1
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Keep the Right in Mind-A Focused Approach to Right Ventricle-Predominant Cardiogenic Shock. Life (Basel) 2023; 13:life13020379. [PMID: 36836735 PMCID: PMC9965084 DOI: 10.3390/life13020379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/21/2023] [Accepted: 01/24/2023] [Indexed: 01/31/2023] Open
Abstract
Cardiogenic shock (CS) remains a highly lethal condition despite many efforts and new interventions. Patients presenting with a rapid onset of hemodynamic instability and subsequent collapse require prompt and appropriate multimodality treatment. Multiple etiologies can lead to heart failure and subsequent shock. As the case prevalence of heart failure increases worldwide, it is of great importance to explore all manners and protocols of presentation and treatment present. With research primarily focusing on CS due to cardiac left-sided pathology, few assessments of right-sided pathology and the subsequent clinical state and treatment have been conducted. This review aims to present an in-depth assessment of the currently available literature, assessing the pathophysiology, presentation and management of CS patients due to right heart failure.
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2
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Echocardiographic evaluation of right heart functions in hemodialysis patients. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.588248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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3
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Altersberger M, Pavelka P, Sachs A, Weber M, Wagner-Menghin M, Prosch H. Student Perceptions of Instructional Ultrasound Videos as Preparation for a Practical Assessment. Ultrasound Int Open 2019; 5:E81-E88. [PMID: 31720557 PMCID: PMC6837857 DOI: 10.1055/a-1024-4573] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 07/04/2019] [Accepted: 10/06/2019] [Indexed: 01/03/2023] Open
Abstract
Background Learning ultrasound early in the medical school curriculum
helps students to understand anatomy and pathology and to perform defined
ultrasound standard views. Instructional videos are a potentially valuable
tool for improving the process of learning ultrasound skills. It was the aim
of the present study to investigate how students perceived instructional
videos as a learning aid, compared to other learning opportunities, in
preparation for an Objective Structured Clinical Examination (OSCE). Materials and Methods
Eleven concise ultrasound videos were created
and implemented in the 4
th
year at the Medical University of
Vienna. The videos illustrate the predefined examination process, image
optimization, and nine standardized ultrasound views. The videos were
available to be used in preparation for the practical ultrasound
examination, which was part of the objective structured clinical
examination. The students’ perceptions of the instructional videos
and other learning methods were surveyed using an online questionnaire.
Results In total, 445 of 640 students (69.5% of the cohort)
used the instructional videos. Of those students, 134 (30%) answered
the questionnaire. Of this group, 88.9% rated the instructional
videos as very helpful (49.6% as extremely helpful). An ANOVA
revealed a significant difference between various learning materials in
terms of helpfulness. Post hoc analysis showed that instructional videos
were perceived as the second most helpful learning material after
“self-execution and feedback.” Conclusion The study revealed that students use instructional videos
frequently and appreciate them as an extra tool for effective studying.
