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Wang Y, Ciampi Q, Cortigiani L, Zagatina A, Kasprzak JD, Wierzbowska-Drabik K, Haberka M, Lowenstein J, Arbucci R, Haber DML, Marconi S, Merlo PM, Barral P, Souto G, Djordjevic-Dikic A, Reisenhofer B, Boshchenko A, Ryabova T, Rodriguez-Zanella H, Rigo F, D'Andrea A, Gaibazzi N, Merli E, Lisi M, Simova I, Barbieri A, Morrone D, Pitino A, De Nes M, Tripepi GL, Yin L, Citro R, Carerj S, Pepi M, Pellikka PA, Picano E. Predictors of hypercontractile heart phenotype in patients with chronic coronary syndromes or heart failure. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03240-6. [PMID: 39390286 DOI: 10.1007/s10554-024-03240-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2024] [Accepted: 09/06/2024] [Indexed: 10/12/2024]
Abstract
Hypercontractile phenotype (HP) of the left ventricle (LV) is an actionable therapeutic target in patients with chronic coronary syndromes (CCS) or heart failure (HF), but its clinical recognition remains difficult. To assess the clinical variables associated with the HP. In a prospective, observational, multicenter study, we recruited 5122 patients (age 65 ± 11 years, 2974 males, 58%) with CCS and/or HF with preserved ejection fraction (EF). Systolic blood pressure (SBP) was measured. We assessed wall motion score index (WMSI), LV end-diastolic volume (EDV), end-systolic volume (ESV), EF, force (SBP/ESV), stroke volume (SV), arterial elastance (SBP/SV), and ventricular-arterial coupling (VAC, as SV/ESV). Univariable and multivariable logistic regression analysis assessed independent factors associated with the highest force sextile. For all the studied patients, force was 4.51 ± 2.11 mmHg/ml, with the highest sextile (Group 6) > 6.36 mmHg/ml. By multivariable logistic regression model, the highest sextile of force was associated with age > 65 years (OR 1.62, 95% CI 1.36-1.93, p < 0.001), hypertension (OR 1.76, 95% CI 1.40-2.21, p < 0.001), female sex (OR 4.52, 95% CI 3.77-5.42, p < 0.001), absence of beta-blocker therapy (OR 1.41, 95% CI 1.16-1.68), rest SBP ≥ 160 mmHg (OR 2.81, 95% CI 2.21-3.56, p < 0.001), high heart rate (OR 2.08, 95% CI 1.61-2.67, p < 0.001), and absence of prior myocardial infarction (OR 1.34, 95% CI 1.07-1.68, p = 0.012). Patients in the highest sextile of force showed lower values of WMSI, SV, EDV, and ESV, and higher values of arterial elastance and VAC. HP of the LV with high force was clinically associated with advanced age, female sex, high resting SBP, and the absence of β-blocker therapy. By transthoracic echocardiography, HP was associated with a small heart with reduced EDV, reduced SV despite high EF, and higher arterial elastance.
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Affiliation(s)
- Yi Wang
- Department of Cardiovascular Ultrasound and Non-Invasive Cardiology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Quirino Ciampi
- Cardiology Division Fatebenefratelli Hospital of Benevento, Benevento, Italy.
