detailed visualization, CCT is essential in early stages for excluding congenital anomalies and coronary artery disease. Echocardiography is preferred for follow-up, with CMR capturing changes over time. The strategic use of these imaging methods aids in confirming AC, differentiating it from other conditions, tracking its progression, managing complications, and addressing end-stage scenarios.
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Affiliation(s)
| | | | - Riccardo Bariani
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | - Marika Martini
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
| | | | - Barbara Bauce
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Italy
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Cosyns B, Haugaa KH. Multiparametric Approach to Asymptomatic Aortic Stenosis: New Surrogate Markers Are Welcome. JACC Cardiovasc Imaging 2024; 17:246-247. [PMID: 38032589 DOI: 10.1016/j.jcmg.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023]
Affiliation(s)
- Bernard Cosyns
- Center for Cardiovascular Disorders, Department of Cardiology, University Hospital Brussels, Free University of Brussels, Brussels, Belgium.
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Thellier N, Altes A, Rietz M, Menet A, Layec J, Outteryck F, Appert L, Tribouilloy C, Maréchaux S. Additive Prognostic Value of Left Ventricular Dispersion and Deformation in Patients With Severe Aortic Stenosis. JACC Cardiovasc Imaging 2024; 17:235-245. [PMID: 37943232 DOI: 10.1016/j.jcmg.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 09/12/2023] [Accepted: 09/25/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Speckle tracking strain echocardiography allows one to visualize the timing of maximum regional strain and quantifies left ventricular-mechanical dispersion (LV-MD). Whether LV-MD and LV-global longitudinal strain (LV-GLS) provide similar or complementary information in mortality risk stratification in patients with severe aortic stenosis (SAS) remains unknown. OBJECTIVES The authors hypothesized that LV mechanical dyssynchrony assessed by LV-MD is associated with an increased risk of mortality and provides additional prognostic information on top of LV-GLS in patients with SAS. METHODS A total of 364 patients with SAS (aortic valve area indexed ≤0.6 cm2/m2 and/or aortic valve area ≤1 cm2), LV ejection fraction ≥50% and no or mild symptoms were enrolled. The endpoint was overall mortality. RESULTS During a median follow-up period of 41 months, 149 patients died. After adjustment, LV-MD ≥68 ms was significantly associated with an increased risk of mortality (adjusted HR: 1.41; 95% CI: 1.01-1.96; P = 0.044). Adding LV-MD ≥68 ms to a multivariable Cox regression model including LV-GLS ≥-15% improved predictive performance in terms of overall mortality, with improved global model fit, reclassification, and better discrimination. Patients with both criteria had an important increase in mortality compared to patients with none or one criterion (adjusted HR: 2.02; 95% CI: 1.34-3.03; P = 0.001). Interobserver reproducibility of LV-MD was good with an intraclass correlation coefficient of 0.90 (95% CI: 0.72-0.97). CONCLUSIONS LV-MD is a reproducible parameter independently associated with an increased risk of mortality in SAS. Increased LV-MD associated with depressed LV-GLS identifies a subgroup of patients with an increased mortality risk. Whether early aortic valve replacement improves the outcome of these patients deserves further studies.
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Affiliation(s)
- Nicolas Thellier
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Alexandre Altes
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Michael Rietz
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Aymeric Menet
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Jeremy Layec
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - François Outteryck
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Ludovic Appert
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France
| | - Christophe Tribouilloy
- Amiens University Hospital Center, Amiens, France; EA 7517 MP3CV Jules Verne University of Picardie, Amiens, France
| | - Sylvestre Maréchaux
- Lille Catholic Hospitals, Heart Valve Center, Cardiology Department, ETHICS EA 7446, Lille Catholic University, Lille, France.
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Stąpór M, Piłat A, Misiuda A, Górkiewicz-Kot I, Kaleta M, Kleczyński P, Żmudka K, Legutko J, Kapelak B, Wierzbicki K, Gackowski A. Preoperative and mid-term right ventricular systolic function assessment, at rest and during exercise, with speckle-tracking echocardiography after left ventricular assist device implantation. Hellenic J Cardiol 2024; 76:31-39. [PMID: 37295667 DOI: 10.1016/j.hjc.2023.05.011] [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: 01/22/2023] [Revised: 04/12/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVES The study aimed to compare pre- and postoperative resting as well as postprocedural resting and exertional right ventricular speckle-tracking echocardiographic parameters at a mid-term follow-up after left ventricular assist device (LVAD) implantation. METHODS Patients with implanted third-generation LVADs with hydrodynamic bearings were prospectively enrolled (NCT05063006). Myocardial deformation was evaluated before pump implantation and at least three months after the procedure, both at rest and during exercise. RESULTS We included 22 patients, 7.3 months (IQR, 4.7-10.2) after the surgery. The mean age was 58.4 ± 7 years, 95.5% were men, and 45.5% had dilated cardiomyopathy. The RV strain analysis was feasible in all subjects both at rest and during exercise. The RV free wall strain (RVFWS) worsened from -13% (IQR, -17.3 to -10.9) to -11.3% (IQR, -12.9 to -6; p = 0.033) after LVAD implantation with a particular decline in the apical RV segment [-11.3% (IQR, -16.4 to -6.2) vs -7.8% (IQR, -11.7 to -3.9; p = 0.012)]. The RV four-chamber longitudinal strain (RV4CSL) remained unchanged [-8.5% (IQR, -10.8 to -6.9) vs -7.3% (IQR, -9.8 to -4.7; p = 0.184)]. Neither RVFWS (-11.3% (IQR, -12.9 to -6) vs -9.9% (IQR, -13.5 to -7.5; p = 0.077) nor RV4CSL [-7.3% (IQR, -9.8 to -4.7) vs -7.9% (IQR, -9.8 to -6.3; p = 0.548)] changed during the exercise test. CONCLUSIONS In patients who are pump-supported, the right ventricular free wall strain tends to worsen after LVAD implantation and remains unchanged during a cycle ergometer stress test.
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Affiliation(s)
- Maciej Stąpór
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland
| | - Adam Piłat
- AGH University of Science and Technology, Department of Automatic Control and Robotics, Kraków, Poland
| | - Agnieszka Misiuda
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland
| | - Izabela Górkiewicz-Kot
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Michał Kaleta
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Paweł Kleczyński
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Krzysztof Żmudka
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Jacek Legutko
- Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
| | - Bogusław Kapelak
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Karol Wierzbicki
- Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland; Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Kraków, Poland
| | - Andrzej Gackowski
- Noninvasive Cardiovascular Laboratory, John Paul II Hospital, Kraków, Poland; Department of Coronary Disease and Heart Failure, Faculty of Medicine, Institute of Cardiology, John Paul II Hospital, Jagiellonian University Medical College, Kraków, Poland.
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Bjerregaard CL, Biering-Sørensen T, Skaarup KG, Sengeløv M, Lassen MCH, Johansen ND, Olsen FJ. Right Ventricular Function in Arrhythmogenic Right Ventricular Cardiomyopathy: Potential Value of Strain Echocardiography. J Clin Med 2024; 13:717. [PMID: 38337410 PMCID: PMC10856386 DOI: 10.3390/jcm13030717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 01/19/2024] [Accepted: 01/22/2024] [Indexed: 02/12/2024] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy is an inherited cardiomyopathy, characterized by abnormal cell adhesions, disrupted intercellular signaling, and fibrofatty replacement of the myocardium. These changes serve as a substrate for ventricular arrhythmias, placing patients at risk of sudden cardiac death, even in the early stages of the disease. Current echocardiographic criteria for diagnosing arrhythmogenic right ventricular cardiomyopathy lack sensitivity, but novel markers of cardiac deformation are not subject to the same technical limitations as current guideline-recommended measures. Measuring cardiac deformation using speckle tracking allows for meticulous quantification of global systolic function, regional function, and dyssynchronous contraction. Consequently, speckle tracking to quantify myocardial strain could potentially be useful in the diagnostic process for the determination of disease progression and to assist risk stratification for ventricular arrhythmias and sudden cardiac death. This narrative review provides an overview of the potential use of different myocardial right ventricular strain measures for characterizing right ventricular dysfunction in arrhythmogenic right ventricular cardiomyopathy and its utility in assessing the risk of ventricular arrhythmias.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital—Rigshospitalet, 2100 Copenhagen, Denmark
- Steno Diabetes Center Copenhagen, 2730 Herlev, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Morten Sengeløv
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital—Herlev and Gentofte, 2900 Hellerup, Denmark; (C.L.B.)
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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Olivetti N, Sacilotto L, Moleta DB, de França LA, Capeline LS, Wulkan F, Wu TC, Pessente GD, de Carvalho MLP, Hachul DT, Pereira ADC, Krieger JE, Scanavacca MI, Vieira MLC, Darrieux F. Enhancing Arrhythmogenic Right Ventricular Cardiomyopathy Detection and Risk Stratification: Insights from Advanced Echocardiographic Techniques. Diagnostics (Basel) 2024; 14:150. [PMID: 38248027 PMCID: PMC10814792 DOI: 10.3390/diagnostics14020150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 12/29/2023] [Accepted: 01/02/2024] [Indexed: 01/23/2024] Open
Abstract
INTRODUCTION The echocardiographic diagnosis criteria for arrhythmogenic right ventricular cardiomyopathy (ARVC) are highly specific but sensitivity is low, especially in the early stages of the disease. The role of echocardiographic strain in ARVC has not been fully elucidated, although prior studies suggest that it can improve the detection of subtle functional abnormalities. The purposes of the study were to determine whether these advanced measures of right ventricular (RV) dysfunction on echocardiogram, including RV strain, increase diagnostic value for ARVC disease detection and to evaluate the association of echocardiographic parameters with arrhythmic outcomes. METHODS The study included 28 patients from the Heart Institute of São Paulo ARVC cohort with a definite diagnosis of ARVC established according to the 2010 Task Force Criteria. All patients were submitted to ECHO's advanced techniques including RV strain, and the parameters were compared to prior conventional visual ECHO and CMR. RESULTS In total, 28 patients were enrolled in order to perform ECHO's advanced techniques. A total of 2/28 (7%) patients died due to a cardiovascular cause, 2/28 (7%) underwent heart transplantation, and 14/28 (50%) patients developed sustained ventricular arrhythmic events. Among ECHO's parameters, RV dilatation, measured by RVDd (p = 0.018) and RVOT PSAX (p = 0.044), was significantly associated with arrhythmic outcomes. RV free wall longitudinal strain < 14.35% in absolute value was associated with arrhythmic outcomes (p = 0.033). CONCLUSION Our data suggest that ECHO's advanced techniques improve ARVC detection and that abnormal RV strain can be associated with arrhythmic risk stratification. Further studies are necessary to better demonstrate these findings and contribute to risk stratification in ARVC, in addition to other well-known risk markers.
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Affiliation(s)
- Natália Olivetti
- Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.); (T.C.W.); (G.D.P.); (D.T.H.); (M.I.S.)
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.C.); (F.W.); (M.L.P.d.C.); (A.d.C.P.); (J.E.K.)
| | - Luciana Sacilotto
- Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.); (T.C.W.); (G.D.P.); (D.T.H.); (M.I.S.)
| | - Danilo Bora Moleta
- Echocardiogram Imaging Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (D.B.M.); (M.L.C.V.)
| | - Lucas Arraes de França
- Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil;
| | - Lorena Squassante Capeline
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.C.); (F.W.); (M.L.P.d.C.); (A.d.C.P.); (J.E.K.)
| | - Fanny Wulkan
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.C.); (F.W.); (M.L.P.d.C.); (A.d.C.P.); (J.E.K.)
| | - Tan Chen Wu
- Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.); (T.C.W.); (G.D.P.); (D.T.H.); (M.I.S.)
| | - Gabriele D’Arezzo Pessente
- Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.); (T.C.W.); (G.D.P.); (D.T.H.); (M.I.S.)
| | - Mariana Lombardi Peres de Carvalho
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.C.); (F.W.); (M.L.P.d.C.); (A.d.C.P.); (J.E.K.)
| | - Denise Tessariol Hachul
- Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.); (T.C.W.); (G.D.P.); (D.T.H.); (M.I.S.)
| | - Alexandre da Costa Pereira
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.C.); (F.W.); (M.L.P.d.C.); (A.d.C.P.); (J.E.K.)
| | - José E. Krieger
- Laboratory of Genetics and Molecular Cardiology, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.C.); (F.W.); (M.L.P.d.C.); (A.d.C.P.); (J.E.K.)
| | - Mauricio Ibrahim Scanavacca
- Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.); (T.C.W.); (G.D.P.); (D.T.H.); (M.I.S.)
| | - Marcelo Luiz Campos Vieira
- Echocardiogram Imaging Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (D.B.M.); (M.L.C.V.)