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Affiliation(s)
- Martin Altersberger
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria.,Teaching Center, Medical University of Vienna, Vienna, Austria
| | - Philipp Pavelka
- Teaching Center, Medical University of Vienna, Vienna, Austria
| | - Alexander Sachs
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | - Michael Weber
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
| | | | - Helmut Prosch
- University Department of Radiology and Nuclear Medicine, Medical University of Vienna, Vienna, Austria
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4
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Magunia H, Jordanow A, Keller M, Rosenberger P, Nowak-Machen M. The effects of anesthesia induction and positive pressure ventilation on right-ventricular function: an echocardiography-based prospective observational study. BMC Anesthesiol 2019; 19:199. [PMID: 31684877 PMCID: PMC6829832 DOI: 10.1186/s12871-019-0870-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 10/17/2019] [Indexed: 01/08/2023] Open
Abstract
Background General anesthesia induction with the initiation of positive pressure ventilation creates a vulnerable phase for patients. The impact of positive intrathoracic pressure on cardiac performance has been studied but remains controversial. 3D echocardiography is a valid and MRI-validated bed-side tool to evaluate the right ventricle (RV). The aim of this study was to assess the impact of anesthesia induction (using midazolam, sufentanil and rocuronium, followed by sevoflurane) with positive pressure ventilation (PEEP 5, tidal volume 6–8 ml/kg) on 2D and 3D echocardiography derived parameters of RV function. Methods A prospective observational study on fifty-three patients undergoing elective cardiac surgery in a tertiary care university hospital was designed. Transthoracic echocardiography exams were performed before and immediately after anesthesia induction and were recorded together with hemodynamic parameters and ventilator settings. Results After anesthesia induction TAPSE (mean difference − 1.6 mm (95% CI − 2.6 mm to − 0.7 mm; p = 0.0013) as well as the Tissue Doppler derived tricuspid annulus peak velocity (TDITVs’) were significantly reduced (mean difference − 1.9% (95% CI: − 2.6 to − 1.2; p < 0.0001), but global right ventricular ejection fraction (RVEF; p = 0.1607) and right ventricular stroke volume (RVSV; p = 0.1838) did not change. Conclusions This data shows a preserved right ventricular ejection fraction and right ventricular stroke volume after anesthesia induction and initiation of positive pressure ventilation. However, the baso-apical right ventricular function is significantly reduced. Larger studies are needed in order to determine the clinical impact of these findings especially in patients presenting with impaired right ventricular function before anesthesia induction. Trial registration Retrospecitvely registered, 6th June 2016, ClinicalTrials.gov Identifier NCT02820727.
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Affiliation(s)
- Harry Magunia
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.
| | - Anne Jordanow
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Marius Keller
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany
| | - Martina Nowak-Machen
- Department of Anaesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany.,Department of Anesthesia and Intensive Care Medicine, Klinikum Ingolstadt, Krumenauerstr. 25, 85049, Ingolstadt, Germany
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5
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Hepburn-Brown M, Darvall J, Hammerschlag G. Acute pulmonary embolism: a concise review of diagnosis and management. Intern Med J 2019; 49:15-27. [PMID: 30324770 DOI: 10.1111/imj.14145] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Revised: 09/27/2018] [Accepted: 10/01/2018] [Indexed: 12/14/2022]
Abstract
An acute pulmonary embolism (aPE) is characterised by occlusion of one or more pulmonary arteries. Physiological disturbance may be minimal, but often cardiac output decreases as the right ventricle attempts to overcome increased afterload. Additionally, ventilation-perfusion mismatches can develop in affected vascular beds, reducing systemic oxygenation. Incidence is reported at 50-75 per 100 000 in Australia and New Zealand, with 30-day mortality rates ranging from 0.5% to over 20%. Incidence is likely to increase with the ageing population, increased survival of patients with comorbidities that are considered risk factors and improving sensitivity of imaging techniques. Use of clinical prediction scores, such as the Wells score, has assisted in clinical decision-making and decreased unnecessary radiological investigations. However, imaging (i.e. computed tomography pulmonary angiography or ventilation-perfusion scans) is still necessary for objective diagnosis. Anti-coagulation remains the foundation of PE management. Haemodynamically unstable patients require thrombolysis unless absolutely contraindicated, while stable patients with right ventricular dysfunction or ischaemia should be aggressively anti-coagulated. Stable patients with no right ventricular dysfunction can be discharged home early with anti-coagulation and review. However, treatment should be case dependent with full consideration of the patient's clinical state. Direct oral anti-coagulants have become an alternative to vitamin K antagonists and are facilitating shorter hospital admissions. Additionally, duration of anti-coagulation must be decided by considering any provoking factors, bleeding risk and comorbid state. Patients with truly unprovoked or idiopathic PE often require indefinite treatment, while in provoked cases it is typically 3 months with some patients requiring longer periods of 6-12 months.