| | | | - Angela Zagatina
- Cardiology Department, Research Scientific Cardiocenter "Medika", St. Petersburg, Russian Federation
| | - Jaroslaw D Kasprzak
- Department of Cadiology, Bieganski Hospital, Medical University, Lodz, Poland
| | | | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, Katowice, Poland
| | | | | | | | | | | | - Patricia Barral
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Germán Souto
- Cardiology Department, Ramos Mejia Hospital, Buenos Aires, Argentina
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Center Serbia, Medical School, University Clinical Center Serbia, University of Belgrade, Belgrade, Serbia
| | | | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | - Tamara Ryabova
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | | | - Fausto Rigo
- Department of Cardiology, Dolo Hospital, Venice, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Umberto I Hospital, Nocera Inferiore (ASL Salerno), Siracusa, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | - Elisa Merli
- Cardiology Unit, Ospedale Per Gli Infermi, Faenza, Italy
| | - Matteo Lisi
- Department of Cardiovascular Disease-AUSL Romagna, Division of Cardiology, Ospedale S. Maria Delle Croci, Ravenna, Italy
| | - Iana Simova
- Cardiology Clinic, Heart and Brain Center of Excellence-University Hospital, Medical University Pleven, Pleven, Bulgaria
| | - Andrea Barbieri
- Division of Cardiology, Department of Diagnostics, Clinical and Public Health Medicine, Policlinico University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Annalisa Pitino
- CNR, Institute of Clinical Physiology, Pisa-Roma-Reggio Calabria, Italy
| | - Michele De Nes
- Department of Medicine and Health Science, Cardiology Institute Research Responsible University Hospital, University of Molise, Campobasso, Italy
| | | | - Lixue Yin
- Department of Cardiovascular Ultrasound and Non-Invasive Cardiology, Sichuan Academy of Medical Sciences, Sichuan Provincial People's Hospital, Chengdu, China
| | - Rodolfo Citro
- Department of Medicine and Health Science, Cardiology Institute Research Responsible University Hospital, University of Molise, Campobasso, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G. Martino, University of Messina, Messina, Italy
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, Milano, Italy
| | | | - Eugenio Picano
- Cardiology Clinic, University Center Serbia, Medical School, University Clinical Center Serbia, University of Belgrade, Belgrade, Serbia
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2
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Zhang X, Li K, Cardoso C, Moctezuma-Ramirez A, Elgalad A. Interpreting Diastolic Dynamics and Evaluation through Echocardiography. Life (Basel) 2024; 14:1156. [PMID: 39337939 PMCID: PMC11433582 DOI: 10.3390/life14091156] [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: 08/05/2024] [Revised: 09/04/2024] [Accepted: 09/10/2024] [Indexed: 09/30/2024] Open
Abstract
In patients with heart failure, evaluating left ventricular (LV) diastolic function is vital, offering crucial insights into hemodynamic impact and prognostic accuracy. Echocardiography remains the primary imaging modality for diastolic function assessment, and using it effectively requires a profound understanding of the underlying pathology. This review covers four main topics: first, the fundamental driving forces behind each phase of normal diastolic dynamics, along with the physiological basis of two widely used echocardiographic assessment parameters, E/e' and mitral annulus early diastolic velocity (e'); second, the intricate functional relationship between the left atrium and LV in patients with varying degrees of LV diastolic dysfunction (LVDD); third, the role of stress echocardiography in diagnosing LVDD and the significance of echocardiographic parameter changes; and fourth, the clinical utility of evaluating diastolic function from echocardiography images across diverse cardiovascular care areas.
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Affiliation(s)
- Xiaoxiao Zhang
- Center for Preclinical Surgical and Interventional Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Ke Li
- Internal Medicine, School of Medicine, University of Nevada, Reno, NV 89509, USA
| | - Cristiano Cardoso
- Center for Preclinical Surgical and Interventional Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Angel Moctezuma-Ramirez
- Center for Preclinical Surgical and Interventional Research, The Texas Heart Institute, Houston, TX 77030, USA
| | - Abdelmotagaly Elgalad
- Center for Preclinical Surgical and Interventional Research, The Texas Heart Institute, Houston, TX 77030, USA
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3
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Manolis AA, Manolis TA, Manolis AS. Managing chronic coronary syndrome: how do we achieve optimal patient outcomes? Expert Rev Cardiovasc Ther 2024; 22:243-263. [PMID: 38757743 DOI: 10.1080/14779072.2024.2357344] [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: 01/06/2024] [Accepted: 05/15/2024] [Indexed: 05/18/2024]