- Echocardiogram Imaging Unit, Hospital Israelita Albert Einstein, Sao Paulo 05652-900, Brazil;
| | - Francisco Darrieux
- Arrhythmia Unit, Instituto do Coração (InCor), Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, Sao Paulo 05403-900, Brazil; (L.S.); (T.C.W.); (G.D.P.); (D.T.H.); (M.I.S.)
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Namasivayam M, Bertrand PB, Bernard S, Churchill TW, Khurshid S, Marcus FI, Mestroni L, Saffitz JE, Towbin JA, Zareba W, Picard MH, Sanborn DY. Utility of Left and Right Ventricular Strain in Arrhythmogenic Right Ventricular Cardiomyopathy: A Prospective Multicenter Registry. Circ Cardiovasc Imaging 2023; 16:e015671. [PMID: 38113321 PMCID: PMC10803132 DOI: 10.1161/circimaging.123.015671] [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: 05/06/2023] [Accepted: 11/13/2023] [Indexed: 12/21/2023]
Abstract
BACKGROUND Imaging evaluation of arrhythmogenic right ventricular cardiomyopathy (ARVC) remains challenging. Myocardial strain assessment by echocardiography is an increasingly utilized technique for detecting subclinical left ventricular (LV) and right ventricular (RV) dysfunction. We aimed to evaluate the diagnostic and prognostic utility of LV and RV strain in ARVC. METHODS Patients with suspected ARVC (n = 109) from a multicenter registry were clinically phenotyped using the 2010 ARVC Revised Task Force Criteria and underwent baseline strain echocardiography. Diagnostic performance of LV and RV strain was evaluated using the area under the receiver operating characteristic curve analysis against the 2010 ARVC Revised Task Force Criteria, and the prognostic value was assessed using the Kaplan-Meier analysis. RESULTS Mean age was 45.3±14.7 years, and 48% of patients were female. Estimation of RV strain was feasible in 99/109 (91%), and LV strain was feasible in 85/109 (78%) patients. ARVC prevalence by 2010 ARVC Revised Task Force Criteria is 91/109 (83%) and 83/99 (84%) in those with RV strain measurements. RV global longitudinal strain and RV free wall strain had diagnostic area under the receiver operating characteristic curve of 0.76 and 0.77, respectively (both P<0.001; difference NS). Abnormal RV global longitudinal strain phenotype (RV global longitudinal strain > -17.9%) and RV free wall strain phenotype (RV free wall strain > -21.2%) were identified in 41/69 (59%) and 56/69 (81%) of subjects, respectively, who were not identified by conventional echocardiographic criteria but still met the overall 2010 ARVC Revised Task Force Criteria for ARVC. LV global longitudinal strain did not add diagnostic value but was prognostic for composite end points of death, heart transplantation, or ventricular arrhythmia (log-rank P=0.04). CONCLUSIONS In a prospective, multicenter registry of ARVC, RV strain assessment added diagnostic value to current echocardiographic criteria by identifying patients who are missed by current echocardiographic criteria yet still fulfill the diagnosis of ARVC. LV strain, by contrast, did not add incremental diagnostic value but was prognostic for identification of high-risk patients.
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Affiliation(s)
- Mayooran Namasivayam
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Cardiology, St Vincent’s Hospital, Faculty of Medicine and Health, University of New South Wales, Victor Chang Cardiac Research Institute, Sydney, Australia
| | - Philippe B. Bertrand
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Department of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Samuel Bernard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
- Division of Cardiology, NYU Langone Health, New York University
| | - Timothy W. Churchill
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | - Shaan Khurshid
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
| | | | - Luisa Mestroni
- Division of Cardiology and Cardiovascular Institute, University of Colorado Anschutz Medical Campus, Aurora
| | | | - Jeffrey A. Towbin
- St. Jude Children’s Research Hospital, University of Tennessee Health Science Center, Memphis
| | | | - Michael H. Picard
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston
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Kirkels FP, Rootwelt-Norberg C, Bosman LP, Aabel EW, Muller SA, Castrini AI, Taha K, van Osta N, Lie ØH, Asselbergs FW, Lumens J, te Riele ASJM, Hasselberg NE, Cramer MJ, Haugaa KH, Teske AJ. The added value of abnormal regional myocardial function for risk prediction in arrhythmogenic right ventricular cardiomyopathy. Eur Heart J Cardiovasc Imaging 2023; 24:1710-1718. [PMID: 37474315 PMCID: PMC10667035 DOI: 10.1093/ehjci/jead174] [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: 05/15/2023] [Revised: 07/13/2023] [Accepted: 07/13/2023] [Indexed: 07/22/2023] Open
Abstract
AIMS A risk calculator for individualized prediction of first-time sustained ventricular arrhythmia (VA) in arrhythmogenic right ventricular cardiomyopathy (ARVC) patients has recently been developed and validated (www.ARVCrisk.com). This study aimed to investigate whether regional functional abnormalities, measured by echocardiographic deformation imaging, can provide additional prognostic value. METHODS AND RESULTS From two referral centres, 150 consecutive patients with a definite ARVC diagnosis, no prior sustained VA, and an echocardiogram suitable for deformation analysis were included (aged 41 ± 17 years, 50% female). During a median follow-up of 6.3 (interquartile range 3.1-9.8) years, 37 (25%) experienced a first-time sustained VA. All tested left and right ventricular (LV and RV) deformation parameters were univariate predictors for first-time VA. While LV function did not add predictive value in multivariate analysis, two RV deformation parameters did; RV free wall longitudinal strain and regional RV deformation patterns remained independent predictors after adjusting for the calculator-predicted risk [hazard ratio 1.07 (95% CI 1.02-1.11); P = 0.004 and 4.45 (95% CI 1.07-18.57); P = 0.040, respectively] and improved its discriminative value (from C-statistic 0.78 to 0.82 in both; Akaike information criterion change > 2). Importantly, all patients who experienced VA within 5 years from the echocardiographic assessment had abnormal regional RV deformation patterns at baseline. CONCLUSIONS This study showed that regional functional abnormalities measured by echocardiographic deformation imaging can further refine personalized arrhythmic risk prediction when added to the ARVC risk calculator. The excellent negative predictive value of normal RV deformation could support clinicians considering the timing of implantable cardioverter defibrillator implantation in patients with intermediate arrhythmic risk.
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Affiliation(s)
- Feddo P Kirkels
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christine Rootwelt-Norberg
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Laurens P Bosman
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
| | - Eivind W Aabel
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Steven A Muller
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Anna I Castrini
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karim Taha
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
| | - Nick van Osta
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Øyvind H Lie
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Folkert W Asselbergs
- Department of Cardiology, Amsterdam University Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands
| | - Anneline S J M te Riele
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
- Netherlands Heart Institute, Utrecht, The Netherlands
| | - Nina E Hasselberg
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maarten J Cramer
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
| | - Kristina H Haugaa
- ProCardio Centre for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Arco J Teske
- Division of Heart and Lungs, Department of Cardiology, University Medical Centre Utrecht, Heidelberglaan 100, Utrecht 3582 CX, The Netherlands
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9
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Gasperetti A, James CA, Carrick RT, Protonotarios A, te Riele ASJM, Cadrin-Tourigny J, Compagnucci P, Duru F, van Tintelen P, Elliot PM, Calkins H. Arrhythmic risk stratification in arrhythmogenic right ventricular cardiomyopathy. Europace 2023; 25:euad312. [PMID: 37935403 PMCID: PMC10674106 DOI: 10.1093/europace/euad312] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/19/2023] [Indexed: 11/09/2023] Open
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a heritable cardiomyopathy characterized by a predominantly arrhythmic presentation. It represents the leading cause of sudden cardiac death (SCD) among athletes and poses a significant morbidity threat in the general population. As a causative treatment for ARVC is still not available, the placement of an implantable cardioverter defibrillator represents the current cornerstone for SCD prevention in this setting. Thanks to international ARVC-dedicated efforts, significant steps have been achieved in recent years towards an individualized, patient-centred risk stratification approach. A novel risk calculator algorithm estimating the 5-year risk of arrhythmias of patients with ARVC has been introduced in clinical practice and subsequently validated. The purpose of this article is to summarize the body of evidence that has allowed the development of this tool and to discuss the best way to implement its use in the care of an individual patient.
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MESH Headings
- Humans
- Risk Factors
- Arrhythmogenic Right Ventricular Dysplasia/complications
- Arrhythmogenic Right Ventricular Dysplasia/diagnosis
- Arrhythmogenic Right Ventricular Dysplasia/therapy
- Death, Sudden, Cardiac/etiology
- Death, Sudden, Cardiac/prevention & control
- Death, Sudden, Cardiac/epidemiology
- Arrhythmias, Cardiac/diagnosis
- Arrhythmias, Cardiac/therapy
- Arrhythmias, Cardiac/complications
- Defibrillators, Implantable/adverse effects
- Risk Assessment
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Affiliation(s)
- Alessio Gasperetti
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Cynthia A James
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | - Richard T Carrick
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
| | | | - Anneline S J M te Riele
- Department of Medicine, Division of Cardiology, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, Utrecht, Utrecht, The Netherlands
| | - Julia Cadrin-Tourigny
- Cardiovascular Genetics Center, Montreal Heart Institute, Université de Montréal, Montréal, QC, Canada
| | - Paolo Compagnucci
- Cardiology and Arrhythmology Clinic, Marche University Hospital, Ancona, Italy
| | - Firat Duru
- Department of Cardiology, Arrhythmia Unit, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Peter van Tintelen
- Department of Genetics, University Medical Center Utrecht, University of Utrecht, Heidelberglaan 100, Utrecht, The Netherlands
| | - Perry M Elliot
- Department of Cardiology, UCL Institute of Cardiovascular Science, London, UK
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University, Blalock 545, 600 N. Wolfe St., Baltimore, MD 21287, USA
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10
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Asatryan B. Detecting Concealed Phase and Progression in Subclinical ARVC: Tackling the Age Spectrum Challenge. J Am Coll Cardiol 2023; 82:798-800. [PMID: 37612011 DOI: 10.1016/j.jacc.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/05/2023] [Indexed: 08/25/2023]
Affiliation(s)
- Babken Asatryan
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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11
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Bjerregaard CL, Skaarup KG, Lassen MCH, Biering-Sørensen T, Olsen FJ. Strain Imaging and Ventricular Arrhythmia. Diagnostics (Basel) 2023; 13:diagnostics13101778. [PMID: 37238262 DOI: 10.3390/diagnostics13101778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 05/11/2023] [Accepted: 05/13/2023] [Indexed: 05/28/2023] Open
Abstract
Ventricular arrhythmia is one of the main causes of sudden cardiac death. Hence, identifying patients at risk of ventricular arrhythmias and sudden cardiac death is important but can be challenging. The indication for an implantable cardioverter defibrillator as a primary preventive strategy relies on the left ventricular ejection fraction as a measure of systolic function. However, ejection fraction is flawed by technical constraints and is an indirect measure of systolic function. There has, therefore, been an incentive to identify other markers to optimize the risk prediction of malignant arrhythmias to select proper candidates who could benefit from an implantable cardioverter defibrillator. Speckle-tracking echocardiography allows for a detailed assessment of cardiac mechanics, and strain imaging has repeatedly been shown to be a sensitive technique to identify systolic dysfunction unrecognized by ejection fraction. Several strain measures, including global longitudinal strain, regional strain, and mechanical dispersion, have consequently been proposed as potential markers of ventricular arrhythmias. In this review, we will provide an overview of the potential use of different strain measures in the context of ventricular arrhythmias.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark
- Center for Translational Cardiology and Pragmatic Randomized Trials, Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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12
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Rothschild E, Baruch G, Kaplan A, Laufer-Perl M, Beer G, Kapusta L, Topilsky Y. The prognostic value of right ventricular strain and mechanical dispersion on mortality in patients with normal left ventricle function. Int J Cardiol 2023; 372:130-137. [PMID: 36450336 DOI: 10.1016/j.ijcard.2022.11.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/15/2022] [Accepted: 11/22/2022] [Indexed: 11/29/2022]
Abstract
AIMS We aimed to assess if right ventricular (RV) 4-chamber longitudinal strain (RV4CLS), RV free wall longitudinal strain (RVFWLS) and RV mechanical dispersion index (RVMDI) have prognostic independent value in patients with preserved ejection fraction (pEF), without clearly elevated LV filling pressure. METHODS Retrospective analysis of Peak RV4CLS, RVFWLS, RVMDI and comprehensive echocardiographic assessment including left ventricle (LV), atrium (LA) strain and RV parameters in patients with pEF (EF ≥ 50%; E/e' < 14). Multivariate Cox regression hazards model were used to determine the independent association between RV strain parameters to all-cause mortality and cardiovascular events. RESULTS We analyzed 224 consecutive patients with pEF (age 65.2 ± 19.8, 44% female, Charlson Comorbidity Index median = 3.8), with all-cause mortality of 64 patients and 28 cardiovascular events, during a median follow-up of 8.2 years (interquartile range: 6.8 to 8.4 years). The best strain univariate predictors of mortality were RV4CSL [1.16 (1.07-1.26); p = 0.0001] and RVMDI [1.01 (1.001-1.02); p = 0.02] being superior to LV and LA strain, or other RV functional indices. Moreover, after adjustment for clinical (age, gender, Charlson Comorbidity Index), conventional echocardiographic parameters (LA volume, E/e' average, LVEDD, routine RV functional indices), LV and LA STE, RV4CLS and RVFWLS remained statistically significant associates of all-cause mortality and cardiac events. RV4CLS, or RVFWLS remained statistically significant associated for all-cause mortality, after additional adjustment for RVFAC and RVMDI. CONCLUSIONS RV4CSL and RVMDI provide significant prognostic additive value in patients with preserved ejection fraction with excellent reproducibility, incremental to routine clinical, hemodynamic and LV and LA STE parameters.
