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Sun D, Hu Y, Li Y, Yu X, Chen X, Shen P, Tang X, Wang Y, Lai C, Kang B, Bai Z, Ni Z, Wang N, Wang R, Guan L, Zhou W, Gao Y. Chamber Attention Network (CAN): Towards interpretable diagnosis of pulmonary artery hypertension using echocardiography. J Adv Res 2024; 63:103-115. [PMID: 37926144 DOI: 10.1016/j.jare.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/20/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
INTRODUCTION Accurate identification of pulmonary arterial hypertension (PAH) in primary care and rural areas can be a challenging task. However, recent advancements in computer vision offer the potential for automated systems to detect PAH from echocardiography. OBJECTIVES Our aim was to develop a precise and efficient diagnostic model for PAH tailored to the unique requirements of intelligent diagnosis, especially in challenging locales like high-altitude regions. METHODS We proposed the Chamber Attention Network (CAN) for PAH identification from echocardiographic images, trained on a dataset comprising 13,912 individual subjects. A convolutional neural network (CNN) for view classification was used to select the clinically relevant apical four chamber (A4C) and parasternal long axis (PLAX) views for PAH diagnosis. To assess the importance of different heart chambers in PAH diagnosis, we developed a novel Chamber Attention Module. RESULTS The experimental results demonstrated that: 1) The substantial correspondence between our obtained chamber attention vector and clinical expertise suggested that our model was highly interpretable, potentially uncovering diagnostic insights overlooked by the clinical community. 2) The proposed CAN model exhibited superior image-level accuracy and faster convergence on the internal validation dataset compared to the other four models. Furthermore, our CAN model outperformed the others on the external test dataset, with image-level accuracies of 82.53% and 83.32% for A4C and PLAX, respectively. 3) Implementation of the voting strategy notably enhanced the positive predictive value (PPV) and negative predictive value (NPV) of individual-level classification results, enhancing the reliability of our classification outcomes. CONCLUSIONS These findings indicate that CAN is a feasible technique for AI-assisted PAH diagnosis, providing new insights into cardiac structural changes observed in echocardiography.
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Affiliation(s)
- Dezhi Sun
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Yangyi Hu
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Yunming Li
- Department of Information, Medical Support Center, The General Hospital of Western Theater Command, Chengdu 610083, Sichuan, China
| | - Xianbiao Yu
- Department of Ultrasonic Diagnosis, Army 954 Hospital, Shannan 856000, Tibet, China
| | - Xi Chen
- Department of Respiratory Medicine, Army 954 Hospital, Shannan 856000, Tibet, China
| | - Pan Shen
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Xianglin Tang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Yihao Wang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Chengcai Lai
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Bo Kang
- Department of Academic Affairs, Army 954 Hospital, Shannan 856000, Tibet, China
| | - Zhijie Bai
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Zhexin Ni
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Ningning Wang
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China
| | - Rui Wang
- General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi 830000, Xinjiang, China
| | - Lina Guan
- General Hospital of Xinjiang Military Region of the Chinese People's Liberation Army, Urumqi 830000, Xinjiang, China
| | - Wei Zhou
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China.
| | - Yue Gao
- Department of Pharmaceutical Sciences, Beijing Institute of Radiation Medicine, Beijing 100850, China.
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Torbicki A, Channick R, Galiè N, Kiely DG, Moceri P, Peacock A, Swift AJ, Tawakol A, Vonk Noordegraaf A, Flores D, Martin N, Rosenkranz S. Effect of Macitentan in Pulmonary Arterial Hypertension and the Relationship Between Echocardiography and cMRI Variables: REPAIR Echocardiography Sub-study Results. Cardiol Ther 2024; 13:173-190. [PMID: 38281309 PMCID: PMC10899124 DOI: 10.1007/s40119-023-00345-2] [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: 10/26/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024] Open
Abstract
INTRODUCTION The aim of this sub-study was to evaluate the relationship between echocardiography (echo) and cardiac magnetic resonance imaging (cMRI) variables and to utilize echo to assess the effect of macitentan on right ventricle (RV) structure and function. METHODS REPAIR (NCT02310672) was a prospective, multicenter, single-arm, open-label, 52-week, phase 4 study in pulmonary arterial hypertension (PAH) patients, which investigated the effect of macitentan 10 mg as monotherapy, or in combination with a phosphodiesterase 5 inhibitor, on RV structure, function, and hemodynamics using cMRI and right heart catheterization. In this sub-study, patients were also assessed by echo at screening and at weeks 26 and/or 52. Post hoc correlation analyses between echo and cMRI variables were performed using Pearson's correlation coefficient, Spearman's correlation coefficient, and Bland-Altman analyses. RESULTS The Echo sub-study included 45 patients. Improvements in echo-assessed RV stroke volume (RVSV), left ventricular SV (LVSV), LV end-diastolic volume (LVEDV), RV fractional area change (RVFAC), tricuspid annular plane systolic excursion (TAPSE), and in 2D global longitudinal RV strain (2D GLRVS) were observed at weeks 26 and 52 compared to baseline. There was a strong correlation between echo (LVSV, 2D GLRVS, and LVEDV) and cMRI variables, with a moderate correlation for RVSV. Bland-Altman analyses showed a good agreement for LVSV measured by echo versus cMRI, whereas an overestimation in echo-assessed RVSV was observed compared to cMRI (bias of - 15 mL). Hemodynamic and functional variables, as well as safety, were comparable between the Echo sub-study and REPAIR. CONCLUSIONS A good relationship between relevant echo and cMRI parameters was shown. Improvements in RV structure and function with macitentan treatment was observed by echo, consistent with results observed by cMRI in the primary analysis of the REPAIR study. Echo is a valuable complementary method to cMRI, with the potential to non-invasively monitor treatment response at follow-up. TRIAL REGISTRATION NUMBER REPAIR NCT02310672.
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Affiliation(s)
- Adam Torbicki
- Department of Pulmonary Circulation, Thromboembolic Disease and Cardiology, Centre for Postgraduate Medical Education ECZ-Otwock, ERN-LUNG Member, F. Chopin Hospital European Health Centre, ul. Borowa 14/18, 05-400, Otwock, Poland.