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Affiliation(s)
- Morgan Hepburn-Brown
- Melbourne Medical School, The University of Melbourne, Melbourne, Victoria, Australia.,Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Jai Darvall
- Department of Intensive Care and Anaesthesia/Pain Management, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.,Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Gary Hammerschlag
- Department of Respiratory and Sleep Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
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6
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Salzano A, Marra AM, D’Assante R, Arcopinto M, Bossone E, Suzuki T, Cittadini A. Biomarkers and Imaging. Heart Fail Clin 2019; 15:321-331. [DOI: 10.1016/j.hfc.2018.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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7
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Chetboul V, Damoiseaux C, Lefebvre HP, Concordet D, Desquilbet L, Gouni V, Poissonnier C, Pouchelon JL, Tissier R. Quantitative assessment of systolic and diastolic right ventricular function by echocardiography and speckle-tracking imaging: a prospective study in 104 dogs. J Vet Sci 2018; 19:683-692. [PMID: 30041288 PMCID: PMC6167344 DOI: 10.4142/jvs.2018.19.5.683] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/16/2018] [Accepted: 06/25/2018] [Indexed: 11/20/2022] Open
Abstract
Our aim was (1) to determine the within-day and between-day variability of several indices of systolic and diastolic right ventricular (RV) function by using conventional echocardiography and speckle-tracking echocardiography (STE) (Study 1), (2) to quantify these variables in a large healthy canine population (n = 104) with Doppler-derived estimated systolic pulmonary arterial pressure (SPAP) and left ventricular (LV) function, and (3) to establish the corresponding reference intervals (Study 2). For both studies, RV variables included tricuspid annular plane systolic excursion (TAPSE), right fractional area change (RFAC), STE longitudinal systolic strain (StS) of the RV free wall (RVFW) and of the entire RV (i.e., global RV StS), STE longitudinal systolic RVFW strain rate (SRS), and the diastolic early:late strain rate ratio. All but one within- and between-day coefficients of variation (13/14) were < 15%, the lowest being observed for TAPSE (3.6–9.8%), global RV StS (3.8–9.9%), and RVFW StS (3.7–7.3%). SPAP was weakly and negatively correlated with the TAPSE:body weight ratio (rs = −0.26, p = 0.01) and RVFW SRS (rs = −0.23, p < 0.05). Reference intervals (lower and upper limits with 90% confidence intervals) were provided for all variables. STE provides a non-invasive evaluation of RV function that may be used for clinical investigations in canine cardiology.
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Affiliation(s)
- Valérie Chetboul
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France.,Inserm U955, Team 03, Créteil, 94010 Cedex, France
| | - Cécile Damoiseaux
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
| | - Hervé P Lefebvre
- Research Clinic Unit, National Veterinary School of Toulouse, Toulouse University, Toulouse, F-31076 Cedex 03, France
| | - Didier Concordet
- TOXALIM, National Veterinary School of Toulouse, INRA, Toulouse University, Toulouse, F-31076 Cedex 03, France
| | - Loic Desquilbet
- Clinical Epidemiology and Biostatistics Unit, National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
| | - Vassiliki Gouni
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France.,Inserm U955, Team 03, Créteil, 94010 Cedex, France
| | - Camille Poissonnier
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
| | - Jean-Louis Pouchelon
- Alfort Cardiology Unit (UCA), Centre Hospitalier Universitaire Vétérinaire d'Alfort (CHUVA), National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France.,Inserm U955, Team 03, Créteil, 94010 Cedex, France
| | - Renaud Tissier
- Inserm U955, Team 03, Créteil, 94010 Cedex, France.,Pharmacology-Toxicology Unit, National Veterinary School of Alfort, Paris-Est University, Maisons-Alfort, 94704 Cedex, France
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8
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Ünlü S, Şahinarslan A, Gökalp G, Seçkin Ö, Arınsoy ST, Boyacı NB, Çengel A. The impact of volume overload on right heart function in end-stage renal disease patients on hemodialysis. Echocardiography 2017; 35:314-321. [DOI: 10.1111/echo.13768] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Affiliation(s)
- Serkan Ünlü
- Cardiology Department; Gazi University; Ankara Turkey
- Department of Pharmacology; Gazi University Institute of Health Sciences; Ankara Turkey