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Affiliation(s)
- Ehud Rothschild
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Guy Baruch
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Alon Kaplan
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Beer
- Department of Paediatrics, Paediatric Cardiology Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Livia Kapusta
- Department of Paediatrics, Paediatric Cardiology Unit, Tel Aviv Sourasky Medical Centre and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Paediatric Cardiology, Amalia Children's Hospital, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
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13
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Aljehani A, Kew T, Baig S, Cox H, Sommerfeld LC, Ensam B, Kalla M, Steeds RP, Fabritz L. Characterisation of patients referred to a tertiary-level inherited cardiac condition clinic with suspected arrhythmogenic right ventricular cardiomyopathy (ARVC). BMC Cardiovasc Disord 2023; 23:14. [PMID: 36635648 PMCID: PMC9837886 DOI: 10.1186/s12872-022-03021-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 12/19/2022] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND Arrhythmogenic right ventricular cardiomyopathy (ARVC) or arrhythmogenic cardiomyopathy is a rare inherited disease with incomplete penetrance and an environmental component. Although a rare disease, ARVC is a common cause of sudden cardiac death in young adults. Data on the different stages of ARVC remains scarce. The purpose of this study is to describe the initial presentation and cardiac phenotype of definite and non-definite ARVC for patients seen at a tertiary service. METHODS This is a single centre, observational cohort study of patients with definite and non-definite ARVC seen at the Inherited Cardiac Conditions services at University Hospital Birmingham (UHB) in the period 2010-2021. Patients were identified by interrogation of digital health records, medical history, imaging and by examining 12-lead electrocardiograms (ECG). RESULT The records of 1451 patients were reviewed; of those, 165 patients were at risk of ARVC (mean age 41 ± 17 years, 56% male). 60 patients fulfilled task force criteria for definite ARVC diagnosis (n = 40, 67% males), and 38 (72%) of them carried a known pathogenic variant. The remaining 105 patients (50% males) were non-definite, and of these 45 (62%) carried a known pathogenic variant. Patients in the definite group were more symptomatic, with palpitations (57% vs. 17%), syncope (35% vs. 6%) and shortness of breath (28% vs. 5%, p < 0.001). T-wave inversion in V1-V3 and epsilon waves were observed only in the definite group. Both PR interval and QRS duration were longer in the definite (170 ± 34 ms and 100 ± 19 ms, p < 0.001) compared to (149 ± 25 and 91 ± 14 ms, p = 0.005). Patients with definite ARVC had significantly larger RV end diastolic areas and significantly reduced biventricular function (RVEDA = 27 ± 10 cm2, RVFAC = 37 ± 11% and EF = 56 ± 12%) compared to the non-definite group (RVEDA = 18 ± 4 cm2, RVFAC 49 ± 6% and LVEF 64 ± 7%, p < 0.001). Sustained ventricular tachycardia (VT) occurred more frequently in the definite group compared to the non-definite group (27% vs. 2%, p < 0.001). Ventricular fibrillation was observed in the definite group only (8 of 60 patients, 13%). CONCLUSION Our study showed differences between definite and non-definite ARVC patients in terms of clinical, electrophysiological and imaging features. Major adverse cardiac events occurred more commonly in the definite group, but also were observed in non-definite ARVC. This single centre observational cohort study forms a basis for further prospective multicentre interventional studies.
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Affiliation(s)
- A. Aljehani
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,grid.412149.b0000 0004 0608 0662King Saud Bin Abdulaziz University For Health Sciences, Echocardiography Cardiovascular Technology (ECVT) Program, Riyadh, Saudi Arabia
| | - T. Kew
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - S. Baig
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - H. Cox
- grid.498025.20000 0004 0376 6175West Midlands Regional Genetics Unit, Clinical Genetics, Birmingham Women’s and Children’s NHS Foundation Trust (BWC) Birmingham, Birmingham, UK
| | - L. C. Sommerfeld
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.13648.380000 0001 2180 3484University Centre of Cardiovascular Science, UKE Hamburg, Hamburg, Germany
| | - B. Ensam
- grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - M. Kalla
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R. P. Steeds
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - L. Fabritz
- grid.6572.60000 0004 1936 7486Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, UK ,grid.412563.70000 0004 0376 6589Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK ,Department of Cardiology, University Heart and Vascular Centre Hamburg, UKE Hamburg and DZHK, Hamburg/Kiel/Luebeck, Germany ,grid.13648.380000 0001 2180 3484University Centre of Cardiovascular Science, UKE Hamburg, Hamburg, Germany
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14
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Forså MI, Bjerring AW, Haugaa KH, Smedsrud MK, Sarvari SI, Landgraff HW, Hallén J, Edvardsen T. Young athlete's growing heart: sex differences in cardiac adaptation to exercise training during adolescence. Open Heart 2023; 10:openhrt-2022-002155. [PMID: 36596623 DOI: 10.1136/openhrt-2022-002155] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 12/13/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Athlete's heart is a condition of exercise-induced cardiac remodelling. Adult male endurance athletes more often remodel beyond reference values. The impact of sex on remodelling through adolescence remains unclear. Paediatric reference values do not account for patient sex or exercise history. We aimed to study the effect of sex on cardiac remodelling throughout adolescence. METHODS We recruited 76 male (M) and female (F) 12-year-old cross-country skiers in a longitudinal cohort study. Echocardiography was performed and analysed according to guidelines at age 12 (48 M, 28 F), 15 (34 M, 14 F) and 18 (23 M, 11 F). Repeated echocardiographic measurements were analysed by linear mixed model regression. RESULTS Males displayed greater indexed left ventricular end-diastolic volumes (LV EDVi) from age 12 (M 81±7 vs F 76±7, mL/m², p≤0.01), and progressed further until follow-up at age 18 (M 2.3±9.7 vs F -3.9±4.5 ΔmL/m², p≤0.01). LV EDVi remained above adult upper reference values in both groups. Males increased LV Mass Index from age 12 to 18 (M 33±27 vs F 4±19, Δg/m², p≤0.01). Males displayed LV mass above paediatric reference values at ages 15 and 18. A subset of males (35%) and females (25%) displayed wall thickness above paediatric reference values at age 12. Cardiac function was normal. There was no sex difference in exercise hours. CONCLUSION Sex-related differences in athlete's heart were evident from age 12, and progressed throughout adolescence. Remodelling beyond reference values was more frequent than previously reported, particularly affecting males. Age, sex and exercise history may assist clinicians in distinguishing exercise-induced remodelling from pathology in adolescents.
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Affiliation(s)
- Marianne Inngjerdingen Forså
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anders W Bjerring
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Kristine Smedsrud
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Paediatric Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Sebastian I Sarvari
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Hege W Landgraff
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Jostein Hallén
- Department of Physical Performance, Norwegian School of Sports Sciences, Oslo, Norway
| | - Thor Edvardsen
- ProCardio Center for Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway .,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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15
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Sharma A, Bosman LP, Tichnell C, Nanavati J, Murray B, Nonyane BA, Tandri H, Calkins H, James CA. Arrhythmogenic Right Ventricular Cardiomyopathy Prevalence and Arrhythmic Outcomes in At-Risk Family Members: A Systematic Review and Meta-Analysis. Circ Genom Precis Med 2022; 15:e003530. [DOI: 10.1161/circgen.121.003530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background:
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a complex cardiomyopathy with autosomal dominant inheritance and age-related incomplete penetrance, characterized by a high risk of sudden cardiac death. Recent professional consensus guidelines recommend clinical cardiac lifelong serial screening for at-risk family members refined only by age, but family genotype might influence necessary screening. Although numerous studies report prevalence of disease and arrhythmia in family members and explore predictors of penetrance and arrhythmic risk, a systematic review consolidating this evidence is lacking.
Methods:
We searched Medline (PubMed), Embase, The Cochrane Library, and Web of Science for studies that reported prevalence of (1) diagnosis of ARVC per 2010 Task Force Criteria and/or (2) sustained ventricular arrhythmias (VA) in at least 10 family members of definite patients with ARVC.
Results:
We identified 41 studies, including 36 that reported diagnosis by Task Force Criteria and 22 VA. Meta-analysis of 1359 family members, from 13 unique cohorts showed an average prevalence estimate of 25% for diagnosis as per Task Force Criteria (95% CI, 0.15–0.35, I
2
=
96.44%). Overall prevalence of VA among gene-positive family members was 18% (95% CI, 0.13–0.23, I
2
=33.25%) in 7 independent studies (n=597). Family genotype was a significant risk factor for diagnosis of both ARVC (odds ratio, 6.91 [95% CI, 1.27–37.70];
P
=0.0005) and VA (odds ratio, 13.62 [95% CI, 0.91–204.13];
P
=0.06). Male gender was not associated with disease prevalence (odds ratio, 1.18 [95% CI, 0.72–1.95];
P
=0.42) or VA (odds ratio, 0.81 [95% CI, 0.51–1.29];
P
=0.91).
Conclusions:
The prevalence of ARVC and VA in at-risk family members differs significantly based on family genotype. Although recent recommendations provide a guideline based only on age, we propose screening every 1 to 2 years for gene-positive family members and every 3 to 5 years for first-degree relatives of gene-elusive cases, as long as they are asymptomatic and not athletes.
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Affiliation(s)
- Apurva Sharma
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.S., C.T., B.M., H.T., H.C., C.A.J.)
| | - Laurens P. Bosman
- Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, the Netherlands (L.P.B.)
| | - Crystal Tichnell
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.S., C.T., B.M., H.T., H.C., C.A.J.)
| | - Julie Nanavati
- Welch Medical Library, Johns Hopkins School of Medicine (J.N.)
| | - Brittney Murray
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.S., C.T., B.M., H.T., H.C., C.A.J.)
| | - Bareng A.S. Nonyane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (B.A.S.N.)
| | - Harikrishna Tandri
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.S., C.T., B.M., H.T., H.C., C.A.J.)
| | - Hugh Calkins
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.S., C.T., B.M., H.T., H.C., C.A.J.)
| | - Cynthia A. James
- Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD (A.S., C.T., B.M., H.T., H.C., C.A.J.)
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16
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Contemporary Diagnosis and Management of Hypertrophic Cardiomyopathy: The Role of Echocardiography and Multimodality Imaging. J Cardiovasc Dev Dis 2022; 9:jcdd9060169. [PMID: 35735798 PMCID: PMC9224724 DOI: 10.3390/jcdd9060169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 05/15/2022] [Accepted: 05/16/2022] [Indexed: 01/27/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is an underdiagnosed genetic heart disease with an estimated prevalence of 0.2–0.5%. Although the prognosis of HCM is relatively good, with an annual general mortality of ~0.7%, some patients have an increased risk of sudden death, or of developing severe heart failure requiring heart transplantation or left ventricular (LV) assist device therapy. Therefore, earlier diagnosis and proper identification of high-risk patients may reduce disease-related morbidity/mortality by promoting timely treatment. Echocardiography is the primary imaging modality for patients with suspected HCM; it plays central roles in differential diagnosis from other causes of LV hypertrophy and in evaluating morphology, hemodynamic disturbances, LV function, and associated valvular disease. Echocardiography is also an essential tool for the continuous clinical management of patients with confirmed HCM. Other imaging modalities, such as cardiac computed tomography (CT) and cardiac magnetic resonance imaging (MRI), can supplement echocardiography in identifying high-risk as well as milder HCM phenotypes. The role of such multimodality imaging has been steadily expanding along with recent advancements in surgical techniques and minimally invasive procedures, and the emergence of novel pharmacotherapies directly targeting pathogenic molecules such as myosin inhibitors. Here we review essential knowledge surrounding HCM with a specific focus on structural and functional abnormalities assessed by imaging modalities, leading to treatment strategies.