Abstract
INTRODUCTION Chronic coronary syndrome (CCS) remains the leading cause of death worldwide with high admission/re-admission rates. Medical databases were searched on CCS & its management. AREAS COVERED This review discusses phenotypes per stress-echocardiography, noninvasive/invasive testing (coronary computed-tomography angiography-CCTA; coronary artery calcium - CAC score; echocardiography assessing wall-motion, LV function, valvular disease; biomarkers), multidisciplinary management (risk factors/anti-inflammatory/anti-ischemic/antithrombotic therapies and revascularization), newer treatments (colchicine/ivabradine/ranolazine/melatonin), cardiac rehabilitation/exercise improving physical activity and quality-of-life, use of the implantable-defibrillator, and treatment with extracorporeal shockwave-revascularization for refractory symptoms. EXPERT OPINION CCS is age-dependent, leading cause of death worldwide with high hospitalization rates. Stress-echocardiography defines phenotypes and guides prophylaxis and management. CAC is a surrogate for atherosclerosis burden, best for patients of intermediate/borderline risk. Higher CAC-scores indicate more severe coronary abnormalities. CCTA is preferred for noninvasive detection of CAC and atherosclerosis burden, determining stenosis' functional significance, and guiding management. Combining CAC score with CCTA improves diagnostic yield and assists prognosis. Echocardiography assesses LV wall-motion and function and valvular disease. Biomarkers guide diagnosis/prognosis. CCS management is multidisciplinary: risk-factor management, anti-inflammatory/anti-ischemic/antithrombotic therapies, and revascularization. Newer therapies comprise colchicine, ivabradine, ranolazine, melatonin, glucagon-like peptide-1-receptor antagonists. Cardiac rehabilitation/exercise improves physical activity and quality-of-life. An ICD protects from sudden death. Extracorporeal shockwave-revascularization treats refractory symptoms.
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Affiliation(s)
| | - Theodora A Manolis
- Department of Psychiatry, Aiginiteio University Hospital, Athens, Greece
| | - Antonis S Manolis
- First Department of Cardiology, Ippokrateio University Hospital, Athens, Greece
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Gaibazzi N, Ciampi Q, Cortigiani L, Wierzbowska-Drabik K, Zagatina A, Djordjevic-Dikic A, Manganelli F, Boshchenko A, Borguezan-Daros C, Arbucci R, Marconi S, Lowenstein J, Haberka M, Celutkiene J, D'Andrea A, Rodriguez-Zanella H, Rigo F, Monte I, Costantino MF, Ostojic M, Merli E, Pepi M, Carerj S, Kasprzak JD, Pellikka PA, Picano E. Multiple Phenotypes of Chronic Coronary Syndromes Identified by ABCDE Stress Echocardiography. J Am Soc Echocardiogr 2024; 37:477-485. [PMID: 38092306 DOI: 10.1016/j.echo.2023.12.003] [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: 06/14/2023] [Revised: 11/20/2023] [Accepted: 12/05/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Regional wall motion abnormality is considered a sensitive and specific marker of ischemia during stress echocardiography (SE). However, ischemia is a multifaceted entity associated with either coronary artery disease (CAD) or angina with normal coronary arteries, a distinction difficult to make using a single sign. The aim of this study was to evaluate the diagnostic potential of the five-step ABCDE SE protocol for CAD detection. METHODS From the 2016-2022 Stress Echo 2030 study data bank, 3,229 patients were selected (mean age, 66 ± 12 years; 2,089 men [65%]) with known CAD (n = 1,792) or angina with normal coronary arteries (n = 1,437). All patients were studied using both the ABCDE SE protocol and coronary angiography, within 3 months. In step A, regional wall motion abnormality is assessed; in step B, B-lines and diastolic function; in step C, left ventricular contractile reserve; in step D, coronary flow velocity reserve in the left anterior descending coronary artery; and in step E, heart rate reserve. RESULTS SE response ranged from a score of 0 (all steps normal) to a score of 5 (all steps abnormal). For CAD, rates of abnormal results were 347 for step A (19.4%), 547 (30.5%) for step B, 720 (40.2%) for step C, 615 (34.3%) for step D, and 633 (35.3%) for step E. For angina with normal coronary arteries, rates of abnormal results were 81 (5.6%) for step A, 429 (29.9%) for step B, 432 (30.1%) for step C, 354 (24.6%) for step D, and 445 (31.0%) for step E. The dominant "solitary phenotype" was step B in 109 patients (9.1%). CONCLUSIONS Stress-induced ischemia presents with a wide range of diagnostic phenotypes, highlighting its complex nature. Using a comprehensive approach such as the advanced ABCDE score, which combines multiple markers, proves to be more valuable than relying on a single marker in isolation.
