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Bjerregaard CL, Olsen FJ, Skaarup KG, Jørgensen PG, Galatius S, Pedersen S, Iversen A, Biering-Sørensen T. Association between cardiac time intervals and incident heart failure after acute coronary syndrome. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03206-8. [PMID: 39096406 DOI: 10.1007/s10554-024-03206-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 07/23/2024] [Indexed: 08/05/2024]
Abstract
BACKGROUND Cardiac time intervals are sensitive markers of myocardial dysfunction that predispose to heart failure (HF). We aimed to investigate the association between cardiac time intervals and HF in patients with acute coronary syndrome (ACS). METHODS This study included 386 ACS patients treated with percutaneous coronary intervention (PCI). Patients underwent an echocardiography examination a median of two days after PCI. Cardiac time intervals including isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and systolic ejection time (ET), and myocardial performance index (MPI) were obtained by tissue Doppler echocardiography. The outcome was incident HF. RESULTS During follow-up (median 4.3, IQR:1.0-6.7 years), 140 (36%) developed HF. In unadjusted analyses, IVRT was not associated with HF (HR 1.02 (0.95-1.10), p = 0.61, per 10ms increase), and neither was IVCT (HR 0.07 (0.95-1.22), p = 0.26, per 10ms increase). Increasing MPI was associated with a higher risk of HF (HR 1.20 (1.08-1.34), P = 0.001, per 0.1 increase), and so was decreasing ET (HR 1.13 (1.07-1.18), P < 0.001 per 10ms decrease). After multivariable adjustment for cardiovascular risk factors, MPI (HR 1.13 (1.01-1.27), P = 0.034) and ET (HR 1.09 (1.01-1.17), P = 0.025) remained significantly associated with incident HF. LVEF modified the association between ET and HF (p for interaction = 0.002), such that ET was associated with HF in patients with LVEF ≥ 36% (HR = 1.15 (1.06-1.24), P = 0.001, per 10ms decrease). CONCLUSION In patients admitted with ACS, shortened ET and higher MPI were independently associated with an increased risk of incident HF. Additionally, ET was associated with incident HF in patients with LVEF above 36%.
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Affiliation(s)
- Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark.
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Søren Galatius
- Department of Cardiology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Allan Iversen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark
- Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, 2900, Hellerup, Denmark
- Department of Biomedical Sciences, Center for Translational Cardiology and Pragmatic Randomized Trials, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
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2
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Singh J, Ellingson CJ, Ellingson CA, Scott P, Neary JP. Cardiac cycle timing and contractility following acute sport-related concussion. Res Sports Med 2024; 32:260-267. [PMID: 35850630 DOI: 10.1080/15438627.2022.2102918] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2022] [Accepted: 06/17/2022] [Indexed: 10/17/2022]
Abstract
Cardiac sequelae following sport-related concussion are not well understood. This study describes changes in the cardiac cycle timing intervals and contractility parameters during the acute phase of concussion. Twelve athletes (21 ± 2 years, height = 182 ± 9 cm, mass = 86 ± 15 kg, BMI = 26 ± 3 kg/m2) were assessed within 5 days of sustaining a diagnosed concussion against their own pre-season baseline. A non-invasive cardiac sensor (LLA RecordisTM) was used to record the cardiac cycle parameters of the heart for 1 minute during supine rest. Cardiac cycle timing intervals (Isovolumic relaxation and contraction time, Mitral valve open to E wave, Rapid ejection period, Atrial systole to mitral valve closure, Systole, and Diastole) and contractile forces (Twist force and Atrial systole: AS) were compared. Systolic time significantly decreased during acute concussion (p = 0.034). Magnitude of AS significantly increased during acute concussion (p = 0.013). These results imply that concussion can result in altered systolic function.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Chase J Ellingson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Cody A Ellingson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - Parker Scott
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Saskatchewan, Canada
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3