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17
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Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Clin Electrophysiol 2022; 8:533-553. [PMID: 35450611 DOI: 10.1016/j.jacep.2021.12.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 01/21/2023]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) encompasses a group of conditions characterized by right ventricular fibrofatty infiltration, with a predominant arrhythmic presentation. First described in the late 1970s and early 1980s, it is now frequently recognized to have biventricular involvement. The prevalence is ∼1:2,000 to 1:5,000, depending on geographic location, and it has a slight male predominance. The diagnosis of ARVC is determined on the basis of fulfillment of task force criteria incorporating electrophysiological parameters, cardiac imaging findings, genetic factors, and histopathologic features. Risk stratification of patients with ARVC aims to identify those who are at increased risk of sudden cardiac death or sustained ventricular tachycardia. Factors including age, sex, electrophysiological features, and cardiac imaging investigations all contribute to risk stratification. The current management of ARVC includes exercise restriction, β-blocker therapy, consideration for implantable cardioverter-defibrillator insertion, and catheter ablation. This review summarizes our current understanding of ARVC and provides clinicians with a practical approach to diagnosis and management.
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18
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Harapoz M, Zada M, Matthews J, Kumar S, Thomas L. Echocardiographic predictors of ventricular arrhythmias in patients with non-ischemic cardiomyopathy. IJC HEART & VASCULATURE 2022; 39:100962. [PMID: 35169613 PMCID: PMC8829059 DOI: 10.1016/j.ijcha.2022.100962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 01/19/2022] [Indexed: 11/03/2022]
Abstract
Objective Methods Results Conclusion
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19
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Corbo MD, Vitale E, Pesolo M, Casavecchia G, Gravina M, Pellegrino P, Brunetti ND, Iacoviello M. Recent Non-Invasive Parameters to Identify Subjects at High Risk of Sudden Cardiac Death. J Clin Med 2022; 11:jcm11061519. [PMID: 35329848 PMCID: PMC8955301 DOI: 10.3390/jcm11061519] [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] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 03/03/2022] [Accepted: 03/07/2022] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular diseases remain among the leading causes of death worldwide and sudden cardiac death (SCD) accounts for ~25% of these deaths. Despite its epidemiologic relevance, there are very few diagnostic strategies available useful to prevent SCD mainly focused on patients already affected by specific cardiovascular diseases. Unfortunately, most of these parameters exhibit poor positive predictive accuracy. Moreover, there is also a need to identify parameters to stratify the risk of SCD among otherwise healthy subjects. This review aims to provide an update on the most relevant non-invasive diagnostic features to identify patients at higher risk of developing malignant ventricular arrhythmias and SCD.
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Affiliation(s)
- Maria Delia Corbo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Enrica Vitale
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Maurizio Pesolo
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Grazia Casavecchia
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Matteo Gravina
- University Radiology Unit, University Polyclinic Hospital of Foggia, 71100 Foggia, Italy;
| | - Pierluigi Pellegrino
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Natale Daniele Brunetti
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
| | - Massimo Iacoviello
- Cardiology Unit, Department of Medical and Surgical Sciences, University Polyclinic Hospital of Foggia, University of Foggia, 71100 Foggia, Italy; (M.D.C.); (E.V.); (M.P.); (G.C.); (P.P.); (N.D.B.)
- Correspondence: or
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20
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Echocardiographic Deformation Imaging for Early Detection of Genetic Cardiomyopathies: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:594-608. [PMID: 35144751 DOI: 10.1016/j.jacc.2021.11.045] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 12/14/2022]
Abstract
Clinical screening of the relatives of patients with genetic cardiomyopathies is challenging, as they often lack detectable cardiac abnormalities at presentation. Life-threatening adverse events can already occur in these early stages of disease, so sensitive tools to reveal the earliest signs of disease are needed. The utility of echocardiographic deformation imaging for early detection has been explored for this population in multiple studies but has not been broadly implemented in clinical practice. The authors discuss contemporary evidence on the utility of deformation imaging in relatives of patients with genetic cardiomyopathies. The available body of data shows that deformation imaging reveals early disease-specific abnormalities in dilated cardiomyopathy, hypertrophic cardiomyopathy, and arrhythmogenic cardiomyopathy. Deformation imaging seems promising to enhance the screening and follow-up protocols in relatives, and the authors propose measures to accelerate its implementation in clinical care.
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21
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Laufer-Perl M, Perelman-Gvili M, Sirota Dorfman S, Baruch G, Rothschild E, Beer G, Arbel Y, Arnold JH, Rozenbaum Z, Banai S, Topilsky Y, Kapusta L. Prevalence of Right Ventricle Strain Changes following Anthracycline Therapy. Life (Basel) 2022; 12:life12020291. [PMID: 35207578 PMCID: PMC8877607 DOI: 10.3390/life12020291] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/04/2022] [Accepted: 02/11/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Anthracycline (ANT) is the most recognized therapy known to cause cardiotoxicity, mainly left ventricle (LV) dysfunction. Global Longitudinal Strain (GLS) is the optimal tool for assessment of subclinical LV dysfunction. Right ventricle (RV) function has been recognized as an independent factor for cardiac outcomes; however, data evaluating RV GLS is limited. We aimed to evaluate the change in RV GLS following ANT therapy. Methods: The study cohort is part of the Israel Cardio-Oncology Registry (ICOR). All patients performed echocardiography before (T1) and at the end (T3) of ANT therapy. A significant reduction was defined as a relative reduction of ≥10% in RV GLS values. Results: The study included 40 female patients with breast cancer treated with ANT. During follow-up, both RV GLS and free wall longitudinal strain systolic peak (RV FWLS PK) decreased significantly (p < 0.001 and p = 0.002). Altogether, 30 (75%) and 23 (58%) patients showed RV GLS and RV FWLS PK ≥ 10% relative reduction. At T3, LV ejection fraction and LV GLS were within normal range. Conclusions: RV GLS and RV FWLS PK reduction following ANT exposure is extremely frequent, comparing to LV GLS reduction.
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Affiliation(s)
- Michal Laufer-Perl
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
- Correspondence: (M.L.-P.); (M.P.-G.); Tel.: +972-3-6974509 (M.L.-P.); Fax: +972-3-6974388 (M.L.-P.)
| | - Moran Perelman-Gvili
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
- Internal Medicine T, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel
- Correspondence: (M.L.-P.); (M.P.-G.); Tel.: +972-3-6974509 (M.L.-P.); Fax: +972-3-6974388 (M.L.-P.)
| | - Svetlana Sirota Dorfman
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Guy Baruch
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Ehud Rothschild
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva 8410501, Israel
| | - Gil Beer
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
- Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel
| | - Yaron Arbel
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
| | - Joshua H. Arnold
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
- Department of Medicine, University of Illinois at Chicago, 1853 W. Polk (MC 785), Chicago, IL 60612-7332, USA
| | - Zach Rozenbaum
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
| | - Shmuel Banai
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
| | - Yan Topilsky
- Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel; (S.S.D.); (G.B.); (E.R.); (Y.A.); (Z.R.); (S.B.); (Y.T.)
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
| | - Livia Kapusta
- Sackler School of Medicine, Tel Aviv University, Ramat Aviv, P.O. Box 39040, Tel Aviv 6997801, Israel; (G.B.); (J.H.A.); (L.K.)
- Pediatric Cardiology Unit, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 6423906, Israel
- Department of Pediatric Cardiology, Amalia Children’s Hospital, Radboud University Medical Centre, Greet Grooteplein Zuid 32, 6525 Nijmegen, The Netherlands
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22
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Malik N, Mukherjee M, Wu KC, Zimmerman SL, Zhan J, Calkins H, James CA, Gilotra NA, Sheikh FH, Tandri H, Kutty S, Hays AG. Multimodality Imaging in Arrhythmogenic Right Ventricular Cardiomyopathy. Circ Cardiovasc Imaging 2022; 15:e013725. [PMID: 35147040 DOI: 10.1161/circimaging.121.013725] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Arrhythmogenic right ventricular cardiomyopathy (ARVC) is a rare, heritable myocardial disease associated with the development of ventricular arrhythmias, heart failure, and sudden cardiac death in early adulthood. Multimodality imaging is a central component in the diagnosis and evaluation of ARVC. Diagnostic criteria established by an international task force in 2010 include noninvasive parameters from echocardiography and cardiac magnetic resonance imaging. These criteria identify right ventricular structural abnormalities, chamber and outflow tract dilation, and reduced right ventricular function as features of ARVC. Echocardiography is a widely available and cost-effective technique, and it is often selected for initial evaluation. Beyond fulfillment of diagnostic criteria, features such as abnormal tricuspid annular plane excursion, increased right ventricular basal diameter, and abnormal strain patterns have been described. 3-dimensional echocardiography may also expand opportunities for structural and functional assessment of ARVC. Cardiac magnetic resonance has the ability to assess morphological and functional cardiac features of ARVC and is also a core modality in evaluation, however, tissue characterization of the right ventricle is limited by spatial resolution and low specificity for detection of pathological changes. Nonetheless, the ability of cardiac magnetic resonance to identify left ventricular involvement, offer high negative predictive value, and provide a reproducible structural evaluation of the right ventricle enhance the ability and scope of the modality. In this review, the prognostic significance of multimodality imaging is outlined, including the supplemental value of multidetector computed tomography and nuclear imaging. Strengths and weaknesses of imaging techniques, as well as future direction of multimodality assessment, are also described.
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Affiliation(s)
- Nitin Malik
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (N.M., F.H.S.).,Georgetown University, Washington, DC (N.M., F.H.S.)
| | - Monica Mukherjee
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Katherine C Wu
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Stefan L Zimmerman
- Johns Hopkins University Department of Radiology, Baltimore, MD (S.L.Z.)
| | - Junzhen Zhan
- Johns Hopkins University Department of Pediatrics, Division of Pediatric Cardiology, Baltimore, MD (J.Z., S.K.)
| | - Hugh Calkins
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Cynthia A James
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Nisha A Gilotra
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Farooq H Sheikh
- MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC (N.M., F.H.S.).,Georgetown University, Washington, DC (N.M., F.H.S.)
| | - Harikrishna Tandri
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
| | - Shelby Kutty
- Johns Hopkins University Department of Pediatrics, Division of Pediatric Cardiology, Baltimore, MD (J.Z., S.K.)
| | - Allison G Hays
- Johns Hopkins University Department of Medicine, Division of Cardiology, Baltimore, MD (M.M., K.C.W., H.C., C.A.J., N.A.G., H.T., A.G.H.)
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23
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Casas G, Rodríguez-Palomares JF. Multimodality Cardiac Imaging in Cardiomyopathies: From Diagnosis to Prognosis. J Clin Med 2022; 11:jcm11030578. [PMID: 35160031 PMCID: PMC8836975 DOI: 10.3390/jcm11030578] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/10/2022] [Accepted: 01/17/2022] [Indexed: 12/21/2022] Open
Abstract
Cardiomyopathies are a group of structural and/or functional myocardial disorders which encompasses hypertrophic, dilated, arrhythmogenic, restrictive, and other cardiomyopathies. Multimodality cardiac imaging techniques are the cornerstone of cardiomyopathy diagnosis; transthoracic echocardiography should be the first-line imaging modality due to its availability, and diagnosis should be confirmed by cardiovascular magnetic resonance, which will provide more accurate morphologic and functional information, as well as extensive tissue characterization. Multimodality cardiac imaging techniques are also essential in assessing the prognosis of patients with cardiomyopathies; left ventricular ejection fraction and late gadolinium enhancement are two of the main variables used for risk stratification, and they are incorporated into clinical practice guidelines. Finally, periodic testing with cardiac imaging techniques should also be performed due to the evolving and progressive natural history of most cardiomyopathies.
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Affiliation(s)
- Guillem Casas
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
- Correspondence: (G.C.); (J.F.R.-P.)
| | - José F. Rodríguez-Palomares
- Cardiovascular Imaging Unit and Inherited Cardiovascular Diseases Unit, Cardiology Department, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca, 08035 Barcelona, Spain
- Department de Medicina, Universitat Autónoma de Barcelona, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares, 28029 Madrid, Spain
- Correspondence: (G.C.); (J.F.R.-P.)