| | | | - Nazzareno Galiè
- Cardiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna and Dipartimento DIMES, Università di Bologna, Bologna, Italy
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, NIHR Biomedical Research Centre Sheffield and University of Sheffield, Sheffield, UK
| | - Pamela Moceri
- Cardiology Department, UR2CA, Pasteur University Hospital, Côte-d'Azur University, Nice, France
| | | | - Andrew J Swift
- Department of Infection, Immunity & Cardiovascular Disease, National Institute for Health and Care Research Sheffield Biomedical Research Centre, University of Sheffield, Sheffield, UK
| | - Ahmed Tawakol
- Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | | | - Dayana Flores
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Global Medical Affairs, Allschwil, Switzerland
| | - Nicolas Martin
- Actelion Pharmaceuticals Ltd, a Janssen Pharmaceutical Company of Johnson & Johnson, Statistical Decision Science, Allschwil, Switzerland
| | - Stephan Rosenkranz
- Department of Cardiology, Heart Center, University Hospital Cologne, and Cologne Cardiovascular Research Center (CCRC), University of Cologne, Cologne, Germany
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Alerhand S, Adrian RJ. What echocardiographic findings differentiate acute pulmonary embolism and chronic pulmonary hypertension? Am J Emerg Med 2023; 72:72-84. [PMID: 37499553 DOI: 10.1016/j.ajem.2023.07.011] [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: 05/08/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND Pulmonary embolism (PE) and pulmonary hypertension (PH) are potentially fatal disease states. Early diagnosis and goal-directed management improve outcomes and survival. Both conditions share several echocardiographic findings of right ventricular dysfunction. This can inadvertently lead to incorrect diagnosis, inappropriate and potentially harmful management, and delay in time-sensitive therapies. Fortunately, bedside echocardiography imparts a few critical distinctions. OBJECTIVE This narrative review describes eight physiologically interdependent echocardiographic parameters that help distinguish acute PE and chronic PH. The manuscript details each finding along with associated pathophysiology and summarization of the literature evaluating diagnostic utility. This guide then provides pearls and pitfalls with high-quality media for the bedside evaluation. DISCUSSION The echocardiographic parameters suggesting acute or chronic right ventricular dysfunction (best used in combination) are: 1. Right heart thrombus (acute PE) 2. Right ventricular free wall thickness (acute ≤ 5 mm, chronic > 5 mm) 3. Tricuspid regurgitation pressure gradient (acute ≤ 46 mmHg, chronic > 46 mmHg, corresponding to tricuspid regurgitation maximal velocity ≤ 3.4 m/sec and > 3.4 m/sec, respectively) 4. Pulmonary artery acceleration time (acute ≤ 60-80 msec, chronic < 105 msec) 5. 60/60 sign (acute) 6. Pulmonary artery early-systolic notching (proximally-located, higher-risk PE) 7. McConnell's sign (acute) 8. Right atrial enlargement (equal to left atrial size suggests acute, greater than left atrial size suggests chronic). CONCLUSIONS Emergency physicians must appreciate the echocardiographic findings and associated pathophysiology that help distinguish acute and chronic right ventricular dysfunction. In the proper clinical context, these findings can point towards PE or PH, thereby leading to earlier goal-directed management.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, 150 Bergen Street, Newark, NJ 07103, USA.
| | - Robert James Adrian
- Department of Emergency Medicine, Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA
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Ferraro A, Hartnack S, Schwarzwald CC. Diagnostic value of two-dimensional echocardiographic measurements of the pulmonary artery diameter and the pulmonary artery distensibility index to detect pulmonary hypertension in horses. J Vet Cardiol 2023; 49:52-66. [PMID: 37832424 DOI: 10.1016/j.jvc.2023.08.001] [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: 12/26/2021] [Revised: 07/25/2023] [Accepted: 08/01/2023] [Indexed: 10/15/2023]
Abstract
INTRODUCTION/OBJECTIVES Echocardiographic diagnosis of pulmonary hypertension (PH) in horses is usually based on Doppler interrogation of tricuspid (TR) or pulmonic regurgitation (PR). This study aimed at investigating two-dimensional echocardiographic (2DE) variables, including pulmonary artery diameter (PAD) and pulmonary artery distensibility index (PADI), to diagnose PH. ANIMALS, MATERIALS AND METHODS 41 healthy horses; 82 horses with TR or PR and normal intracardiac pressure gradients; and 35 horses with TR or PR velocities indicating PH. The 2DE variables were compared between groups, cut-offs for the diagnosis of PH were determined, and conditional inference trees served to identify the variable best predicting PH in the absence of TR or PR. RESULTS Horses with PH had larger end-diastolic cross-sectional (short-axis) PAD (PADed-sx) (5.8 ± 1.0 cm; mean ± SD) and smaller PADI[/PADps] (15.4 ± 7.7%) than healthy horses (5.0 ± 0.6 cm, P<0.0001; 20.5 ± 4.4%, P<0.001) and horses with TR or PR but no PH (5.3 ± 0.6 cm, P=0.003; 18.8 ± 4.2%, P=0.005). PADed-sx predicted PH with sensitivity (Se) = 36% and specificity (Sp) = 94% (cut-off 6.0 cm, AUC = 0.668, P=0.002), while PADI[/PADps] predicted PH with Se = 43% and Sp = 92% (cut-off 13.7%, AUC = 0.662, P=0.004). In the absence of TR, PADed-sx and the end-diastolic long-axis aortic diameter-to-PADed-sx ratio (AoDed-lx/PADed-sx) were most suitable to diagnose PH. CONCLUSION Pulmonary artery crosssectional (short-axis) diameter at end-diastole measured in a right-parasternal long axis view of the left ventricular outflow tract and Pulmonary artery distensibility index were moderately specific but not very sensitive to diagnosing PH. Nonetheless, they may be used as complementary indices suggesting PH in the absence of TR or PR.
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Affiliation(s)
- A Ferraro
- Equine Department, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - S Hartnack
- Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland
| | - C C Schwarzwald
- Equine Department, Vetsuisse Faculty, University of Zurich, Winterthurerstrasse 260, 8057 Zurich, Switzerland.
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Yuriditsky E, Horowitz JM, Lau JF. Chronic thromboembolic pulmonary hypertension and the post-pulmonary embolism (PE) syndrome. Vasc Med 2023; 28:348-360. [PMID: 37036116 DOI: 10.1177/1358863x231165105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
Over a third of patients surviving acute pulmonary embolism (PE) will experience long-term cardiopulmonary limitations. Persistent thrombi, impaired gas exchange, and altered hemodynamics account for aspects of the postpulmonary embolism syndrome that spans mild functional limitations to debilitating chronic thromboembolic pulmonary hypertension (CTEPH), the most worrisome long-term consequence. Though pulmonary endarterectomy is potentially curative for the latter, less is understood surrounding chronic thromboembolic disease (CTED) and post-PE dyspnea. Advances in pulmonary vasodilator therapies and growing expertise in balloon pulmonary angioplasty provide options for a large group of patients ineligible for surgery, or those with persistent postoperative pulmonary hypertension. In this clinical review, we discuss epidemiology and pathophysiology as well as advances in diagnostics and therapeutics surrounding the spectrum of disease that may follow months after acute PE.