- Atatürk Chest Diseases and Chest Surgery Education and Research Hospital; Ankara Turkey
| | | | - Gökhan Gökalp
- Cardiology Department; Gazi University; Ankara Turkey
| | - Özden Seçkin
- Cardiology Department; Gazi University; Ankara Turkey
| | | | | | - Atiye Çengel
- Cardiology Department; Gazi University; Ankara Turkey
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9
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Khoche S, Ramsingh D, Maus T. The Year in Perioperative Echocardiography: Selected Highlights From 2016. J Cardiothorac Vasc Anesth 2017; 31:1554-1561. [DOI: 10.1053/j.jvca.2017.04.049] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 01/15/2023]
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10
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Zochios V, Protopapas AD, Parhar K. Markers of Right Ventricular Dysfunction in Adult Cardiac Surgical Patients. J Cardiothorac Vasc Anesth 2017; 31:1570-1574. [DOI: 10.1053/j.jvca.2017.06.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Indexed: 11/11/2022]
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11
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Laszlo R, Baumann T, Konz H, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Right ventricular function assessed by tissue Doppler echocardiography in older subjects without evidence for structural cardiac disease. Aging Clin Exp Res 2017; 29:557-562. [PMID: 27245355 DOI: 10.1007/s40520-016-0590-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 05/18/2016] [Indexed: 12/23/2022]
Abstract
The aim of our study was to obtain right ventricular (RV) tissue Doppler imaging (TDI) data in older subjects (n = 95, mean age: 74.5 ± 4.6 years) without evidence of hemodynamically significant structural heart disease recruited from a large population-based cohort (ActiFE-Ulm study). Our data indicate that aging may be accompanied by decreasing RV diastolic function and at most little alterations of RV systolic function. Mean values of all parameters were still within the guideline-suggested reference range with most of them closer to the abnormality thresholds. On an individual basis, respective thresholds were also exceeded in some subjects (almost all parameters <20 %) despite the absence of evidence for structural cardiac disease. RV-TDI is a feasible method for evaluation of RV systolic and diastolic function also in a geriatric population as sufficient TDI data was obtainable in the majority of our participants. Published reference values also seem to be mostly suitable although among older subjects, presumed pathological measures might still be compatible with physiological age-related alterations. Therefore, they always have to be interpreted across the clinical context and in relation to other parameters of morphology and function obtained by other ultrasound imaging techniques (M-mode, B-mode, etc.) in the context of echocardiographic evaluation of the right heart.
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Affiliation(s)
- Roman Laszlo
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany.
| | - Tobias Baumann
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Hanna Konz
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
| | - Dhayana Dallmeier
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Jochen Klenk
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Michael Denkinger
- AGAPLESION Bethesda Clinic, Geriatric Medicine, University of Ulm, Zollernring 26, 89073, Ulm, Germany
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Dietrich Rothenbacher
- Institute of Epidemiology and Medical Biometry, University of Ulm, Helmholtzstr. 22, 89081, Ulm, Germany
| | - Juergen Michael Steinacker
- Division of Sports and Rehabilitation Medicine, Department of Internal Medicine II (Cardiology), University of Ulm, Leimgrubenweg 14, 89070, Ulm, Germany
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12
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Flo Forner A, Hasheminejad E, Sabate S, Ackermann MA, Turton EW, Ender J. Agreement of tricuspid annular systolic excursion measurement between transthoracic and transesophageal echocardiography in the perioperative setting. Int J Cardiovasc Imaging 2017; 33:1385-1394. [DOI: 10.1007/s10554-017-1128-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/25/2017] [Indexed: 11/29/2022]
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13
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Magunia H, Schmid E, Hilberath JN, Häberle L, Grasshoff C, Schlensak C, Rosenberger P, Nowak-Machen M. 2D Echocardiographic Evaluation of Right Ventricular Function Correlates With 3D Volumetric Models in Cardiac Surgery Patients. J Cardiothorac Vasc Anesth 2016; 31:595-601. [PMID: 28129939 DOI: 10.1053/j.jvca.2016.11.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Indexed: 11/11/2022]