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Affiliation(s)
| | - Quirino Ciampi
- Division of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
| | | | | | - Angela Zagatina
- Cardiology Department, Research Cardiology Center "Medika", Saint Petersburg, Russian Federation
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia and School of Medicine University of Belgrade, Belgrade, Serbia
| | - Fiore Manganelli
- Department of Cardiology, San Giuseppe Moscati Hospital, Avellino, Italy
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, Tomsk, Russian Federation
| | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Sofia Marconi
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas, Buenos Aires, Argentina
| | - Maciej Haberka
- Cardiology Department, University of Silesia, Katowice, Poland
| | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, Center for Innovative Medicine, Vilnius, Lithuania
| | | | | | - Fausto Rigo
- Villa Salus Foundation/IRCCS San Camillo Hospital, Venice, Italy
| | - Ines Monte
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy
| | | | - Miodrag Ostojic
- University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, Italy
| | - Mauro Pepi
- Cardiology Division, Centro Cardiologico Monzino, IRCCS, Milan, Italy
| | - Scipione Carerj
- Cardiology Division, University Hospital G. Martino, University of Messina, Messina, Italy
| | | | | | - Eugenio Picano
- CNR Institute of Clinical Physiology Biomedicine Department, Pisa, Italy
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5
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Zhuravleva OA, Ryabova TR, Vrublevsky AV, Svyazova NN, Margolis NY, Boshchenko AA. Stress Echocardiography by the ABCDE Protocol ln the Assessment of Prognosis of Stable Coronary Heart Disease. KARDIOLOGIIA 2024; 64:22-30. [PMID: 38742512 DOI: 10.18087/cardio.2024.4.n2572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 10/23/2023] [Indexed: 05/16/2024]
Abstract
AIM To assess the role of clinical indicators and parameters of stress echocardiography performed according to an extended protocol as predictors for the occurrence of a composite cardiovascular endpoint (CCVEP) in IHD. MATERIAL AND METHODS The study included 186 patients (60.2% men, mean age 60.6±9.9 years) with an established (n=73; 39.2%) and suspected (60.8%) diagnosis of IHD. Stress EchoCG with adenosine triphosphate (38.2%), transesophageal pacing (15.1%), dobutamine (2.6%), and bicycle ergometry on a recumbent ergometer (44.1%) was performed. The stress EchoCG protocol included assessment of regional wall motion abnormalities (WMA), B-lines, LV contractile reserve (CTR), coronary reserve (CR), and heart rate reserve. The median follow-up period was 13 [9; 20] months. The composite CCVEP included death from cardiovascular diseases and their complications, acute coronary syndrome, and revascularization and was defined at the first of these events. Statistical analysis was performed with the Statistica 16.0 and SPSS Statistics 23.0 software packages. Differences were considered statistically significant at p<0.05. RESULTS Invasive or noninvasive coronary angiography was performed in 90.3% of patients; obstructive coronary disease (stenosis ≥50%) was detected in 67.9% of cases. During the follow-up period, 58 (31.2%) patients had cardiovascular complications. The risk of developing CCVEP was associated with the pretest probability (PTP) of ischemic heart disease (odds ratio, OR, 1.05; 95% confidence interval, CI, 1.02-1.08), dyslipidemia (DLP) (OR 0.40; 95% CI 0.20-0.82), carotid atherosclerosis (OR 0.39; 95% CI 0.18-0.86), LV ejection fraction (OR 0.96; 95% CI 0.93-0.99), appearance at peak stress of new significant (2 LV segments or more) regional WMAs (OR 0.32; 95% CI 0.18-6.55), decreased LV CTR (OR 0.46; 95% CI 0.27-0.79) and CR (OR 0.33; 95% CI 0.18-0.61); p<0.05 for all. In a multivariate analysis with Cox regression, the model with clinical indicators included PTP of IHD (OR 1.04; 95% CI 1.01-1.07; p=0.01) and DLP (OR 0.14; 95% CI 0.02-1.01; p=0.05) as predictors. The model with stress EchoCG parameters included the appearance of new significant WMAs (OR 0.33, 95% CI 0.16-0.65; p=0.001) and reduced <2.0 CR (OR 0.44; 95% CI 0.24-0.82; p=0.01). A comparative analysis of Kaplan-Meier curves confirmed statistically significant differences in the dynamics of the CCVEP occurrence depending on the absence or presence of hemodynamically significant WMAs and/or reduced CR during stress EchoCG (p<0.01). CONCLUSION Reduced LV CR and WMA during stress EchoCG in patients with suspected or confirmed IHD are significant independent predictors for the CCVEP occurrence. Among clinical indicators, PTP of IHD and DLP are of the greatest importance for prognosis.