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24
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Allwood RP. Differentiating right ventricular remodelling from cardiac pathology in athletes. SONOGRAPHY 2022. [DOI: 10.1002/sono.12299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Richard P. Allwood
- Cardiology Department St Vincent's Hospital Melbourne Melbourne Victoria Australia
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Diagnosis of Mitral Valve Prolapse: Much More than Simple Prolapse. Multimodality Approach to Risk Stratification and Therapeutic Management. J Clin Med 2022; 11:jcm11020455. [PMID: 35054149 PMCID: PMC8781541 DOI: 10.3390/jcm11020455] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/06/2022] [Accepted: 01/12/2022] [Indexed: 02/04/2023] Open
Abstract
Mitral valve prolapse (MVP) is the most common valvular disease with a prevalence of 2%. It has generally a benign course; however, recent findings suggested an association between MVP and complex arrhythmias and eventually cardiac arrest and for this reason, it is also called arrhythmogenic MVP. Subjects who experience this complication are in general young women, with thickened mitral leaflets or bileaflet prolapse not necessarily associated with severe mitral regurgitation (MR). The nature of the relation between MVP and cardiac arrest is not clearly understood. Actually, the challenging task is to find the cluster of prognostic factors including T-wave inversion, polymorphic premature ventricular contractions, bileaflet prolapse, MR severity, but most importantly, those parameters of hypercontractility, mitral annulus disjunction (MAD), and myocardial fibrosis using a multimodality approach. Transthoracic echocardiography is the first-line imaging modality for the diagnosis of MVP, but also for detecting MAD and hypercontractility, followed by cardiac magnetic resonance for tissue characterization and detection of myocardial and papillary muscle fibrosis, using either late gadolinium enhancement (at the basal segment of the inferolateral wall and papillary muscles) (macro-fibrosis), or diffuse fibrosis by T1 mapping (native and post contrast T1). Moreover, there are also preliminary data on positron emission tomography utilizing 18F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation. The objective of this review article is to provide the clinician with an overview and a practical clinical approach to MVP for risk stratification and treatment guidance.
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27
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Guidelines for Echocardiographic Diagnosis of Cardiomyopathy: Recommendations from Echocardiography Group of Ultrasound Medicine Branch in Chinese Medical Association, Echocardiography Committee of Cardiovascular Branch in Chinese Medical Association. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2022. [DOI: 10.37015/audt.2022.210021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Song Y, Li L, Chen X, Ji K, Lu M, Hauer R, Chen L, Zhao S. Left Ventricular Longitudinal Dyssynchrony by CMR Feature Tracking Is Related to Adverse Prognosis in Advanced Arrhythmogenic Cardiomyopathy. Front Cardiovasc Med 2021; 8:712832. [PMID: 34708081 PMCID: PMC8542718 DOI: 10.3389/fcvm.2021.712832] [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: 05/21/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Left ventricular (LV) involvement has been associated with unfavorable prognosis in arrhythmogenic cardiomyopathy (ACM). We aim to evaluate LV mechanics by cardiovascular magnetic resonance-feature tracking (CMR-FT) in ACM patients with right ventricular (RV) dysfunction. Methods: We retrospectively recruited ACM patients diagnosed according to the revised Task Force Criteria (rTFC) from January 2015 to July 2017. All patients underwent CMR examinations and collections of clinical, electrocardiographic data. The strain and dyssynchrony parameters of LV and RV were analyzed. These patients were followed, and primary study outcome was defined as a composite of cardiovascular events (arrhythmic events and heart transplantation), secondary study outcome included arrhythmic events. Results: Eighty-nine ACM patients (40.40 ± 13.98 years, 67.42% male) were included. LV and RV ejection fractions were 49.12 ± 12.02% and 22.28 ± 10.11%, respectively. During a median (IQR) follow-up for 18.20 (11.60-30.04) months, 30 patients experienced cardiovascular events which included 22 patients who experienced arrhythmic events. Patients with cardiovascular events had impaired LV global longitudinal strain (-10.82 ± 2.77 vs. -12.61 ± 3.18%, p = 0.010), impaired LV global circumferential strain (-11.81 ± 2.40 vs. -13.04 ± 2.83%, p = 0.044), and greater LV longitudinal dyssynchrony (LVLD) (80.98 ± 30.98 vs. 64.23 ± 25.51 ms, p = 0.012) than those without. After adjusting for age, sex, and other confounding factors, LVLD ≥89.15 ms was an independent risk factor for cardiovascular events (HR: 4.50, 95% CI: 1.94 to 10.42; p = 0.001) and for arrhythmic events (HR: 4.79, 95% CI: 1.74 to 13.20; p = 0.003). Conclusions: LVLD by CMR-FT was an independent risk factor for cardiovascular and arrhythmic events in ACM patients in advanced stage, which could provide prognostic value for this subtype.
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Affiliation(s)
- Yanyan Song
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu Li
- Department of Diagnostic Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xiuyu Chen
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Keshan Ji
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Minjie Lu
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Richard Hauer
- Netherlands Heart Institute and Department of Cardiology, University Medical Center, Utrecht, Netherlands
| | - Liang Chen
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shihua Zhao
- Department of Magnetic Resonance Imaging, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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29
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Quattrone A, Lie OH, Nestaas E, de Lange C, Try K, Lindberg HL, Skulstad H, Erikssen G, Edvardsen T, Haugaa K, Estensen ME. Long-term follow-up and sex differences in adults operated for tetralogy of Fallot. Open Heart 2021; 8:e001738. [PMID: 34663747 PMCID: PMC8524375 DOI: 10.1136/openhrt-2021-001738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 09/29/2021] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Adults operated for tetralogy of Fallot (TOF) have high risk of ventricular arrhythmias (VA). QRS duration >180 ms is an established risk factor for VA. We aimed to investigate heart function, prevalence of arrhythmias and sex differences in patients with TOF at long-term follow-up. METHODS We included TOF-operated patients≥18 years from our centre's registry. We reviewed medical records and the most recent echocardiographic exam. VA was recorded on ECGs, 24-hour Holter registrations and from implantable cardioverter defibrillator. RESULTS We included 148 patients (age 37±10 years). Left ventricular global longitudinal strain (LV GLS, -15.8±3.1% vs -18.8±3.2%, p=0.001) and right ventricular (RV) GLS (-15.8±3.9% vs -19.1±4.1%, p=0.001) were lower in men at all ages compared with women. Higher RV D1 (4.3±0.5 cm vs 4.6±0.6 cm, p=0.01), lower ejection fraction (55%±8% vs 50%±9%, p=0.02), lower RV GLS (-18.1±4.0 ms vs -16.1±4.8 ms, p=0.04) and N-terminal pro-brain natriuretic peptide (NT-proBNP) over reference range (n=27 (23%) vs n=8 (77%), p<0.001) were associated with higher incidence of VA. QRS duration was longer in men (151±30 ms vs 128±25 ms, p<0.001). No patients had QRS duration >180 ms. QRS duration did not differ in those with and without VA (143±32 ms vs 137±28 ms, p=0.06). CONCLUSIONS Our results confirmed reduced RV function in adults operated for TOF. Male patients had impaired LV and RV function expressed by lower LV and RV GLS values at all ages. Reduced cardiac function and elevated NT-proBNP were associated with higher incidence of VA and may be important in risk assessment.
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Affiliation(s)
- Alessia Quattrone
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Oyvind H Lie
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Eirik Nestaas
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Charlotte de Lange
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, Oslo, Norway
- Department of Radiology and Clinical Physiology, Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Kirsti Try
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Harald L Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Helge Skulstad
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Gunnar Erikssen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina Haugaa
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Mette E Estensen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
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van Osta N, Kirkels FP, van Loon T, Koopsen T, Lyon A, Meiburg R, Huberts W, Cramer MJ, Delhaas T, Haugaa KH, Teske AJ, Lumens J. Uncertainty Quantification of Regional Cardiac Tissue Properties in Arrhythmogenic Cardiomyopathy Using Adaptive Multiple Importance Sampling. Front Physiol 2021; 12:738926. [PMID: 34658923 PMCID: PMC8514656 DOI: 10.3389/fphys.2021.738926] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 08/31/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: Computational models of the cardiovascular system are widely used to simulate cardiac (dys)function. Personalization of such models for patient-specific simulation of cardiac function remains challenging. Measurement uncertainty affects accuracy of parameter estimations. In this study, we present a methodology for patient-specific estimation and uncertainty quantification of parameters in the closed-loop CircAdapt model of the human heart and circulation using echocardiographic deformation imaging. Based on patient-specific estimated parameters we aim to reveal the mechanical substrate underlying deformation abnormalities in patients with arrhythmogenic cardiomyopathy (AC). Methods: We used adaptive multiple importance sampling to estimate the posterior distribution of regional myocardial tissue properties. This methodology is implemented in the CircAdapt cardiovascular modeling platform and applied to estimate active and passive tissue properties underlying regional deformation patterns, left ventricular volumes, and right ventricular diameter. First, we tested the accuracy of this method and its inter- and intraobserver variability using nine datasets obtained in AC patients. Second, we tested the trueness of the estimation using nine in silico generated virtual patient datasets representative for various stages of AC. Finally, we applied this method to two longitudinal series of echocardiograms of two pathogenic mutation carriers without established myocardial disease at baseline. Results: Tissue characteristics of virtual patients were accurately estimated with a highest density interval containing the true parameter value of 9% (95% CI [0-79]). Variances of estimated posterior distributions in patient data and virtual data were comparable, supporting the reliability of the patient estimations. Estimations were highly reproducible with an overlap in posterior distributions of 89.9% (95% CI [60.1-95.9]). Clinically measured deformation, ejection fraction, and end-diastolic volume were accurately simulated. In presence of worsening of deformation over time, estimated tissue properties also revealed functional deterioration. Conclusion: This method facilitates patient-specific simulation-based estimation of regional ventricular tissue properties from non-invasive imaging data, taking into account both measurement and model uncertainties. Two proof-of-principle case studies suggested that this cardiac digital twin technology enables quantitative monitoring of AC disease progression in early stages of disease.
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Affiliation(s)
- Nick van Osta
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Feddo P Kirkels
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tim van Loon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Tijmen Koopsen
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Aurore Lyon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Roel Meiburg
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Maarten J Cramer
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Arco J Teske
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
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Taha K, Bourfiss M, Te Riele ASJM, Cramer MJM, van der Heijden JF, Asselbergs FW, Velthuis BK, Teske AJ. A head-to-head comparison of speckle tracking echocardiography and feature tracking cardiovascular magnetic resonance imaging in right ventricular deformation. Eur Heart J Cardiovasc Imaging 2021; 22:950-958. [PMID: 32462176 PMCID: PMC8291671 DOI: 10.1093/ehjci/jeaa088] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Revised: 12/21/2019] [Accepted: 04/14/2020] [Indexed: 11/14/2022] Open
Abstract
AIMS Speckle tracking echocardiography (STE) and feature tracking cardiovascular magnetic resonance imaging (FT-CMR) are advanced imaging techniques which are both used for quantification of global and regional myocardial strain. Direct comparisons of STE and FT-CMR regarding right ventricular (RV) strain analysis are limited. We aimed to study clinical performance, correlation and agreement of RV strain by these techniques, using arrhythmogenic right ventricular cardiomyopathy (ARVC) as a model for RV disease. METHODS AND RESULTS We enrolled 110 subjects, including 34 patients with definite ARVC, 30 preclinical relatives of ARVC patients, and 46 healthy control subjects. Global and regional RV longitudinal peak strain (PS) were measured by STE and FT-CMR. Both modalities showed reduced strain values in ARVC patients compared to ARVC relatives (STE global PS: P < 0.001; FT-CMR global PS: P < 0.001) and reduced strain values in ARVC relatives compared to healthy control subjects (STE global PS: P = 0.042; FT-CMR global PS: P = 0.084). There was a moderate, albeit significant correlation between RV strain values obtained by STE and FT-CMR [global PS r = 0.578 (95% confidence interval 0.427-0.697), P < 0.001]. Agreement between the techniques was weak (limits of agreement for global PS: ±11.8%). Correlation and agreement both deteriorated when regional strain was studied. CONCLUSION RV STE and FT-CMR show a similar trend within the spectrum of ARVC and have significant correlation, but inter-modality agreement is weak. STE and FT-CMR may therefore both individually have added value for assessment of RV function, but RV PS values obtained by these techniques currently cannot be used interchangeably in clinical practice.