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Affiliation(s)
- Eugene Yuriditsky
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - James M Horowitz
- Department of Medicine, Division of Cardiology, NYU Langone Health, New York, NY, USA
| | - Joe F Lau
- Department of Cardiology, Northwell Health, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA
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Rehman A, Darira J, Ahmed MS, Hamid K, Shazlee MK, Hyder SMS. Evaluating Signs of Pulmonary Hypertension on Computed Tomography and Correlating With Echocardiography: A Study at a Tertiary Care Hospital. Cureus 2022; 14:e25319. [PMID: 35755553 PMCID: PMC9231577 DOI: 10.7759/cureus.25319] [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] [Accepted: 05/19/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction: Pulmonary hypertension (PH) is a threatening condition, and it is far more common than previously assumed, especially after the COVID pandemic. Its outcome is not good; if detected late, and can lead to right ventricular failure, which can be fatal. Our goal was to evaluate CT signs of PH, correlate them with echocardiography, and identify the cut-off values of these signs in our population. Method: In this study, 160 patients having both CT and echocardiography with a maximum gap of one month were assessed from June to November 2021. The association between CT signs and echocardiography to diagnose PH was investigated. The Pearson and Spearman correlation and area under receiver operating curve (AUROC) tests were performed in the analysis. Receiver operating characteristic curve analysis was also used to assess CT’s diagnostic capability and cut-off values. Result: The correlation between main pulmonary artery (MPA) diameter and main pulmonary artery to aorta ratio (MPA/AO) with mean pulmonary artery pressure (mPAP) was weak but statistically significant (r = 0.316 and r = 0.321, p<0.001). However, there was a very weak correlation between the right and left pulmonary artery and mPAP with correlation coefficients (r) of 0.155 and 0.138, respectively. For the first time in our population, we measured the cut-off values of MPA and MPA/AO ratios for PH which were 26 and 0.88 mm, respectively. Conclusions: The CT signs of PH correlate with echocardiography; however, should not be used solely; the cut-off values should be used according to race and population.
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El-Bokl A, Jimenez E, Hiremath G, Cortez D. Is derived vectorcardiography a potential screening tool for pulmonary hypertension? J Electrocardiol 2021; 70:79-83. [PMID: 34971852 DOI: 10.1016/j.jelectrocard.2021.12.004] [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: 10/16/2021] [Revised: 12/07/2021] [Accepted: 12/10/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Patients with atrial septal defects and pulmonary hypertension would benefit from early identification and treatment of pulmonary hypertension prior to closure. Noninvasive screening tools for pulmonary hypertension are inadequate. Electrocardiography, though readily available, has so far been of limited screening utility in patients with pulmonary hypertension. We hypothesize that derived vectorcardiographic parameters will aid in identifying increased right ventricular afterload and thus provide an additional screening tool for pulmonary hypertension in patients with secundum atrial septal defects. OBJECTIVE Establish whether vectorcardiography can be used to screen for pulmonary hypertension. METHODS A retrospective review of patients with secundum atrial septal defects (ASD) who underwent cardiac catheterization at the University of Minnesota from 2012 to 2020 was performed. We excluded patients with other congenital heart diagnoses, insufficient hemodynamic data, or lacking sinus rhythm electrocardiogram at time of cardiac catheterization. Parameters analyzed included: Sokolow-Lion right ventricular hypertrophy criteria, PR duration, QRS duration, corrected QT intervals, QRS and T wave frontal plane axes, rSR', R' amplitude, as well as vectorcardiographic parameters (Kors regression-related method), the QRS vector magnitude, T wave vector magnitude, and the spatial QRS-T angle. These were compared to measures of pulmonary hypertension obtained at cardiac catheterization. RESULTS The spatial QRS-T angle significantly differentiated ASD patients with pulmonary hypertension (median 104 degrees, interquartile range 55-137 degrees) from ASD patients without pulmonary hypertension (median 37 degrees, interquartile range 21-63 degrees, p-value of 0.002). At a cut-off of 124 degrees, the positive and negative predictive values for identification of pulmonary hypertension were 36.4% and 96.4%, respectively, with an odds ratio of 13.4 (95% confidence interval of 2.9 to 63.7). The positive predictive value was significantly improved when combined with echocardiographic data to screen for pulmonary hypertension. CONCLUSION The spatial QRS-T angle is associated with pulmonary hypertension in patients with secundum atrial septal defects.
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Affiliation(s)
- Amr El-Bokl
- University of Minnesota, Division of Pediatric Cardiology, Department of Pediatrics, Minneapolis, MN, United States of America.
| | - Erick Jimenez
- University of Minnesota, Division of Pediatric Cardiology, Department of Pediatrics, Minneapolis, MN, United States of America
| | - Gurumurthy Hiremath
- University of Minnesota, Division of Pediatric Cardiology, Department of Pediatrics, Minneapolis, MN, United States of America
| | - Daniel Cortez
- University of Minnesota, Division of Pediatric Cardiology, Department of Pediatrics, Minneapolis, MN, United States of America; University of California, Davis Medical Center, United States of America
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Nundlall N, Playford D, Strange G, Davis TME, Davis WA. Prevalence, Incidence and Associates of Pulmonary Hypertension Complicating Type 2 Diabetes: Insights from the Fremantle Diabetes Study Phase 2 and National Echocardiographic Database of Australia. J Clin Med 2021; 10:jcm10194503. [PMID: 34640520 PMCID: PMC8509549 DOI: 10.3390/jcm10194503] [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] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 09/25/2021] [Accepted: 09/27/2021] [Indexed: 11/16/2022] Open
Abstract
There is a paucity of epidemiologic data examining the relationship between pulmonary hypertension (PH) and diabetes. The aim of this study was to determine prevalence, incidence and associates of PH complicating type 2 diabetes. Data from 1430 participants (mean age 65.5 years, 51.5% males) in the Fremantle Diabetes Study Phase 2 (FDS2) were linked with the National Echocardiographic Database of Australia (NEDA) to ascertain the prevalence and incidence of PH (estimated right ventricular systolic pressure (eRVSP) >30 mmHg as a new suggested threshold or the conventional >40 mmHg) over a 12-year period. PH prevalence in FDS2 was compared with that in NEDA overall and a geographically close sub-population. Multivariable analyses identified associates of prevalent/incident PH in the FDS2 cohort. Of 275 FDS2 patients (19.2%) with pre-entry echocardiography, 90 had eRVSP >30 mmHg and 35 had eRVSP >40 mmHg (prevalences 32.7% (95% CI 27.3–38.7%) and 12.7% (9.1–17.4%), respectively), rates that are 35–50% greater than national/local NEDA general population estimates. Moreover, 70 (5.0%) and 123 (9.2%) FDS2 participants were identified with incident PH at the respective eRVSP thresholds (incidence (95% CI) 7.6 (6.0–9.7) and 14.2 (11.8–17.0)/1000 person-years), paralleling data from recognised high-risk conditions such as systemic sclerosis. The baseline plasma N-terminal pro-brain natriuretic peptide concentration was the strongest independent associate of prevalent/incident PH. Approximately 1 in 8 people with type 2 diabetes have PH using the eRVSP >40 mmHg threshold. Its presence should be considered as part of regular clinical assessment of individuals with type 2 diabetes.