Abstract
OBJECTIVES The early diagnosis and treatment of right ventricular (RV) dysfunction are of critical importance in cardiac surgery patients and impact clinical outcome. Two-dimensional (2D) transesophageal echocardiography (TEE) can be used to evaluate RV function using surrogate parameters due to complex RV geometry. The aim of this study was to evaluate whether the commonly used visual evaluation of RV function and size using 2D TEE correlated with the calculated three-dimensional (3D) volumetric models of RV function. DESIGN AND SETTING Retrospective study, single center, University Hospital. PARTICIPANTS AND INTERVENTION Seventy complete datasets were studied consisting of 2D 4-chamber view loops (2-3 beats) and the corresponding 4-chamber view 3D full-volume loop of the right ventricle. RV function and RV size of the 2D loops then were assessed retrospectively purely qualitatively individually by 4 clinician echocardiographers certified in perioperative TEE. Corresponding 3D volumetric models calculating RV ejection fraction and RV end-diastolic volumes then were established and compared with the 2D assessments. MEASUREMENTS AND MAIN RESULTS 2D assessment of RV function correlated with 3D volumetric calculations (Spearman's rho -0.5; p<0.0001). No correlation could be established between 2D estimates of RV size and actual 3D volumetric end-diastolic volumes (Spearman's rho 0.15; p = 0.25). CONCLUSION The 2D assessment of right ventricular function based on visual estimation as frequently used in clinical practice appeared to be a reliable method of RV functional evaluation. However, 2D assessment of RV size seemed unreliable and should be used with caution.
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Affiliation(s)
- Harry Magunia
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Eckhard Schmid
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Jan N Hilberath
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany; Department of Anesthesiology and Intensive Care Medicine, Herzentrum Lahr, Lahr, Germany
| | - Leo Häberle
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Christian Grasshoff
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Christian Schlensak
- Department of Thoracic and Cardiovascular Surgery, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Peter Rosenberger
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany
| | - Martina Nowak-Machen
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Tübingen, Eberhard-Karls-University Tübingen, Tübingen, Germany.
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14
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Biteker FS, Başaran Ö, Doğan V, Çaylak SD, Yıldırım B, Sözen H. Prognostic value of transthoracic echocardiography and biomarkers of cardiac dysfunction in community-acquired pneumonia. Clin Microbiol Infect 2016; 22:1006.e1-1006.e6. [PMID: 27596535 DOI: 10.1016/j.cmi.2016.08.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 08/11/2016] [Accepted: 08/13/2016] [Indexed: 02/05/2023]
Abstract
The aim of this study was to determine the prognostic role of echocardiography and compare with admission N-terminal proB-type natriuretic peptide (NT-proBNP) levels in adult patients with community-acquired pneumonia (CAP). Consecutive adult patients hospitalized with CAP were prospectively enrolled and followed-up until hospital discharge or death. Echocardiography was performed within the first 48 hours. Complicated hospitalization (CH) was defined as intensive care unit admission, need for mechanical ventilation or in-hospital mortality. This study was registered with ClinicalTrials.gov, number NCT02441855. A total of 15 CH (13.5%) occurred among 111 patients with CAP. CAP patients with a CH compared with those without CH had significantly higher NT-proBNP values (1267.4±1146.1 vs. 305.6±545.7 pg/mL, p <0.001) and troponin I (23.8±24.3 vs. 10.3±6.3 ng/mL, p 0.02) but had lower left ventricle ejection fraction (52.7±8.7 vs. 60.5±6.7%, p <0.001) and tricuspid annular plane systolic excursion (TAPSE), which is a measure of right ventricular systolic function (17.1±4.4 vs. 21.8±4 mm; p 0.001). Patients with elevation of NT-proBNP and decreased TAPSE at presentation had a significantly higher probability of CH (60%) than patients with either elevated NT-proBNP or decreased TAPSE (40%). Patients with neither elevated NT-proBNP nor decreased TAPSE had a 0% probability of CH. This is the first study to demonstrate that decreased right ventricular systolic function is associated with increased rates of adverse events in patients with CAP.