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Affiliation(s)
- O A Zhuravleva
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - T R Ryabova
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - A V Vrublevsky
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - N N Svyazova
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - N Y Margolis
- Research Institute of Cardiology, Tomsk National Research Medical Center
| | - A A Boshchenko
- Research Institute of Cardiology, Tomsk National Research Medical Center
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6
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Chang IC, Pellikka PA, Winchester DE. 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease: A Summary for JASE. J Am Soc Echocardiogr 2024; 37:303-306. [PMID: 37858904 DOI: 10.1016/j.echo.2023.10.008] [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: 08/17/2023] [Revised: 10/04/2023] [Accepted: 10/04/2023] [Indexed: 10/21/2023]
Abstract
This report provides a descriptive summary of the ACC/AHA/ASE/ASNC/ASPC/HFSA/HRS/SCAI/SCCT/SCMR/STS 2023 Multimodality Appropriate Use Criteria for the Detection and Risk Assessment of Chronic Coronary Disease with an emphasis on the role of stress echocardiography.
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Affiliation(s)
- Ian C Chang
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Cortigiani L, Gaibazzi N, Ciampi Q, Rigo F, Rodríguez‐Zanella H, Wierzbowska‐Drabik K, Kasprzak JD, Arbucci R, Lowenstein J, Zagatina A, Bartolacelli Y, Gregori D, Carerj S, Pepi M, Pellikka PA, Picano E. High Resting Coronary Flow Velocity by Echocardiography Is Associated With Worse Survival in Patients With Chronic Coronary Syndromes. J Am Heart Assoc 2024; 13:e031270. [PMID: 38362899 PMCID: PMC11010105 DOI: 10.1161/jaha.123.031270] [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: 06/18/2023] [Accepted: 11/14/2023] [Indexed: 02/17/2024]
Abstract
BACKGROUND Resting coronary flow velocity (CFV) in the mid-distal left anterior descending coronary artery can be easily assessed with transthoracic echocardiography. In this observational study, the authors sought to assess the relationship between resting CFV, CFV reserve (CFVR), and outcome in patients with chronic coronary syndromes. METHODS AND RESULTS In a prospective multicenter study design, the authors retrospectively analyzed 7576 patients (age, 66±11 years; 4312 men) with chronic coronary syndromes and left ventricular ejection fraction ≥50% referred for dipyridamole stress echocardiography. Recruitment (years 2003-2021) involved 7 accredited laboratories, with interobserver variability <10% for CFV measurement at study entry. Baseline peak diastolic CFV was obtained by pulsed-wave Doppler in the mid-distal left anterior descending coronary artery. CFVR (abnormal value ≤2.0) was assessed with dipyridamole. All-cause death was the only end point. The mean CFV of the left anterior descending coronary artery was 31±12 cm/s. The mean CFVR was 2.32±0.60. During a median follow-up of 5.9±4.3 years, 1121 (15%) patients died. At multivariable analysis, resting CFV ≥32 cm/s was identified by a receiver operating curve as the best cutoff and was independently associated with mortality (hazard ratio [HR], 1.24 [95% CI, 1.10-1.40]; P<0.0001) together with CFVR ≤2.0 (HR, 1.78 [95% CI, 1.57-2.02]; P<0.0001), age, diabetes, history of coronary surgery, and left ventricular ejection fraction. When both CFV and CFVR were considered, the mortality rate was highest in patients with resting CFV ≥32 cm/s and CFVR ≤2.0 and lowest in patients with resting CFV <32 cm/s and CFVR >2.0. CONCLUSIONS High resting CFV is associated with worse survival in patients with chronic coronary syndromes and left ventricular ejection fraction ≥50%. The value is independent and additive to CFVR. The combination of high resting CFV and low CFVR is associated with the worst survival.