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Affiliation(s)
- Nishant Nundlall
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
| | - David Playford
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
| | - Geoff Strange
- School of Medicine, The University of Notre Dame, Fremantle, WA 6160, Australia; (N.N.); (D.P.); (G.S.)
- The Heart Research Institute, Newtown, NSW 2042, Australia
- Department of Cardiology, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia
| | - Timothy M. E. Davis
- Fremantle Hospital, Medical School, The University of Western Australia, Fremantle, WA 6160, Australia;
- Correspondence:
| | - Wendy A. Davis
- Fremantle Hospital, Medical School, The University of Western Australia, Fremantle, WA 6160, Australia;
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Jung YH, Ren X, Suffredini G, Dodd-O JM, Gao WD. Right ventricular diastolic dysfunction and failure: a review. Heart Fail Rev 2021; 27:1077-1090. [PMID: 34013436 DOI: 10.1007/s10741-021-10123-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2021] [Indexed: 01/08/2023]
Abstract
Right ventricular diastolic dysfunction and failure (RVDDF) has been increasingly identified in patients with cardiovascular diseases, including heart failure and other diseases with cardiac involvement. It is unknown whether RVDDF exists as a distinct clinical entity; however, its presence and degree have been shown to be a sensitive marker of end-organ dysfunction related to multiple disease processes including systemic hypertension, pulmonary hypertension, heart failure, and endocrine disease. In this manuscript, we review issues pertaining to RVDDF including anatomic features of the right ventricle, physiologic measurements, RVDDF diagnosis, underlying mechanisms, clinical impact, and clinical management. Several unique features of RVDDF are also discussed.
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Affiliation(s)
- Youn-Hoa Jung
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Xianfeng Ren
- Department of Anesthesiology, China-Japan Friendship Hospital, Beijing, China
| | - Giancarlo Suffredini
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Jeffery M Dodd-O
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA
| | - Wei Dong Gao
- Department of Anesthesiology and Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA.
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Ujihira K, Kohmoto T, Gimelli G, Raval A, Jacobson K, Wolff M, Osaki S. The impact of increased pulmonary arterial pressure on outcomes after transcatheter aortic valve replacement. Catheter Cardiovasc Interv 2020; 96:E723-E734. [DOI: 10.1002/ccd.28862] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 02/27/2020] [Accepted: 03/15/2020] [Indexed: 12/13/2022]
Affiliation(s)
- Kosuke Ujihira
- Division of Cardiothoracic surgery, Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Takushi Kohmoto
- Division of Cardiothoracic surgery, Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Giorgio Gimelli
- Division of Cardiovascular medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Amish Raval
- Division of Cardiovascular medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Kurt Jacobson
- Division of Cardiovascular medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Matthew Wolff
- Division of Cardiovascular medicine, Department of Medicine University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
| | - Satoru Osaki
- Division of Cardiothoracic surgery, Department of Surgery University of Wisconsin School of Medicine and Public Health Madison Wisconsin USA
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Zhou X, Ferrara F, Contaldi C, Bossone E. Right Ventricular Size and Function in Chronic Heart Failure. Heart Fail Clin 2019; 15:205-217. [DOI: 10.1016/j.hfc.2018.12.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Kiely DG, Levin DL, Hassoun PM, Ivy D, Jone PN, Bwika J, Kawut SM, Lordan J, Lungu A, Mazurek JA, Moledina S, Olschewski H, Peacock AJ, Puri G, Rahaghi FN, Schafer M, Schiebler M, Screaton N, Tawhai M, van Beek EJ, Vonk-Noordegraaf A, Vandepool R, Wort SJ, Zhao L, Wild JM, Vogel-Claussen J, Swift AJ. EXPRESS: Statement on imaging and pulmonary hypertension from the Pulmonary Vascular Research Institute (PVRI). Pulm Circ 2019; 9:2045894019841990. [PMID: 30880632 PMCID: PMC6732869 DOI: 10.1177/2045894019841990] [Citation(s) in RCA: 90] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 03/01/2019] [Indexed: 01/08/2023] Open
Abstract
Pulmonary hypertension (PH) is highly heterogeneous and despite treatment advances it remains a life-shortening condition. There have been significant advances in imaging technologies, but despite evidence of their potential clinical utility, practice remains variable, dependent in part on imaging availability and expertise. This statement summarizes current and emerging imaging modalities and their potential role in the diagnosis and assessment of suspected PH. It also includes a review of commonly encountered clinical and radiological scenarios, and imaging and modeling-based biomarkers. An expert panel was formed including clinicians, radiologists, imaging scientists, and computational modelers. Section editors generated a series of summary statements based on a review of the literature and professional experience and, following consensus review, a diagnostic algorithm and 55 statements were agreed. The diagnostic algorithm and summary statements emphasize the key role and added value of imaging in the diagnosis and assessment of PH and highlight areas requiring further research.