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Affiliation(s)
- Karim Taha
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Netherlands Heart Institute, Utrecht, the Netherlands
| | - Mimount Bourfiss
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Maarten-Jan M Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands.,Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.,Health Data Research UK and Institute of Health Informatics, University College London, London, UK
| | - Birgitta K Velthuis
- Department of Radiology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands
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Affiliation(s)
- Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
| | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova Medical School, Padova, Italy
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Claeys M, Claessen G, Claus P, De Bosscher R, Dausin C, Voigt JU, Willems R, Heidbuchel H, La Gerche A. Right ventricular strain rate during exercise accurately identifies male athletes with right ventricular arrhythmias. Eur Heart J Cardiovasc Imaging 2021; 21:282-290. [PMID: 31578557 DOI: 10.1093/ehjci/jez228] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 09/19/2019] [Indexed: 11/13/2022] Open
Abstract
AIMS Athletes with right ventricular (RV) arrhythmias, even in the absence of desmosomal mutations, may have subtle RV abnormalities which can be unmasked by deformation imaging. As exercise places a disproportionate stress on the right ventricle, evaluation of cardiac function and deformation during exercise might improve diagnostic performance. METHODS AND RESULTS We performed bicycle stress echocardiography in 17 apparently healthy endurance athletes (EAs), 12 non-athletic controls (NAs), and 17 athletes with RV arrhythmias without desmosomal mutations (EI-ARVCs) and compared biventricular function at rest and during low (25% of upright peak power) and moderate intensity (60%). At rest, we observed no differences in left ventricular (LV) or RV function between groups. During exercise, however, the increase in RV fractional area change (RVFAC), RV free wall strain (RVFWSL), and strain rate (RVFWSRL) were significantly attenuated in EI-ARVCs as compared to EAs and NAs. At moderate exercise intensity, EI-ARVCs had a lower RVFAC, RVFWSL, and RVFWSRL (all P < 0.01) compared to the control groups. Exercise-related increases in LV ejection fraction, strain, and strain rate were also attenuated in EI-ARVCs (P < 0.05 for interaction). Exercise but not resting parameters identified EI-ARVCs and RVFWSRL with a cut-off value of >-2.35 at moderate exercise intensity had the greatest accuracy to detect EI-ARVCs (area under the curve 0.95). CONCLUSION Exercise deformation imaging holds promise as a non-invasive diagnostic tool to identify intrinsic RV dysfunction concealed at rest. Strain rate appears to be the most accurate parameter and should be incorporated in future, prospective studies to identify subclinical disease in an early stage.
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Affiliation(s)
- Mathias Claeys
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium.,Division of Cardiology, University Hospitals Leuven, Herestraat 49, BE-3000 Leuven, Belgium
| | - Guido Claessen
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium.,Division of Cardiology, University Hospitals Leuven, Herestraat 49, BE-3000 Leuven, Belgium.,Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
| | - Piet Claus
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium
| | - Ruben De Bosscher
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium.,Division of Cardiology, University Hospitals Leuven, Herestraat 49, BE-3000 Leuven, Belgium
| | - Christoph Dausin
- Department of Movement Sciences, KU Leuven, Tervuursevest 101, Box 1500, BE-3001 Leuven, Belgium
| | - Jens-Uwe Voigt
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium.,Division of Cardiology, University Hospitals Leuven, Herestraat 49, BE-3000 Leuven, Belgium
| | - Rik Willems
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium.,Division of Cardiology, University Hospitals Leuven, Herestraat 49, BE-3000 Leuven, Belgium
| | - Hein Heidbuchel
- Division of Cardiology, University Hospital Antwerp and University of Antwerp, Wilrijkstraat 10, BE-2650 Edegem, Belgium
| | - Andre La Gerche
- Department of Cardiovascular Sciences, KU Leuven, Herestraat 49, BE-3000 Leuven, Belgium.,Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia
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Groeneveld SA, van der Ree MH, Taha K, de Bruin-Bon RHA, Cramer MJ, Teske AJ, Bouma BJ, Amin AS, Wilde AAM, Postema PG, Hassink RJ. Echocardiographic deformation imaging unmasks global and regional mechanical dysfunction in patients with idiopathic ventricular fibrillation: A multicenter case-control study. Heart Rhythm 2021; 18:1666-1672. [PMID: 34058391 DOI: 10.1016/j.hrthm.2021.05.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/14/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Idiopathic ventricular fibrillation (IVF) is diagnosed in patients with sudden onset of ventricular fibrillation of unidentified origin. New diagnostic tools that can detect subtle abnormalities are needed to diagnose and treat patients with an underlying substrate. OBJECTIVE The purpose of this study was to explore echocardiographic deformation characteristics in IVF patients. METHODS Echocardiograms were analyzed with deformation imaging by 2-dimensional speckle tracking. Global and regional measurements of the left ventricle (LV) and right ventricle (RV) were performed. Regional LV deformation patterns were evaluated for the presence of postsystolic shortening. Regional RV deformation patterns were classified as type I (normal) or type II/III (abnormal). RESULTS In total, 47 IVF patients (mean age 45 years; left ventricular ejection fraction [LVEF] 56%) and 47 healthy controls (mean age 41 years; LVEF 60%) were included. IVF patients showed more global deformation abnormalities as indicated by lower LV global longitudinal strain (18.5% ± 2.6% vs 21.6% ± 1.8%; P <.001) and higher LV mechanical dispersion (41 ± 12 ms vs 26 ± 6 ms; P <.001). In addition, IVF patients showed more regional LV postsystolic shortening compared to healthy controls (50% vs 11%; P <.001). Abnormal RV deformation patterns were observed in 16% of IVF patients and in none of the control subjects (P <.001). CONCLUSION We were able to show both regional and global echocardiographic deformation abnormalities in IVF patients. This study provides evidence that localized myocardial disease is present in a subset of IVF patients.
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Affiliation(s)
- Sanne A Groeneveld
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - Martijn H van der Ree
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Karim Taha
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Rianne H A de Bruin-Bon
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Maarten J Cramer
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arco J Teske
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Berto J Bouma
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Ahmad S Amin
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Arthur A M Wilde
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Pieter G Postema
- Heart Center, Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Cardiovascular Sciences, Amsterdam, The Netherlands
| | - Rutger J Hassink
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
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Tadic M, Kersten J, Nita N, Schneider L, Buckert D, Gonska B, Scharnbeck D, Dahme T, Imhof A, Belyavskiy E, Cuspidi C, Rottbauer W. The Prognostic Importance of Right Ventricular Longitudinal Strain in Patients with Cardiomyopathies, Connective Tissue Diseases, Coronary Artery Disease, and Congenital Heart Diseases. Diagnostics (Basel) 2021; 11:diagnostics11060954. [PMID: 34073460 PMCID: PMC8228710 DOI: 10.3390/diagnostics11060954] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 05/18/2021] [Accepted: 05/21/2021] [Indexed: 11/16/2022] Open
Abstract
Right ventricular (RV) systolic function represents an important independent predictor of adverse outcomes in many cardiovascular (CV) diseases. However, conventional parameters of RV systolic function (tricuspid annular plane excursion (TAPSE), RV myocardial performance index (MPI), and fractional area change (FAC)) are not always able to detect subtle changes in RV function. New evidence indicates a significantly higher predictive value of RV longitudinal strain (LS) over conventional parameters. RVLS showed higher sensitivity and specificity in the detection of RV dysfunction in the absence of RV dilatation, apparent wall motion abnormalities, and reduced global RV systolic function. Additionally, RVLS represents a significant and independent predictor of adverse outcomes in patients with dilated cardiomyopathy (CMP), hypertrophic CMP, arrhythmogenic RV CMP, and amyloidosis, but also in patients with connective tissue diseases and patients with coronary artery disease. Due to its availability, echocardiography remains the main imaging tool for RVLS assessment, but cardiac magnetic resonance (CMR) also represents an important additional imaging tool in RVLG assessment. The findings from the large studies support the routine evaluation of RVLS in the majority of CV patients, but this has still not been adopted in daily clinical practice. This clinical review aims to summarize the significance and predictive value of RVLS in patients with different types of cardiomyopathies, tissue connective diseases, and coronary artery disease.
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Affiliation(s)
- Marijana Tadic
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
- Correspondence: ; Tel.: +49-17632360011
| | - Johannes Kersten
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Nicoleta Nita
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Leonhard Schneider
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Dominik Buckert
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Birgid Gonska
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Dominik Scharnbeck
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Tilman Dahme
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Armin Imhof
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
| | - Evgeny Belyavskiy
- Department of Cardiology, Charité—Universitätsmedizin Berlin (Campus Virchow-Klinikum), 13353 Berlin, Germany;
| | - Cesare Cuspidi
- Department of Medicine and Surgery, University of Milan-Bicocca, 20126 Milan, Italy;
| | - Wolfgang Rottbauer
- Klinik für Innere Medizin II, Universitätsklinikum Ulm, Albert-Einstein Allee 23, 89081 Ulm, Germany; (J.K.); (N.N.); (L.S.); (D.B.); (B.G.); (D.S.); (T.D.); (A.I.); (W.R.)
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Abstract
Sudden cardiac death (SCD) is the worst clinical event occurring in the clinical context of cardiomyopathies. Current guidelines recommend using LV ejection fraction as the only imaging-derived parameter to identify patients who may benefit from ICD implantation in cardiomyopathies with reduced ejection fraction; however, a relevant proportion of high-risk population is left with unmet therapeutic goal. In case of dilated, hypertrophic, or arrhythmogenic cardiomyopathies, there is still a room for more sensitive and specific risk markers for identifying a cluster at higher risk of SCD. In this paper, we reviewed the evidence supporting the use of advanced echocardiography, CMR, and nuclear cardiology for SCD stratification in patients with the most common cardiomyopathies. The added value of these modalities may be explained on the basis of tissue characterization, especially scar detection, a central player in the pathogenesis of arrhythmias. Therefore, integration of these modalities to our everyday clinical practice may help in dealing with the gray zones where current guidelines are still ineffective for patient selection.
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Kamińska H, Małek ŁA, Barczuk-Falęcka M, Bartoszek M, Strzałkowska-Kominiak E, Marszałek M, Brzezik E, Brzewski M, Werner B. The Role of Cardiac Magnetic Resonance in Evaluation of Idiopathic Ventricular Arrhythmia in Children. J Clin Med 2021; 10:jcm10071335. [PMID: 33804813 PMCID: PMC8036515 DOI: 10.3390/jcm10071335] [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: 02/11/2021] [Revised: 03/16/2021] [Accepted: 03/22/2021] [Indexed: 11/18/2022] Open
Abstract
The aim of the study was to assess the role of cardiovascular magnetic resonance (CMR) in the diagnosis of idiopathic VA in children. This retrospective single-centre study included a total of 80 patients with idiopathic ventricular arrhythmia that underwent routine CMR imaging between 2016 and 2020 at our institution. All patients underwent a 3.0 T scan involving balanced steady-state free precession cine images as well as dark-blood T2W images and assessment of late gadolinium enhancement (LGE). In 26% of patients (n = 21) CMR revealed cardiac abnormalities, in 20% (n = 16) not suspected on prior echocardiography. The main findings included: non-ischemic ventricular scars (n = 8), arrhythmogenic right ventricular cardiomyopathy (n = 6), left ventricular clefts (n = 4) and active myocarditis (n = 3). LGE was present in 57% of patients with abnormal findings. Univariate predictors of abnormal CMR result included abnormalities in echocardiography and severe VA (combination of >10% of 24 h VA burden and/or presence of ventricular tachycardia and/or polymorphic VA). CMR provides valuable clinical information in many cases of idiopathic ventricular arrhythmia in children, mainly due to its advanced tissue characterization capabilities and potential to assess the right ventricle.
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Affiliation(s)
- Halszka Kamińska
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (H.K.); (B.W.)
| | - Łukasz A. Małek
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, National Institute of Cardiology, 04-635 Warsaw, Poland
- Correspondence: ; Tel.: +48-22-815-65-56 (ext. 4861)
| | - Marzena Barczuk-Falęcka
- Department of Pediatric Radiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.B.-F.); (M.B.); (E.B.); (M.B.)
| | - Marta Bartoszek
- Department of Pediatric Radiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.B.-F.); (M.B.); (E.B.); (M.B.)
| | - Ewa Strzałkowska-Kominiak
- Faculty of Mathematics and Information Science, Warsaw University of Technology, 00-662 Warsaw, Poland;
| | - Mikołaj Marszałek
- English Division, Medical University of Warsaw, 02-109 Warsaw, Poland;
| | - Ewa Brzezik
- Department of Pediatric Radiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.B.-F.); (M.B.); (E.B.); (M.B.)
| | - Michał Brzewski
- Department of Pediatric Radiology, Medical University of Warsaw, 02-091 Warsaw, Poland; (M.B.-F.); (M.B.); (E.B.); (M.B.)
| | - Bożena Werner
- Department of Pediatric Cardiology and General Pediatrics, Medical University of Warsaw, 02-091 Warsaw, Poland; (H.K.); (B.W.)