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Affiliation(s)
| | | | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli HospitalBeneventoItaly
| | - Fausto Rigo
- Cardiology Division, Villa Salus HospitalMestreItaly
| | | | | | | | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas CenterBuenos AiresArgentina
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas CenterBuenos AiresArgentina
| | - Angela Zagatina
- Saint Petersburg State Pediatric Medical UniversitySaint PetersburgRussian Federation
| | - Ylenia Bartolacelli
- Paediatric Cardiology and Adult Congenital Heart Disease Program, Department of Cardio‐Thoracic and Vascular Medicine IRCCS Azienda Ospedaliero‐Universitaria di BolognaPoliclinico S. Orsola‐Malpighi HospitalBolognaItaly
| | - Dario Gregori
- Biostatistics, Epidemiology and Public Health UnitPadova UniversityPadovaItaly
| | - Scipione Carerj
- Divisione di Cardiologia, Policlinico UniversitarioUniversità di MessinaMessinaItaly
| | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCSMilanItaly
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8
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Picano E, Pierard L, Peteiro J, Djordjevic-Dikic A, Sade LE, Cortigiani L, Van De Heyning CM, Celutkiene J, Gaibazzi N, Ciampi Q, Senior R, Neskovic AN, Henein M. The clinical use of stress echocardiography in chronic coronary syndromes and beyond coronary artery disease: a clinical consensus statement from the European Association of Cardiovascular Imaging of the ESC. Eur Heart J Cardiovasc Imaging 2024; 25:e65-e90. [PMID: 37798126 DOI: 10.1093/ehjci/jead250] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/07/2023] Open
Abstract
Since the 2009 publication of the stress echocardiography expert consensus of the European Association of Echocardiography, and after the 2016 advice of the American Society of Echocardiography-European Association of Cardiovascular Imaging for applications beyond coronary artery disease, new information has become available regarding stress echo. Until recently, the assessment of regional wall motion abnormality was the only universally practiced step of stress echo. In the state-of-the-art ABCDE protocol, regional wall motion abnormality remains the main step A, but at the same time, regional perfusion using ultrasound-contrast agents may be assessed. Diastolic function and pulmonary B-lines are assessed in step B; left ventricular contractile and preload reserve with volumetric echocardiography in step C; Doppler-based coronary flow velocity reserve in the left anterior descending coronary artery in step D; and ECG-based heart rate reserve in non-imaging step E. These five biomarkers converge, conceptually and methodologically, in the ABCDE protocol allowing comprehensive risk stratification of the vulnerable patient with chronic coronary syndromes. The present document summarizes current practice guidelines recommendations and training requirements and harmonizes the clinical guidelines of the European Society of Cardiology in many diverse cardiac conditions, from chronic coronary syndromes to valvular heart disease. The continuous refinement of imaging technology and the diffusion of ultrasound-contrast agents improve image quality, feasibility, and reader accuracy in assessing wall motion and perfusion, left ventricular volumes, and coronary flow velocity. Carotid imaging detects pre-obstructive atherosclerosis and improves risk prediction similarly to coronary atherosclerosis. The revolutionary impact of artificial intelligence on echocardiographic image acquisition and analysis makes stress echo more operator-independent and objective. Stress echo has unique features of low cost, versatility, and universal availability. It does not need ionizing radiation exposure and has near-zero carbon dioxide emissions. Stress echo is a convenient and sustainable choice for functional testing within and beyond coronary artery disease.