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Affiliation(s)
- David G. Kiely
- Sheffield Pulmonary Vascular Disease
Unit, Royal Hallamshire Hospital, Sheffield, UK
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
| | - David L. Levin
- Department of Radiology, Mayo Clinic,
Rochester, MN, USA
| | - Paul M. Hassoun
- Department of Medicine John Hopkins
University, Baltimore, MD, USA
| | - Dunbar Ivy
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Pei-Ni Jone
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | | | - Steven M. Kawut
- Department of Medicine, Perelman School
of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Jim Lordan
- Freeman Hospital, Newcastle Upon Tyne,
Newcastle, UK
| | - Angela Lungu
- Technical University of Cluj-Napoca,
Cluj-Napoca, Romania
| | - Jeremy A. Mazurek
- Division of Cardiovascular Medicine,
Hospital
of the University of Pennsylvania,
Philadelphia, PA, USA
| | | | - Horst Olschewski
- Division of Pulmonology, Ludwig
Boltzmann Institute Lung Vascular Research, Graz, Austria
| | - Andrew J. Peacock
- Scottish Pulmonary Vascular Disease,
Unit, University of Glasgow, Glasgow, UK
| | - G.D. Puri
- Department of Anaesthesiology and
Intensive Care, Post Graduate Institute of Medical Education and Research,
Chandigarh, India
| | - Farbod N. Rahaghi
- Brigham and Women’s Hospital, Harvard
Medical School, Boston, MA, USA
| | - Michal Schafer
- Paediatric Cardiology, Children’s
Hospital, University of Colorado School of Medicine, Denver, CO, USA
| | - Mark Schiebler
- Department of Radiology, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | | | - Merryn Tawhai
- Auckland Bioengineering Institute,
Auckland, New Zealand
| | - Edwin J.R. van Beek
- Edinburgh Imaging, Queens Medical
Research Institute, University of Edinburgh, Edinburgh, UK
| | | | - Rebecca Vandepool
- University of Arizona, Division of
Translational and Regenerative Medicine, Tucson, AZ, USA
| | - Stephen J. Wort
- Royal Brompton Hospital, London,
UK
- Imperial College, London, UK
| | | | - Jim M. Wild
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
| | - Jens Vogel-Claussen
- Institute of diagnostic and
Interventional Radiology, Medical Hospital Hannover, Hannover, Germany
| | - Andrew J. Swift
- Department of Infection, Immunity and
Cardiovascular Disease and Insigneo Institute, University of Sheffield, Sheffield,
UK
- Academic Department of Radiology,
University of Sheffield, Sheffield, UK
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13
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Ferrara F, Zhou X, Gargani L, Wierzbowska-Drabik K, Vriz O, Fadel BM, Stanziola AA, Kasprzak J, Vannan M, Bossone E. Echocardiography in Pulmonary Arterial Hypertension. Curr Cardiol Rep 2019; 21:22. [DOI: 10.1007/s11886-019-1109-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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14
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Comprehensive Noninvasive Evaluation of Right Ventricle-Pulmonary Circulation Axis in Pediatric Patients with Pulmonary Hypertension. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2019; 21:6. [DOI: 10.1007/s11936-019-0710-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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Ferrara F, Gargani L, Armstrong WF, Agoston G, Cittadini A, Citro R, D'Alto M, D'Andrea A, Dellegrottaglie S, De Luca N, Di Salvo G, Ghio S, Grünig E, Guazzi M, Kasprzak JD, Kolias TJ, Kovacs G, Lancellotti P, La Gerche A, Limongelli G, Marra AM, Moreo A, Ostenfeld E, Pieri F, Pratali L, Rudski LG, Saggar R, Saggar R, Scalese M, Selton-Suty C, Serra W, Stanziola AA, Voilliot D, Vriz O, Naeije R, Bossone E. The Right Heart International Network (RIGHT-NET): Rationale, Objectives, Methodology, and Clinical Implications. Heart Fail Clin 2018; 14:443-465. [PMID: 29966641 DOI: 10.1016/j.hfc.2018.03.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Right Heart International Network is a multicenter international study aiming to prospectively collect exercise Doppler echocardiography tests of the right heart pulmonary circulation unit (RHPCU) in large cohorts of healthy subjects, elite athletes, and individuals at risk of or with overt pulmonary hypertension. It is going to provide standardization of exercise stress echocardiography of RHPCU and explore the full physiopathologic response.
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Affiliation(s)
| | - Luna Gargani
- Institute of Clinical Physiology-C.N.R., Pisa, Italy
| | - William F Armstrong
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Gergely Agoston
- Department of Family Medicine, University of Szeged, Szeged, Hungary
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital of Salerno, Salerno, Italy
| | - Michele D'Alto
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonello D'Andrea
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Santo Dellegrottaglie
- Division of Cardiology, Ospedale Medico-Chirurgico Accreditato Villa dei Fiori, Acerra, Naples, Italy; Zena and Michael A. Wiener Cardiovascular Institute, Marie-Josee and Henry R. Kravis Center for Cardiovascular Health, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Nicola De Luca
- Hypertension Research Center "CIRIAPA", Federico II University, Napoli, Italy
| | | | - Stefano Ghio
- Fondazione IRCCS, Policlinico San Matteo, Pavia, Italy
| | - Ekkehard Grünig
- Centre for Pulmonary Hypertension, Thoraxclinic, Heidelberg University Hospital, Heidelberg, Germany
| | - Marco Guazzi
- Heart Failure Unit, Cardiopulmonary Laboratory, University Cardiology Department, IRCCS Policlinico San Donato University Hospital, Milan, Italy
| | | | - Theodore John Kolias
- Division of Cardiovascular Medicine, University of Michigan Medical Center, Ann Arbor, MI, USA
| | - Gabor Kovacs
- Department of Internal Medicine, Division of Pulmonology, Medical University of Graz, Graz, Austria; Ludwig Boltzmann Institute for Lung Vascular Research, Graz, Austria
| | - Patrizio Lancellotti
- Department of Cardiology, University of Liège Hospital, GIGA Cardiovascular Sciences, Liege, Belgium; Gruppo Villa Maria Care and Research, Anthea Hospital, Bari, Italy
| | | | - Giuseppe Limongelli
- Department of Cardiology, University of Campania "Luigi Vanvitelli", Naples, Italy; Institute of Cardiovascular Sciences, University College of London, London, UK
| | | | | | - Ellen Ostenfeld
- Department of Clinical Sciences Lund, Clinical Physiology, Skåne University Hospital, Lund, Sweden
| | - Francesco Pieri
- Department of Heart, Thorax and Vessels, Azienda Ospedaliero Universitaria, Florence, Italy
| | | | - Lawrence G Rudski
- Azrieli Heart Center and Center for Pulmonary Vascular Diseases, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Rajan Saggar
- Lung and Heart-Lung Transplant Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Pulmonary Hypertension Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Rajeev Saggar
- Lung Institute Banner University Medical Center-Phoenix, University of Arizona, Phoenix, AZ, USA
| | - Marco Scalese
- Institute of Clinical Physiology-C.N.R., Pisa, Italy
| | | | - Walter Serra
- Cardiology Unit, Surgery Department, University Hospital of Parma, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Damien Voilliot
- Centre Hospitalier Lunéville, Service de Cardiologie, Lunéville, France
| | - Olga Vriz
- Heart Centre, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | | | - Eduardo Bossone
- Cardiology Division, Heart Department, "Cava de' Tirreni and Amalfi Coast" Hospital, University of Salerno, Salerno, Italy.
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16
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Rengier F, Melzig C, Derlin T, Marra AM, Vogel-Claussen J. Advanced imaging in pulmonary hypertension: emerging techniques and applications. Int J Cardiovasc Imaging 2018; 35:1407-1420. [DOI: 10.1007/s10554-018-1448-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 08/24/2018] [Indexed: 02/07/2023]
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17
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Ferrara F, Gargani L, Ruohonen S, Vriz O, Scalese M, Russo V, Marra AM, Stanziola AA, Cittadini A, D'Andrea A, Naeije R, Bossone E. Reference values and correlates of right atrial volume in healthy adults by two-dimensional echocardiography. Echocardiography 2018; 35:1097-1107. [PMID: 29756642 DOI: 10.1111/echo.14015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Right atrial (RA) volume is an important parameter in the evaluation of patients with pulmonary hypertension. Aim of this study was to define reference ranges for RA volume by two-dimensional echocardiography (2DE) in healthy adults. METHODS A total of 596 healthy subjects [mean age 45.7 ± 14.6 years, range 18-88 years; 60.1% women] underwent a transthoracic echocardiography. In addition, a meta-analysis was performed of published studies measuring RA volume in healthy subjects, using 2DE single plane area-length (A-L) and/or method of disks (MOD) at end-systole in apical four-chamber view. RESULTS In our cohort, RA volume was higher in men than women but did not vary with age. Body surface area (BSA), stroke volume (SV), and tricuspid annular plane systolic excursion (TAPSE) were the only independent variables associated with RA volume (β coefficient 0.569, 0.123, and 0.131, respectively; all P < .001). In the pooled analysis, normalized RA volume was 25.7 ± 7.0 mL/m2 in men and 21.2 ± 5.8 mL/m2 in women for A-L, 21.6 ± 5.6 mL/m2 in men and 18.2 ± 5.4 mL/m2 in women for MOD (all P values < .0001). The upper limit was about 36 mL/m2 in men and 31 mL/m2 in women for A-L and 31 mL/m2 in men and 27 mL/m2 in women for MOD. CONCLUSIONS RA volume was found to be higher in men but not influenced by age. It was mainly correlated with larger BSA, indices of preload (SV) and RV longitudinal function (TAPSE). A statistically significant difference was found between A-L and MOD.