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Mitroi C, García-Izquierdo E, García-Lunar I, Castro-Urda V, Toquero-Ramos J, Moñivas-Palomero V, Mingo-Santos S, Cavero MA, Brugada J, Fernández-Lozano I. Right ventricular function and dyssynchrony in Brugada syndrome: Highlighting the importance of the mechanical substrate in the right ventricular outflow tract. Int J Cardiol 2021; 333:233-238. [PMID: 33727123 DOI: 10.1016/j.ijcard.2021.03.014] [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: 02/14/2021] [Revised: 03/04/2021] [Accepted: 03/08/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Current evidence suggests that Brugada syndrome (BrS), far from being a purely electrical condition, is associated with subtle mechanical abnormalities primarily affecting the right ventricle (RV). We aimed to characterize RV function in BrS and investigate the echocardiographic profile of patients with arrhythmic events, with a special focus on parameters of RV dyssynchrony using speckle-tracking echocardiography (STE). METHODS An echocardiogram was performed in 71 BrS patients and 25 healthy controls. STE was performed to assess regional and global RV mechanics, including RV outflow tract shortening (RVOTS). RVOT contraction time was considered to calculate the modified RV mechanical dispersion (RVMDm). Arrhythmic events were prospectively evaluated in the BrS cohort. RESULTS Compared to controls, BrS patients showed subtle contractile abnormalities, including impaired RV longitudinal strain, higher RV index of myocardial performance (RIMP) and lower RVOTS. BrS patients also exhibited a greater contraction delay between the lateral and the septal aspect of the RV. After a median follow-up of 7.3 year (IQR 5.2-10.8), 6 patients presented malignant arrhythmic events. RIMP >0.50, RVOTS <16.2% and RVMDm > 42 ms showed high sensitivity for the identification of BrS patients with arrhythmic events during follow-up. CONCLUSIONS Subtle RV mechanical abnormalities were present in BrS patients. RIMP and RVOTS, a novel STE-derived parameter, were found to be sensitive markers of arrhythmic events. Adding the RVOT contraction time to the analysis of RVMD may help identify patients at higher risk, reflecting the importance of the RVOT mechanical substrate in the assessment of the arrhythmic risk in BrS.
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Affiliation(s)
- Cristina Mitroi
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Inés García-Lunar
- Cardiology Department, Hospital Universitario Ramón y Cajal, Madrid, Spain; Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares, Madrid, Spain
| | - Victor Castro-Urda
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Jorge Toquero-Ramos
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | | | - Susana Mingo-Santos
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Miguel A Cavero
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain
| | - Josep Brugada
- Institut Clínic Cardio-Vascular, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ignacio Fernández-Lozano
- Cardiology Department, Hospital Universitario Puerta de Hierro, Majadahonda, Spain; Centro de Investigación Biomédica en Red (CIBER) de Enfermedades Cardiovasculares, Madrid, Spain
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van Osta N, Kirkels F, Lyon A, Koopsen T, van Loon T, Cramer MJ, Teske AJ, Delhaas T, Lumens J. Electromechanical substrate characterization in arrhythmogenic cardiomyopathy using imaging-based patient-specific computer simulations. Europace 2021; 23:i153-i160. [PMID: 33751081 PMCID: PMC7943356 DOI: 10.1093/europace/euaa407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 12/14/2020] [Indexed: 01/11/2023] Open
Abstract
AIMS Arrhythmogenic cardiomyopathy (AC) is an inherited cardiac disease, characterized by life-threatening ventricular arrhythmias and progressive cardiac dysfunction. The aim of this study is to use computer simulations to non-invasively estimate the individual patient's myocardial tissue substrates underlying regional right ventricular (RV) deformation abnormalities in a cohort of AC mutation carriers. METHODS AND RESULTS In 68 AC mutation carriers and 20 control subjects, regional longitudinal deformation patterns of the RV free wall (RVfw), interventricular septum (IVS), and left ventricular free wall (LVfw) were obtained using speckle-tracking echocardiography. We developed and used a patient-specific parameter estimation protocol based on the multi-scale CircAdapt cardiovascular system model to create virtual AC subjects. Using the individual's deformation data as model input, this protocol automatically estimated regional RVfw and global IVS and LVfw tissue properties. The computational model was able to reproduce clinically measured regional deformation patterns for all subjects, with highly reproducible parameter estimations. Simulations revealed that regional RVfw heterogeneity of both contractile function and compliance were increased in subjects with clinically advanced disease compared to mutation carriers without clinically established disease (17 ± 13% vs. 8 ± 4%, P = 0.01 and 18 ± 11% vs. 10 ± 7%, P < 0.01, respectively). No significant difference in activation delay was found. CONCLUSION Regional RV deformation abnormalities in AC mutation carriers were related to reduced regional contractile function and tissue compliance. In clinically advanced disease stages, a characteristic apex-to-base heterogeneity of tissue abnormalities was present in the majority of the subjects, with most pronounced disease in the basal region of the RVfw.
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Affiliation(s)
- Nick van Osta
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50 (UNS50), 6229 ER Maastricht, The Netherlands
| | - Feddo Kirkels
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50 (UNS50), 6229 ER Maastricht, The Netherlands
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Aurore Lyon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50 (UNS50), 6229 ER Maastricht, The Netherlands
| | - Tijmen Koopsen
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50 (UNS50), 6229 ER Maastricht, The Netherlands
| | - Tim van Loon
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50 (UNS50), 6229 ER Maastricht, The Netherlands
| | - Maarten-Jan Cramer
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Arco J Teske
- Division Heart and Lungs, Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tammo Delhaas
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50 (UNS50), 6229 ER Maastricht, The Netherlands
| | - Joost Lumens
- Department of Biomedical Engineering, Cardiovascular Research Institute Maastricht, Maastricht University, Universiteitssingel 50 (UNS50), 6229 ER Maastricht, The Netherlands
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Assessment of right atrial dyssynchrony by 2D speckle-tracking in healthy young men following high altitude exposure at 4100 m. PLoS One 2021; 16:e0247107. [PMID: 33600469 PMCID: PMC7891700 DOI: 10.1371/journal.pone.0247107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/01/2021] [Indexed: 11/30/2022] Open
Abstract
Background High altitude exposure induces overload of right-sided heart and may further predispose to supraventricular arrhythmia. It has been reported that atrial mechanical dyssynchrony is associated with atrial arrhythmia. Whether high altitude exposure causes higher right atrial (RA) dyssynchrony is still unknown. The aim of study was to investigate the effect of high altitude exposure on right atrial mechanical synchrony. Methods In this study, 98 healthy young men underwent clinical examination and echocardiography at sea level (400 m) and high altitude (4100 m) after an ascent within 7 days. RA dyssynchrony was defined as inhomogeneous timing to peak strain and strain rate using 2D speckle-tracking echocardiography. Results Following high altitude exposure, standard deviation of the time to peak strain (SD-TPS) [36.2 (24.5, 48.6) ms vs. 21.7 (12.9, 32.1) ms, p<0.001] and SD-TPS as percentage of R–R’ interval (4.6 ± 2.1% vs. 2.5 ± 1.8%, p<0.001) significantly increased. Additionally, subjects with higher SD-TPS (%) at high altitude presented decreased right ventricular global longitudinal strain and RA active emptying fraction, but increased RA minimal volume index, which were not observed in lower group. Multivariable analysis showed that mean pulmonary arterial pressure and tricuspid E/A were independently associated with SD-TPS (%) at high altitude. Conclusion Our data for the first time demonstrated that high altitude exposure causes RA dyssynchrony in healthy young men, which may be secondary to increased pulmonary arterial pressure. In addition, subjects with higher RA dyssynchrony presented worse RA contractile function and right ventricular performance.
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41
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Kirkels FP, Lie ØH, Cramer MJ, Chivulescu M, Rootwelt-Norberg C, Asselbergs FW, Teske AJ, Haugaa KH. Right Ventricular Functional Abnormalities in Arrhythmogenic Cardiomyopathy: Association With Life-Threatening Ventricular Arrhythmias. JACC Cardiovasc Imaging 2021; 14:900-910. [PMID: 33582062 DOI: 10.1016/j.jcmg.2020.12.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES This study aimed to perform an external validation of the value of right ventricular (RV) deformation patterns and RV mechanical dispersion in patients with arrhythmogenic cardiomyopathy (AC). Secondly, this study assessed the association of these parameters with life-threatening ventricular arrhythmia (VA). BACKGROUND Subtle RV dysfunction assessed by echocardiographic deformation imaging is valuable in AC diagnosis and risk prediction. Two different methods have emerged, the RV deformation pattern recognition and RV mechanical dispersion, but these have neither been externally validated nor compared. METHODS We analyzed AC probands and mutation-positive family members, matched from 2 large European referral centers. We performed speckle tracking echocardiography, whereby we classified the subtricuspid deformation patterns from normal to abnormal and assessed RV mechanical dispersion from 6 segments. We defined VA as sustained ventricular tachycardia, appropriate implantable cardioverter-defibrillator therapy, or aborted cardiac arrest. RESULTS We included 160 subjects, 80 from each center (43% proband, 55% women, age 41 ± 17 years). VA had occurred in 47 (29%) subjects. In both cohorts, patients with a history of VA showed abnormal deformation patterns (96% and 100%) and had greater RV mechanical dispersion (53 ± 30 ms vs. 30 ± 21 ms; p < 0.001 for the total cohort). Both parameters were independently associated to VA (adjusted odds ratio: 2.71 [95% confidence interval: 1.47 to 5.00] per class step-up, and 1.26 [95% confidence interval: 1.07 to 1.49]/10 ms, respectively). The association with VA significantly improved when adding RV mechanical dispersion to pattern recognition (net reclassification improvement 0.42; p = 0.02 and integrated diagnostic improvement 0.06; p = 0.01). CONCLUSIONS We externally validated 2 RV dysfunction parameters in AC. Adding RV mechanical dispersion to RV deformation patterns significantly improved the association with life-threatening VA, indicating incremental value.
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Affiliation(s)
- Feddo P Kirkels
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Øyvind H Lie
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Maarten J Cramer
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Monica Chivulescu
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Christine Rootwelt-Norberg
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Folkert W Asselbergs
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands; Utrecht University, Utrecht, the Netherlands; Institute of Cardiovascular Science and Institute of Health Informatics, Faculty of Population Health Sciences, University College London, London, United Kingdom
| | - Arco J Teske
- Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Kristina H Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Friedberg MK. Peeking Beyond Strain's Peak: Regional Strain Patterns and Dispersion in Arrhythmogenic Right Ventricular Cardiomyopathy. JACC Cardiovasc Imaging 2021; 14:911-914. [PMID: 33582065 DOI: 10.1016/j.jcmg.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Mark K Friedberg
- Labatt Family Heart Center, Hospital for Sick Children, Toronto, Ontario, Canada.
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Quattrone A, Lie OH, Nestaas E, de Lange C, Try K, Lindberg HL, Skulstad H, Erikssen G, Edvardsen T, Haugaa K, Estensen ME. Impact of pregnancy and risk factors for ventricular arrhythmias in women with tetralogy of Fallot. Open Heart 2021; 8:openhrt-2020-001400. [PMID: 33414183 PMCID: PMC7797246 DOI: 10.1136/openhrt-2020-001400] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 11/20/2020] [Accepted: 12/07/2020] [Indexed: 11/12/2022] Open
Abstract
Objective Patients with tetralogy of Fallot (TOF) have high survival rates 30 years after surgical repair. Many patients experience pregnancy; however, the effects of pregnancy on the long-term cardiovascular outcome are not well known. We investigated the association of pregnancy and cardiac function with occurrence of ventricular arrhythmia (VA) in women with TOF. Methods We recruited 80 women with repaired TOF from the national database. Holter monitoring or implanted devices detected VA, defined as non-sustained or sustained ventricular tachycardia or aborted cardiac arrest. All patients underwent echocardiography. Blood tests included NT-proBNP (N-terminal pro-brain natriuretic peptide). Results 55 (69%) women had experienced pregnancy. Mean age was lower in nulliparous compared with those with children (30±9 vs 40±9, p<0.01). VA had occurred in 17 (21%) women. Prevalence of VA was higher in women who had experienced pregnancy (n=16, 94%) compared with nulliparous (n=1, 6%) (p=0.02), also when adjusted for age (OR 12.9 (95% CI 1.5 to 113.2), p=0.02). Right ventricular mechanical dispersion was more pronounced in patients with VA (50±8 ms vs 39±14 ms, p=0.01, age-adjusted OR 2.1 (95% CI 1.3 to 7.5), p=0.01). NT-proBNP was also a marker of VA (211 ng/L (127 to 836) vs 139 ng/L (30 to 465), p=0.007). NT-proBNP >321 ng/L (normal values <170 ng/L) detected women with VA (p=0.019), also independent of age (OR 7.2 (95% CI 1.7 to 30.1), p=0.007). Conclusion Pregnancy was associated with higher prevalence of VA among women with TOF. Right ventricular mechanical dispersion and NT-proBNP were age-independent markers of VA. These may have importance for pregnancy counselling and risk stratification.