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Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology of the National Research Council, CNR, Via Moruzzi 1, 56124 Pisa, Italy
| | - Luc Pierard
- University of Liège, Walloon Region, Belgium
| | - Jesus Peteiro
- CHUAC-Complexo Hospitalario Universitario A Coruna, CIBER-CV, University of A Coruna, 15070 La Coruna, Spain
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Clinical Centre of Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia
| | - Leyla Elif Sade
- University of Pittsburgh Medical Center UPMC Heart & Vascular Institute, Pittsburgh, PA, USA
| | | | | | - Jelena Celutkiene
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Faculty of Medicine, Institute of Clinical Medicine, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, 43100 Parma, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, 82100 Benevento, Italy
| | - Roxy Senior
- Imperial College, UK
- Royal Brompton Hospital Imperial College London, UK
- Northwick Park Hospital, London, UK
| | - Aleksandar N Neskovic
- Department of Cardiology, University Clinical Hospital Center Zemun-Belgrade Faculty of Medicine, University of Belgrade, Serbia
| | - Michael Henein
- Department of Public Health and Clinical Medicine Units: Section of Medicine, Umea University, Umea, Sweden
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Zagatina A, Rivadeneira Ruiz M, Ciampi Q, Wierzbowska-Drabik K, Kasprzak J, Kalinina E, Begidova I, Peteiro J, Arbucci R, Marconi S, Lowenstein J, Boshchenko A, Manganelli F, Čelutkienė J, Morrone D, Merli E, Re F, Borguezan-Daros C, Haberka M, Saad AK, Djordjevic-Dikic A, Ratanasit NC, Rigo F, Colonna P, Pretto JLDCES, Mori F, D’Alfonso MG, Ostojic M, Stanetic B, Preradovic TK, Costantino F, Barbieri A, Citro R, Pitino A, Pepi M, Carerj S, Pellikka PA, Picano E. Rest and Stress Left Atrial Dysfunction in Patients with Atrial Fibrillation. J Clin Med 2023; 12:5893. [PMID: 37762833 PMCID: PMC10532252 DOI: 10.3390/jcm12185893] [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: 08/21/2023] [Revised: 09/01/2023] [Accepted: 09/09/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Left atrial (LA) myopathy with paroxysmal and permanent atrial fibrillation (AF) is frequent in chronic coronary syndromes (CCS) but sometimes occult at rest and elicited by stress. AIM This study sought to assess LA volume and function at rest and during stress across the spectrum of AF. METHODS In a prospective, multicenter, observational study design, we enrolled 3042 patients [age = 64 ± 12; 63.8% male] with known or suspected CCS: 2749 were in sinus rhythm (SR, Group 1); 191 in SR with a history of paroxysmal AF (Group 2); and 102 were in permanent AF (Group 3). All patients underwent stress echocardiography (SE). We measured left atrial volume index (LAVI) in all patients and LA Strain reservoir phase (LASr) in a subset of 486 patients. RESULTS LAVI increased from Group 1 to 3, both at rest (Group 1 = 27.6 ± 12.2, Group 2 = 31.6 ± 12.9, Group 3 = 43.3 ± 19.7 mL/m2, p < 0.001) and at peak stress (Group 1 = 26.2 ± 12.0, Group 2 = 31.2 ± 12.2, Group 3 = 43.9 ± 19.4 mL/m2, p < 0.001). LASr progressively decreased from Group 1 to 3, both at rest (Group 1 = 26.0 ± 8.5%, Group 2 = 23.2 ± 11.2%, Group 3 = 8.5 ± 6.5%, p < 0.001) and at peak stress (Group 1 = 26.9 ± 10.1, Group 2 = 23.8 ± 11.0 Group 3 = 10.7 ± 8.1%, p < 0.001). Stress B-lines (≥2) were more frequent in AF (Group 1 = 29.7% vs. Group 2 = 35.5% vs. Group 3 = 57.4%, p < 0.001). Inducible ischemia was less frequent in SR (Group 1 = 16.1% vs. Group 2 = 24.7% vs. Group 3 = 24.5%, p = 0.001). CONCLUSIONS In CCS, rest and stress LA dilation and reservoir dysfunction are often present in paroxysmal and, more so, in permanent AF and are associated with more frequent inducible ischemia and pulmonary congestion during stress.