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Affiliation(s)
- Francesco Ferrara
- Cardiology Division, Heart Department, University Hospital of Salerno, "Cava de' Tirreni and Amalfi Coast" Hospital, Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | - Saku Ruohonen
- Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland
| | - Olga Vriz
- Cardiology and Emergency Department, Hospital of San Daniele del Friuli, Udine, Italy
| | - Marco Scalese
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | - Valentina Russo
- Cardiology Division, Heart Department, University Hospital of Salerno, "Cava de' Tirreni and Amalfi Coast" Hospital, Salerno, Italy
| | | | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II,", Naples, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
| | | | | | - Eduardo Bossone
- Cardiology Division, Heart Department, University Hospital of Salerno, "Cava de' Tirreni and Amalfi Coast" Hospital, Salerno, Italy
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18
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Miller DL, Dong Z, Dou C, Raghavendran K. Pulmonary Capillary Hemorrhage Induced by Different Imaging Modes of Diagnostic Ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1012-1021. [PMID: 29428168 PMCID: PMC5869104 DOI: 10.1016/j.ultrasmedbio.2017.11.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/03/2017] [Accepted: 11/13/2017] [Indexed: 05/16/2023]
Abstract
The induction of pulmonary capillary hemorrhage (PCH) is a well-established non-thermal biological effect of pulsed ultrasound in animal models. Typically, research has been done using laboratory pulsed ultrasound systems with a fixed beam and, recently, by B-mode diagnostic ultrasound. In this study, a GE Vivid 7 Dimension ultrasound machine with 10 L linear array probe was used at 6.6 MHz to explore the relative PCH efficacy of B-mode imaging, M-mode (fixed beam), color angio mode Doppler imaging and pulsed Doppler mode (fixed beam). Anesthetized rats were scanned in a warmed water bath, and thresholds were determined by scanning at different power steps, 2 dB apart, in different groups of six rats. Exposures were performed for 5 min, except for a 15-s M-mode group. Peak rarefactional pressure amplitude thresholds were 1.5 MPa for B-mode and 1.1 MPa for angio Doppler mode. For the non-scanned modes, thresholds were 1.1 MPa for M-mode and 0.6 MPa for pulsed Doppler mode with its relatively high duty cycle (7.7 × 10-3 vs. 0.27 × 10-3 for M-mode). Reducing the duration of M-mode to 15 s (from 300 s) did not significantly reduce PCH (area, volume or depth) for some power settings, but the threshold was increased to 1.4 MPa. Pulmonary sonographers should be aware of this unique adverse bio-effect of diagnostic ultrasound and should consider reduced on-screen mechanical index settings for potentially vulnerable patients.
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Affiliation(s)
- Douglas L Miller
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA.
| | - Zhihong Dong
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Chunyan Dou
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Krishnan Raghavendran
- Department of Surgery, University of Michigan Health System, Ann Arbor, Michigan, USA
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19
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Venner C, Odille F, Voilliot D, Chaouat A, Chabot F, Felblinger J, Bonnemains L. Can MRI detect pulmonary hypertension in a population pre-selected by echocardiography? Acta Radiol 2018; 59:180-187. [PMID: 28595488 DOI: 10.1177/0284185117712541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The place of magnetic resonance imaging (MRI) in the assessment of pulmonary hypertension (PH) remains controversial. Several studies proposed to use MRI to assess pulmonary pressure but the level of proof is low. Purpose To evaluate the diagnostic power of cardiac MRI within a non-selected population of patients suspected of PH after an echocardiography. Material and Methods Fifty-six consecutive patients, suspected of PH after an echocardiography, were assessed with right heart catheterization and cardiac MRI (including a high temporal resolution pulmonary flow curve). We extracted from the MRI data the main parameters proposed by all precedent studies available in the literature. We looked for multivariate linear relations between those parameters and the mean pulmonary arterial pressure (mPAP), and eventually assessed with a logit regression the ability of those parameters to diagnose PH in our population. Results The multivariate model retained only two parameters: the right ventricle ejection fraction and the pulmonary trunk minimum area. The prediction of mPAP (r2 = 0.5) yielded limits of agreement of 15 mmHg. However, the prediction of PH within the population was feasible and the method yielded a specificity of 80% for a sensitivity of 100%. Conclusion The performance of MRI to assess mPAP is too low to be used as a replacement for right heart catheterization but MRI could be used as second line examination after echocardiography to avoid right heart catheterization for normal patients.