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Affiliation(s)
- Alessia Quattrone
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Oyvind H Lie
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Eirik Nestaas
- Department of Paediatrics, Vestfold Hospital Trust, Tønsberg, Norway
| | - Charlotte de Lange
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, Oslo, Norway.,Sahlgrenska University Hospital, Goteborg, Sweden
| | - Kirsti Try
- Division of Radiology and Nuclear Medicine, Section of Pediatric Radiology, Oslo University Hospital, Oslo, Norway
| | - Harald L Lindberg
- Department of Cardiothoracic Surgery, Oslo University Hospital, Oslo, Norway
| | - Helge Skulstad
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Gunnar Erikssen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway
| | - Thor Edvardsen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Mette E Estensen
- Department of Cardiology, Oslo University Hospital, Oslo, Norway .,University of Oslo, Oslo, Norway
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Electromechanical delay by speckle-tracking echocardiography: A novel tool to distinguish between Brugada syndrome and isolated right bundle branch block. Int J Cardiol 2020; 320:161-167. [DOI: 10.1016/j.ijcard.2020.06.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 12/19/2022]
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La Gerche A. Exercise-Induced Arrhythmogenic (Right Ventricular) Cardiomyopathy Is Real…if you Consider it. JACC Cardiovasc Imaging 2020; 14:159-161. [PMID: 33221208 DOI: 10.1016/j.jcmg.2020.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/08/2020] [Accepted: 09/09/2020] [Indexed: 11/24/2022]
Affiliation(s)
- André La Gerche
- Clinical Research Domain, Baker Heart and Diabetes Institute, Melbourne, Australia; National Centre for Sports Cardiology, St. Vincent's Hospital Melbourne, Fitzroy, Australia.
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Prihadi EA, Vollema EM, Ng ACT, Ajmone Marsan N, Bax JJ, Delgado V. Determinants and prognostic implications of left ventricular mechanical dispersion in aortic stenosis. Eur Heart J Cardiovasc Imaging 2020; 20:740-748. [PMID: 30726895 PMCID: PMC6593318 DOI: 10.1093/ehjci/jez004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 01/16/2018] [Indexed: 12/23/2022] Open
Abstract
AIMS The present study aimed at investigating the association between left ventricular (LV) mechanical dispersion measured with speckle tracking echocardiography and severity of aortic stenosis (AS) and its impact on prognosis. METHODS AND RESULTS This retrospective study included 630 patients [age 72 (62-78) years, 61.4% men] with various grades of AS (mild AS, 19.8%; moderate AS, 37.0%; severe AS, 43.2%). LV mechanical dispersion (defined as standard deviation of time from Q/R on electrocardiogram to peak longitudinal strain in 17 LV segments) was assessed by speckle tracking echocardiography. Clinical, electrocardiographic, and echocardiographic determinants of increased LV mechanical dispersion were evaluated. During a follow-up of 107 (43-133) months, the independent association between LV mechanical dispersion and all-cause mortality (n = 302, 48%) was evaluated including aortic valve replacement as time-dependent co-variate. LV mechanical dispersion increased significantly with increasing severity of AS (mild AS, 54.5 ± 17.2 ms; moderate AS, 56.7 ± 19.3 ms; severe AS, 70.9 ± 24.3 ms; P < 0.001). Independent determinants of increased mechanical dispersion included older age (β = 0.28; P = 0.003), lower LV ejection fraction (β = -0.24; P = 0.020), smaller aortic valve area (β = -8.55; P = 0.001), larger LV mass index (β = 0.20; P < 0.001), and longer QRS duration (β = 1.12 per each 10 ms increase; P = 0.012). LV mechanical dispersion showed incremental prognostic value for all-cause mortality (hazard ratio 1.10 per each 10 ms increase, 95% confidence interval 1.04-1.15; P < 0.001). CONCLUSION LV mechanical dispersion assessed by speckle tracking echocardiography increases significantly with severity of AS and is significantly associated with all-cause mortality.
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Affiliation(s)
- Edgard A Prihadi
- Department of Cardiology, Leiden University Medical Centre, Heart Lung Center, Albinusdreef 2, Leiden, The Netherlands
| | - E Mara Vollema
- Department of Cardiology, Leiden University Medical Centre, Heart Lung Center, Albinusdreef 2, Leiden, The Netherlands
| | - Arnold C T Ng
- Department of Cardiology, Leiden University Medical Centre, Heart Lung Center, Albinusdreef 2, Leiden, The Netherlands.,Antwerp Cardiovascular Center, ZNA Middelheim, Lindendreef 1, Antwerp, BelgiumDepartment of Cardiology, Princess Alexandra Hospital, The University of Queensland, 199 Ipswich Rd, Woolloongabba QLD, Australia
| | - Nina Ajmone Marsan
- Department of Cardiology, Leiden University Medical Centre, Heart Lung Center, Albinusdreef 2, Leiden, The Netherlands
| | - Jeroen J Bax
- Department of Cardiology, Leiden University Medical Centre, Heart Lung Center, Albinusdreef 2, Leiden, The Netherlands
| | - Victoria Delgado
- Department of Cardiology, Leiden University Medical Centre, Heart Lung Center, Albinusdreef 2, Leiden, The Netherlands
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Cavigli L, Focardi M, Cameli M, Mandoli GE, Mondillo S, D'Ascenzi F. The right ventricle in “Left-sided” cardiomyopathies: The dark side of the moon. Trends Cardiovasc Med 2020; 31:476-484. [DOI: 10.1016/j.tcm.2020.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/07/2023]
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48
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Popa-Fotea NM, Micheu MM, Onciul S, Zamfir D, Dorobanţu M. Combined right and left ventricular mechanical dispersion enhance the arrhythmic risk stratification in hypertrophic cardiomyopathy. J Cardiol 2020; 76:364-370. [PMID: 32507507 DOI: 10.1016/j.jjcc.2020.04.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/29/2020] [Accepted: 04/11/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Ventricular arrhythmias are the most frequent cause of sudden cardiac death in individuals with hypertrophic cardiomyopathy (HCM). In the present study we investigated if combined left ventricular (LV) and right ventricular (RV) mechanical dispersion (MD) are correlated with ventricular arrhythmias. We aimed also to analyze if MD enhances the arrhythmic risk stratification in HCM. METHODS The cohort included 47 subjects with HCM and 36 healthy individuals. All the studied population underwent clinical, 24-h electrocardiographic (ECG) monitoring for detection and description of non-sustained ventricular tachycardia (NSVT) in terms of number of events, maximal rate and length and comprehensive transthoracic echocardiography, including strain rate imaging. MD was calculated as standard deviation of time from the peak of R wave on ECG to maximum LV or RV shortening in 17 LV and 3 RV segments. RESULTS HCM subjects with NSVT on ECG monitoring had increased LVMD (81±18ms vs 42±8ms) and RVMD (52±26 vs 25±23ms) compared with the HCM group without NSVT or compared with the healthy controls. On receiver operating characteristic curves the cut-off values associated with optimal specificity and sensitivity were 62ms for LVMD and 39ms for RVMD. LVMD (OR=1.86, 95% CI 1-1.06, p=0.01) and RVMD (OR=1.04, 95% CI 1.01-1.07, p=0.003) were the only independent variables that correlated with longer and faster NSVT and furthermore improved the risk stratification of NSVTs. CONCLUSIONS In a cohort of subjects with HCM, LVMD and RVMD correlates with the presence of NSVT on ECG monitoring. Combined LVMD and RVMD may improve the risk stratification of HCM with NSVT.
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Affiliation(s)
- Nicoleta-Monica Popa-Fotea
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Miruna Mihaela Micheu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.
| | - Sebastian Onciul
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
| | - Diana Zamfir
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania
| | - Maria Dorobanţu
- Department of Cardiology, Clinical Emergency Hospital of Bucharest, Bucharest, Romania; University of Medicine and Pharmacy Carol Davila, Bucharest, Romania
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Stokke MK, Castrini AI, Aneq MÅ, Jensen HK, Madsen T, Hansen J, Bundgaard H, Gilljam T, Platonov PG, Svendsen JH, Edvardsen T, Haugaa KH. Absence of ECG Task Force Criteria does not rule out structural changes in genotype positive ARVC patients. Int J Cardiol 2020; 317:152-158. [PMID: 32504717 DOI: 10.1016/j.ijcard.2020.05.095] [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: 11/04/2019] [Revised: 05/21/2020] [Accepted: 05/27/2020] [Indexed: 02/08/2023]
Abstract
AIMS In Arrhythmogenic Right Ventricular Cardiomyopathy (ARVC), electrophysiological pathology has been claimed to precede morphological and functional pathology. Accordingly, an ECG without ARVC markers should be rare in ARVC patients with pathology identified by cardiac imaging. We quantified the prevalence of ARVC patients with evidence of structural disease, yet without ECG Task Force Criteria (TFC). METHODS AND RESULTS We included 182 probands and family members with ARVC-associated mutations (40 ± 17 years, 50% women, 73% PKP2 mutations) from the Nordic ARVC Registry in a cross-sectional analysis. For echocardiography and cardiac MR (CMR), we differentiated between "abnormalities" and TFC. "Abnormalities" were defined as RV functional or structural measures outside TFC reference values, without combinations required to fulfill TFC. ECG TFC were used as defined, as these are not composite parameters. We found that only 4% of patients with ARVC fulfilled echocardiographic TFC without any ECG TFC. However, importantly, 38% of patients had imaging abnormalities without any ECG TFC. These results were supported by CMR data from a subset of 51 patients: 16% fulfilled CMR TFC without fulfilling ECG TFC, while 24% had CMR abnormalities without any ECG TFC. In a multivariate analysis, echocardiographic TFC were associated with arrhythmic events. CONCLUSION More than one third of ARVC genotype positive patients had subtle imaging abnormalities without fulfilling ECG TFC. Although most patients will have both imaging and ECG abnormalities, structural abnormalities in ARVC genotype positive patients cannot be ruled out by the absence of ECG TFC.
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Affiliation(s)
- Mathis K Stokke
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Anna I Castrini
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway
| | - Meriam Åström Aneq
- Department of Clinical physiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Henrik Kjærulf Jensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Trine Madsen
- Department of Cardiology, Center for Cardiovascular Research, Aalborg Hospital, Aarhus University Hospital, Denmark
| | - Jim Hansen
- Department of Cardiology, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Unit for Inherited Cardiac Diseases, The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Gilljam
- Department of Cardiology, Institute of Medicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Pyotr G Platonov
- Department of Cardiology, Lund University and Arrhythmia Clinic, Skåne University Hospital, Lund, Sweden
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark; Department of Cardiology, The Heart Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Thor Edvardsen
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kristina H Haugaa
- Center for Cardiological Innovation, Department of Cardiology, Oslo University Hospital, Rikshospitalet, Norway; Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway.
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Effect of kidney transplantation on right ventricular function, assessment by 2- dimensional speckle tracking echocardiography. Cardiovasc Ultrasound 2020; 18:16. [PMID: 32456642 PMCID: PMC7251705 DOI: 10.1186/s12947-020-00200-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 05/18/2020] [Indexed: 11/10/2022] Open
Abstract
Background Advanced chronic kidney disease often results in adverse cardiovascular outcomes and is the leading cause of mortality in patients with end stage renal diseases (ESRD). There is much information about the effect of chronic kidney diseases (CKD) on the left ventricle (LV) chamber, but the right ventricle (RV) as a neglected chamber had not been evaluated precisely, in spite of its importance. Objectives The aim of this study was to evaluate the impact of successful kidney transplants on the RV systolic and diastolic function using the advanced method of 2D speckle tracking echocardiography and comparison with the conventional methods. Method The study included 48 patients with CKD who were eligible for kidney transplantation and underwent successful kidney transplantations. Right ventricular indices were evaluated, while RV function was focused by conventional methods and 2D speckle tracking echocardiography before the successful kidney transplant and 1 week, 1 month, and 3 months after the successful kidney transplant. Results The results of the study showed that RV global longitudinal strain and RV free wall longitudinal strain improved over the time (P = 0.024, P < 0.001 respectively). It also represented that kidney transplantation did not have significant effect on the RV mid cavity diameter, tissue velocity, Myocardial performance index, RV longitudinal diameter, and Tricuspid annular plane systolic excursion indices, but for other indices this effect was significant. On the differences between the mean slope of regression line of the GLS variable in hypertensive subjects (1.0 ± 0.2) and non-hypertensive subjects (0.36 ± 0.32), an independent t-test showed that between the two groups in terms of the improvement of RVGLS, there was a significant statistical difference (P = 0.0067). Conclusion Most of the ESRD patients had subtle RV dysfunction which could be better detected by recent echocardiography methods than conventional methods. Moreover, kidney transplantation led to considerable improvements in RV function in this population.
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