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Affiliation(s)
- F S Biteker
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey.
| | - Ö Başaran
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - V Doğan
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Turkey
| | - S Dirgen Çaylak
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
| | - B Yıldırım
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Emergency Medicine, Muğla, Turkey
| | - H Sözen
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Infectious Diseases and Clinical Microbiology, Turkey
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15
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Laszlo R, Baumann T, Konz H, Dallmeier D, Klenk J, Denkinger M, Koenig W, Rothenbacher D, Steinacker JM. Echocardiographic B-mode evaluation of the right heart in older people: The ActiFE Study. Arch Gerontol Geriatr 2016; 67:145-52. [PMID: 27518473 DOI: 10.1016/j.archger.2016.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Revised: 07/29/2016] [Accepted: 07/29/2016] [Indexed: 11/24/2022]
Abstract
PURPOSE Right heart B-mode echocardiography reference values have been predominantly obtained in younger age cohorts (<65years). Aims of the study were to describe and evaluate the feasibility of right heart B-mode echocardiography in a large geriatric cohort and to analyze standard parameters in defined subgroups with or without any evidence for structural cardiac disease. METHODS ActiFE-Ulm study is a population-based cohort study including a sample of people≥65years old living in the region of Ulm, Germany. Echocardiography including right heart parameters was performed within a cardiovascular follow-up of 688 subjects. PRINCIPAL RESULTS Non-obtainability of right heart B-mode data was rather not a consequence of accompanying cardiac diseases or risk factors but of a more obese body composition. Mean values of right heart measurements of our subpopulation of subjects without evidence for structural cardiac disease were continuously higher than those of the guidelines (e.g. mean right ventricular end diastolic area 23.5±5.6cm(2) (males), 20.3±5.0cm(2) (females)). On an individual basis, guideline-suggested abnormality thresholds were also often exceeded, whereas this situation occurred more often in male than in female subjects. MAJOR CONCLUSIONS Methodically, right heart B-mode echocardiography in older subjects is challenging. Our results suggest an ageing-associated right heart enlargement. Utilization of published right heart reference values in older adults seems to be problematic and in clinical practice, they always have to be interpreted within the clinical and functional context and in relation to other right heart echocardiographic parameters.
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Affiliation(s)
- Roman Laszlo
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany.
| | - Tobias Baumann
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
| | - Hannah Konz
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
| | - Dhayana Dallmeier
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Zollernring 26, 89073 Ulm, Germany
| | - Jochen Klenk
- University of Ulm, Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Michael Denkinger
- University of Ulm, AGAPLESION Bethesda Clinic, Geriatric Center Ulm/Alb-Donau, Zollernring 26, 89073 Ulm, Germany
| | - Wolfgang Koenig
- Klinik für Herz-& Kreislauferkrankungen, Deutsches Herzzentrum München, Technische Universität München, Lazarettstr. 36, 80636, Munich, Germany
| | - Dietrich Rothenbacher
- University of Ulm, Institute of Epidemiology and Medical Biometry, Helmholtzstr. 22, 89081 Ulm, Germany
| | - Juergen Michael Steinacker
- University of Ulm, Department of Internal Medicine II (cardiology), Division of Sports and Rehabilitation Medicine, Leimgrubenweg 14, 89070 Ulm, Germany
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Scrutinio D, Catanzaro R, Santoro D, Ammirati E, Passantino A, Oliva F, La Rovere MT, De Salvo M, Guzzetti D, Vaninetti R, Venezia M, Frigerio M. Tricuspid Annular Plane Systolic Excursion in Acute Decompensated Heart Failure: Relevance for Risk Stratification. Can J Cardiol 2016; 32:963-9. [DOI: 10.1016/j.cjca.2015.09.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/15/2015] [Accepted: 09/15/2015] [Indexed: 12/26/2022] Open
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