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Affiliation(s)
- Clement Venner
- Department of Cardiology, CHU Nancy, Nancy, France
- U947, INSERM, Nancy, France
- IADI, Université de Lorraine, Nancy, France
| | - Freddy Odille
- U947, INSERM, Nancy, France
- IADI, Université de Lorraine, Nancy, France
| | - Damien Voilliot
- Department of Cardiology, CHU Nancy, Nancy, France
- U947, INSERM, Nancy, France
- IADI, Université de Lorraine, Nancy, France
| | - Ari Chaouat
- Department of Pneumology, CHU Nancy, Nancy, France
| | | | - Jacques Felblinger
- U947, INSERM, Nancy, France
- IADI, Université de Lorraine, Nancy, France
- CIC-IT 1433, CHU Nancy, Nancy, France
| | - Laurent Bonnemains
- U947, INSERM, Nancy, France
- IADI, Université de Lorraine, Nancy, France
- Department of Cardiac Surgery, CHU Strasbourg, Strasbourg, France
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20
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Ferrara F, Gargani L, Ostenfeld E, D'Alto M, Kasprzak J, Voilliot D, Selton-Suty C, Vriz O, Marra AM, Argiento P, Stanziola AA, Cittadini A, D'Andrea A, Bossone E. Imaging the right heart pulmonary circulation unit: Insights from advanced ultrasound techniques. Echocardiography 2017; 34:1216-1231. [DOI: 10.1111/echo.13594] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
- Francesco Ferrara
- Heart Department; Cardiology Division; “Cava de' Tirreni and Amalfi Coast” Hospital; University of Salerno; Salerno Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R.; Pisa Italy
| | - Ellen Ostenfeld
- Department of Clinical Sciences Lund; Clinical Physiology and Skane University Hospital; Lund University; Lund Sweden
| | - Michele D'Alto
- Department of Cardiology; Second University of Naples; Napoli Italy
| | - Jaroslaw Kasprzak
- Department of Cardiology; Bieganski Hospital; Medical University of Lodz; Lodz Poland
| | - Damien Voilliot
- Cardiology Service; Institute Lorrain du Cœur et des Vaisseaux; Centre Hospitalier Universitaire de Nancy; Vandœuvre-lès-Nancy France
| | - Christine Selton-Suty
- Cardiology Service; Institute Lorrain du Cœur et des Vaisseaux; Centre Hospitalier Universitaire de Nancy; Vandœuvre-lès-Nancy France
| | - Olga Vriz
- Cardiology and Emergency Department; Hospital of San Daniele del Friuli; Udine Italy
| | | | - Paola Argiento
- Department of Cardiology; Second University of Naples; Napoli Italy
| | - Anna A. Stanziola
- Department of Respiratory Diseases; Monaldi Hospital; University “Federico II,”; Naples Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences; University Federico II of Naples; Naples Italy
| | | | - Eduardo Bossone
- Heart Department; Cardiology Division; “Cava de' Tirreni and Amalfi Coast” Hospital; University of Salerno; Salerno Italy
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21
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Berthelot E, Bailly MT, Hatimi SE, Robard I, Rezgui H, Bouchachi A, Montani D, Sitbon O, Chemla D, Assayag P. Pulmonary hypertension due to left heart disease. Arch Cardiovasc Dis 2017; 110:420-431. [PMID: 28411107 DOI: 10.1016/j.acvd.2017.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 01/24/2017] [Indexed: 01/03/2023]
Abstract
Pulmonary hypertension due to left heart disease, also known as group 2 pulmonary hypertension according to the European Society of Cardiology/European Respiratory Society classification, is the most common cause of pulmonary hypertension. In patients with left heart disease, the development of pulmonary hypertension favours right heart dysfunction, which has a major impact on disease severity and outcome. Over the past few years, this condition has been considered more frequently. However, epidemiological studies of group 2 pulmonary hypertension are less exhaustive than studies of other causes of pulmonary hypertension. In group 2 patients, pulmonary hypertension may be caused by an isolated increase in left-sided filling pressures or by a combination of this condition with increased pulmonary vascular resistance, with an abnormally high pressure gradient between arteries and pulmonary veins. A better understanding of the conditions underlying pulmonary hypertension is of key importance to establish a comprehensive diagnosis, leading to an adapted treatment to reduce heart failure morbidity and mortality. In this review, epidemiology, mechanisms and diagnostic approaches are reviewed; then, treatment options and future approaches are considered.
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Affiliation(s)
| | - Minh Tam Bailly
- AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Safwane El Hatimi
- AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
| | - Ingrid Robard
- AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Hatem Rezgui
- AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Amir Bouchachi
- AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - David Montani
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France; AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, Hôpital Bicêtre, Le Kremlin Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Olivier Sitbon
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France; AP-HP, Service de Pneumologie, Centre de Référence de l'Hypertension Pulmonaire Sévère, Hôpital Bicêtre, Le Kremlin Bicêtre, France; INSERM UMR_S 999, Hôpital Marie Lannelongue, Le Plessis Robinson, France
| | - Denis Chemla
- Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France; AP-HP, Service de Physiologie, Unité INSERM U_999, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Patrick Assayag
- AP-HP, Service de Cardiologie, Hôpital Bicêtre, Le Kremlin-Bicêtre, France; Univ. Paris-Sud, Faculté de Médecine, Université Paris-Saclay, Le Kremlin Bicêtre, France
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22
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Picano E, Ciampi Q, Citro R, D’Andrea A, Scali MC, Cortigiani L, Olivotto I, Mori F, Galderisi M, Costantino MF, Pratali L, Di Salvo G, Bossone E, Ferrara F, Gargani L, Rigo F, Gaibazzi N, Limongelli G, Pacileo G, Andreassi MG, Pinamonti B, Massa L, Torres MAR, Miglioranza MH, Daros CB, de Castro e Silva Pretto JL, Beleslin B, Djordjevic-Dikic A, Varga A, Palinkas A, Agoston G, Gregori D, Trambaiolo P, Severino S, Arystan A, Paterni M, Carpeggiani C, Colonna P. Stress echo 2020: the international stress echo study in ischemic and non-ischemic heart disease. Cardiovasc Ultrasound 2017; 15:3. [PMID: 28100277 PMCID: PMC5242057 DOI: 10.1186/s12947-016-0092-1] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 12/12/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Stress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities. METHODS In a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy). RESULTS We expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios. CONCLUSIONS The study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.
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Affiliation(s)
- Eugenio Picano
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Quirino Ciampi
- Cardiology Division, Fatebenefratelli Hospital, Benevento, Italy
| | - Rodolfo Citro
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Antonello D’Andrea
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Maria Chiara Scali
- Cardiology Department, Pisa University and Nottola (Siena) Hospital, Pisa, Italy
| | | | | | - Fabio Mori
- Cardiology Department, Careggi Hospital, Florence, Italy
| | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, Italy
| | | | - Lorenza Pratali
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | | | - Eduardo Bossone
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Francesco Ferrara
- Heart Department, University Hospital “San Giovanni di Dio e Ruggi d’Aragona”, Salerno, Italy
| | - Luna Gargani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Fausto Rigo
- Division of Cardiology, Ospedale dell’Angelo Mestre-Venice, Mestre, Italy
| | - Nicola Gaibazzi
- Cardiology Department, Parma University Hospital, Parma, Italy
| | | | - Giuseppe Pacileo
- Division of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | | | - Bruno Pinamonti
- Cardiology Department, University Hospital “Ospedale Riuniti”, Trieste, Italy
| | - Laura Massa
- Cardiology Department, University Hospital “Ospedale Riuniti”, Trieste, Italy
| | - Marco A. R. Torres
- Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | - Branko Beleslin
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Ana Djordjevic-Dikic
- Cardiology Clinic, Clinical Center of Serbia, Medical School, University of Belgrade, Belgrade, Serbia