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Affiliation(s)
- Angela Zagatina
- Cardiology Department, Research Scientific Cardiocenter “Medika”, 197110 St. Petersburg, Russia; (A.Z.); (E.K.); (I.B.)
| | | | - Quirino Ciampi
- Fatebenefratelli Hospital of Benevento, 82100 Benevento, Italy;
| | | | - Jaroslaw Kasprzak
- Cardiology Department, Bieganski Hospital, Medical University, 93-510 Lodz, Poland;
| | - Elena Kalinina
- Cardiology Department, Research Scientific Cardiocenter “Medika”, 197110 St. Petersburg, Russia; (A.Z.); (E.K.); (I.B.)
| | - Irina Begidova
- Cardiology Department, Research Scientific Cardiocenter “Medika”, 197110 St. Petersburg, Russia; (A.Z.); (E.K.); (I.B.)
| | - Jesus Peteiro
- CHUAC—Complexo Hospitalario Universitario A Coruna, University of A Coruna, 15071 La Coruna, Spain;
| | - Rosina Arbucci
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (R.A.); (S.M.); (J.L.)
| | - Sofia Marconi
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (R.A.); (S.M.); (J.L.)
| | - Jorge Lowenstein
- Cardiodiagnosticos, Investigaciones Medicas Center, Buenos Aires C1082, Argentina; (R.A.); (S.M.); (J.L.)
| | - Alla Boshchenko
- Cardiology Research Institute, Tomsk National Research Medical Centre of the Russian Academy of Sciences, 634028 Tomsk, Russia;
| | - Fiore Manganelli
- Cardiology Department, SG Moscati Hospital, 83100 Avellino, Italy;
| | - Jelena Čelutkienė
- Centre of Cardiology and Angiology, Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Centre of Innovative Medicine, LT-10257 Vilnius, Lithuania;
| | - Doralisa Morrone
- Cardiothoracic Department, University of Pisa, 56126 Pisa, Italy;
| | - Elisa Merli
- Department of Cardiology, Ospedale per gli Infermi, Faenza, 48100 Ravenna, Italy;
| | - Federica Re
- Department of Cardiology, Ospedale San Camillo, 00149 Roma, Italy;
| | | | - Maciej Haberka
- Department of Cardiology, SHS, Medical University of Silesia, 40-635 Katowice, Poland;
| | - Ariel K. Saad
- División de Cardiología, Hospital de Clínicas José de San Martín, Buenos Aires C1120, Argentina;
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, University Center Serbia, Medical School, University of Belgrade, 11000 Belgrade, Serbia;
| | - Nithima Chaowalit Ratanasit
- Division of Cardiology, Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand;
| | - Fausto Rigo
- Department of Cardiology, Dolo Hospital, 30031 Venice, Italy;
| | - Paolo Colonna
- Cardiology Division, Bari University Hospital, 70100 Bari, Italy;
| | | | - Fabio Mori
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.)
| | - Maria Grazia D’Alfonso
- SOD Diagnostica Cardiovascolare, DAI Cardio-Toraco-Vascolare, Azienda Ospedaliera-Universitaria Careggi, 50139 Firenze, Italy; (F.M.); (M.G.D.)
| | - Miodrag Ostojic
- Department of Noninvasive Cardiology, University Clinical Center, School of Medicine, 78000 Banja-Luka, Bosnia and Herzegovina; (M.O.); (B.S.); (T.K.P.)
| | - Bojan Stanetic
- Department of Noninvasive Cardiology, University Clinical Center, School of Medicine, 78000 Banja-Luka, Bosnia and Herzegovina; (M.O.); (B.S.); (T.K.P.)
| | - Tamara Kovacevic Preradovic
- Department of Noninvasive Cardiology, University Clinical Center, School of Medicine, 78000 Banja-Luka, Bosnia and Herzegovina; (M.O.); (B.S.); (T.K.P.)
| | | | - Andrea Barbieri
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, 41124 Modena, Italy;
| | - Rodolfo Citro
- Cardiology Division, Ospedale Ruggi di Aragona, 84100 Salerno, Italy;
| | | | - Mauro Pepi
- Centro Cardiologico Monzino, IRCCS, 20138 Milano, Italy;
| | - Scipione Carerj
- Cardiology Division, University Hospital Polyclinic G.Martino, University of Messina, 98166 Messina, Italy;
| | | | - Eugenio Picano
- CNR, Institute of Clinical Physiology, 56124 Pisa, Italy;
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