| | - Albert Varga
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Attila Palinkas
- Department of Internal Medicine, Elisabeth Hospital, Hodmezovasarhely, Hungary
| | - Gergely Agoston
- Institute of Family Medicine, University of Szeged, Szeged, Hungary
| | - Dario Gregori
- Department of Biostatistics, University of Padua, Padua, Italy
| | | | | | - Ayana Arystan
- RSE, Medical Centre Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, Kazakhstan
| | - Marco Paterni
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Clara Carpeggiani
- Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - Paolo Colonna
- Cardiology Hospital, Policlinico of Bari, Bari, Italy
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23
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Gabrielli L, Ocaranza MP, Sitges M, Kanacri A, Saavedra R, Sepulveda P, Sepulveda L, Rossel V, Zagolin M, Verdejo HE, Baraona F, Zalaquett R, Chiong M, Lavandero S, Castro PF. Acute effect of iloprost inhalation on right atrial function and ventricular dyssynchrony in patients with pulmonary artery hypertension. Echocardiography 2016; 34:53-60. [DOI: 10.1111/echo.13401] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Luigi Gabrielli
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
| | - María Paz Ocaranza
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
| | - Marta Sitges
- Institute Clinic Cardiovascular; Hospital Clínic of Barcelona; IDIBAPS, August Pi i Sunyer Biomedical Research Institute; University of Barcelona; Barcelona Spain
| | - Andrés Kanacri
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
| | - Rodrigo Saavedra
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
| | - Pablo Sepulveda
- Clinic Hospital; Faculty of Medicine; University of Santiago; Santiago Chile
| | - Luis Sepulveda
- Salvador Hospital; Faculty of Medicine; University of Chile; Santiago Chile
| | - Victor Rossel
- Clinic Hospital; Faculty of Medicine; University of Santiago; Santiago Chile
| | | | - Hugo E. Verdejo
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
| | - Fernando Baraona
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
| | - Ricardo Zalaquett
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
| | - Mario Chiong
- Advanced Center for Chronic Diseases (ACCDiS) & Molecular Studies of the Cell (CEMC); Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine; University of Chile; Santiago Chile
- Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas Texas
| | - Sergio Lavandero
- Advanced Center for Chronic Diseases (ACCDiS) & Molecular Studies of the Cell (CEMC); Faculty of Chemical and Pharmaceutical Sciences & Faculty of Medicine; University of Chile; Santiago Chile
- Department of Internal Medicine; University of Texas Southwestern Medical Center; Dallas Texas
| | - Pablo F. Castro
- Advanced Center for Chronic Diseases (ACCDiS); Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
- Division of Cardiovascular Diseases; Faculty of Medicine; Pontificia Universidad Católica; Santiago Chile
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24
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Ferrara F, Rudski LG, Vriz O, Gargani L, Afilalo J, D'Andrea A, D'Alto M, Marra AM, Acri E, Stanziola AA, Ghio S, Cittadini A, Naeije R, Bossone E. Physiologic correlates of tricuspid annular plane systolic excursion in 1168 healthy subjects. Int J Cardiol 2016; 223:736-743. [PMID: 27573598 DOI: 10.1016/j.ijcard.2016.08.275] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Accepted: 08/16/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND TAPSE provides a simple, reproducible estimate of the longitudinal function of the right ventricle (RV). However, the normal limits and physiologic correlates of tricuspid annular plane systolic excursion (TAPSE) are not exactly known. The aim of this study was to explore the full spectrum of TAPSE values and determine the physiologic correlates of TAPSE. METHODS AND RESULTS From June 2007 to December 2013, 1168 healthy subjects [mean age 45.1±16years, range 16 to 92; 555 (47.5%) men] underwent comprehensive transthoracic echocardiography (TTE) as recommended by current guidelines. TAPSE values were higher in men than women (24.0±3.5 vs 23.2±3.0mm, p value<0.0001) but did not vary according to age. On multivariable linear regression analysis, cardiac output, RV basal and longitudinal dimensions were the only variables independently associated with TAPSE (β coefficient=0.161, 0.116 and 0.115 respectively). On the other hand echocardiographically-derived systolic pulmonary artery pressure (SPAP), pulmonary vascular resistance and mitral E/e' ratio were significantly higher in older subjects. Therefore a significant decrease of TAPSE/SPAP was detected in >60years old cohort (p=0.0001). CONCLUSIONS Our large cohort of healthy subjects provides sex and age-based TAPSE and TAPSE/SPAP normal cut-offs. TAPSE was found to be higher in men but not influenced by age. It was mainly correlated with echo-Doppler indices reflecting pre-load as opposed to afterload. On the other hand a significant decrease of TAPSE/SPAP with older age was registered as a direct consequence of increased SPAP with aging.
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Affiliation(s)
- Francesco Ferrara
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University Hospital of Salerno, Salerno, Italy
| | - Lawrence G Rudski
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Olga Vriz
- Hospital of San Daniele del Friuli, Cardiology and Emergency Department, Udine, Italy
| | - Luna Gargani
- Institute of Clinical Physiology - C.N.R., Pisa, Italy
| | - Jonathan Afilalo
- Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | | | - Michele D'Alto
- Second University of Naples, Department of Cardiology, Napoli, Italy
| | | | - Edvige Acri
- Cardiology Division, University of Messina, Italy
| | - Anna Agnese Stanziola
- Department of Respiratory Diseases, Monaldi Hospital, University "Federico II", Naples, Italy
| | - Stefano Ghio
- Cardiology Division, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Antonio Cittadini
- Department of Translational Medical Sciences, University Federico II of Naples, Naples, Italy
| | | | - Eduardo Bossone
- Cardiology Division, "Cava de' Tirreni and Amalfi Coast" Hospital, Heart Department, University Hospital of Salerno, Salerno, Italy.
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25
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Ma C, Shen DR, Zhang Q, Ding YQ, Wang YX, Peng L, Meng BY, Ti YX. [A preliminary investigation of relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:340-344. [PMID: 27097580 PMCID: PMC7390076 DOI: 10.7499/j.issn.1008-8830.2016.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Accepted: 02/15/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To preliminarily investigate the relationship between serum apelin level and pulmonary artery pressure in children with congenital heart disease. METHODS One hundred and twenty-six children with congenital heart disease undergoing surgical treatment were enrolled as subjects. The serum level of apelin was determined before surgery and at 7 days after surgery. The ratio of pulmonary artery systolic pressure to aortic systolic pressure (Pp/Ps) was calculated before extracorporeal circulation. According to the Pp/Ps value, patients were classified into non-pulmonary arterial hypertension (PAH) group, mild PAH group, moderate PAH group, and severe PAH group. Pulmonary artery mean pressure was estimated by echocardiography at 7 days after surgery. RESULTS The non-PAH group had the highest serum level of apelin before and after surgery, followed by the mild PAH group, moderate PAH group, and severe PAH group (P<0.05). All groups had significantly increased serum levels of apelin at 7 days after surgery (P<0.05). The serum level of apelin was negatively correlated with pulmonary artery pressure before surgery (r=-0.51, P<0.05) and at 7 days after surgery (r=-0.54, P<0.05). CONCLUSIONS The decrease in serum apelin level is associated with the development of pulmonary hypertension in children with congenital heart disease. The significance of serum apelin in predicting the development and degree of pulmonary hypertension in children with congenital heart disease deserves further studies.
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Affiliation(s)
- Chao Ma
- Cardiovascular Center, Shenzhen Children's Hospital of Chinese Medical University, Shenzhen, Guangdong 518026, China.
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