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Minczykowski A, Guzik P, Sajkowska A, Pałasz-Borkowska A, Wykrętowicz A. Interrelationships between Peak Strain Dispersion, Myocardial Work Indices, Isovolumetric Relaxation and Systolic-Diastolic Coupling in Middle-Aged Healthy Subjects. J Clin Med 2023; 12:5623. [PMID: 37685690 PMCID: PMC10488442 DOI: 10.3390/jcm12175623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 08/11/2023] [Accepted: 08/24/2023] [Indexed: 09/10/2023] Open
Abstract
In echocardiography, peak strain dispersion (PSD) is the standard deviation of the time to peak longitudinal strain for each left ventricular (LV) segment during systole. It assesses the coordination and synchrony of LV segment contractility. Global work efficiency (GWE) and global wasted work (GWW) quantify LV myocardial work and, if impaired, the coupling between LV systolic contraction and early relaxation. Isovolumetric relaxation (IVRT) measures the duration of initial LV relaxation, while the ratio of early diastolic recoil to systolic excursion (E'VTI/S'VTI) describes systolic-diastolic coupling. We evaluated these parameters in 69 healthy subjects and found that PSD correlated negatively with GWE (r = -0.49, p < 0.0001) and E'VTI/S'VTI (r = -0.44, p = 0.0002), but positively with GWW (r = 0.4, p = 0.0007) and IVRT (r = 0.53, p < 0.0001). GWE correlated negatively with GWW (r = -0.94, p < 0.0001) and IVRT (r = -0.30, p = 0.0127), but positively with E'VTI/S'VTI (r = 0.3, p = 0.0132). In addition, E'VTI/S'VTI was negatively correlated with GWW (r = -0.35, p = 0.0032) and IVRT (r = -0.36, p = 0.0024). These associations remained significant after adjustment for sex, age and LV mass index of the subjects. In conclusion, there is an interaction between measures of LV asynchrony, myocardial work, diastolic function and its systolic-diastolic coupling in middle-aged healthy subjects. The clinical value of these interactions requires further investigation.
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Affiliation(s)
- Andrzej Minczykowski
- Department of Cardiology-Intensive Therapy, Poznań University of Medical Sciences, 49 Przybyszewskiego, 60-355 Poznań, Poland; (P.G.); (A.S.); (A.P.-B.); (A.W.)
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4
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Bardutz H, Singh J, Rehman Z, Bernat P. Parkinson's Disease and the Cardiac Cycle: A Rapid Literature Review and Case Series. Life (Basel) 2023; 13:life13041003. [PMID: 37109530 PMCID: PMC10143446 DOI: 10.3390/life13041003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 03/17/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Cardiac function in patients with Parkinson's Disease (PD) is not well understood. We conducted a review of the literature to summarize all available data on the cardiac cycle in patients with PD and followed up the review with a case series to describe the cardiac cycle timing intervals in this patient population. METHODS Using the search terms ("Cardiac cycle" OR "echocardiography" OR "LVET" OR "IVCT" OR "IVRT" OR "LVEF" OR "Systolic Dysfunction" OR "Diastolic Dysfunction") AND ("Parkinson's Disease"), 514 studies were found with 19 included in the review. RESULTS Studies focused on the impact of medication, the presence of autonomic dysfunction, and resting-state, descriptive observational studies which considered the cardiac cycle. While inconsistent, the evidence suggests that patients with PD have some systolic dysfunction, with recent research implying the presence of subclinical systolic dysfunction. From the case series, 13 participants with PD were included and collected cardiac data daily for 6 weeks. Heart rate was consistent on a weekly basis at 67-71 bpm. Mean week-by-week cardiac parameters were also consistent with the systolic time interval at 332-348 ms, isovolumic relaxation time at 92-96 ms, and isovolumic contraction time at 34-36 ms. CONCLUSION These timing intervals add valuable normative values for this patient population and the review of the literature suggests that more research is required to better understand cardiac cycle timing intervals in patients with Parkinson's Disease.
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Affiliation(s)
- Holly Bardutz
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
| | - Jyotpal Singh
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
| | - Ziaur Rehman
- Department of Medicine, University of Saskatchewan, Regina, SK S4P 0W5, Canada
| | - Patrick Bernat
- Faculty of Kinesiology & Health Studies, University of Regina, Regina, SK S4S 0A2, Canada
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5
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Singh J, Ellingson CJ, Ellingson CA, Scott P, Neary JP. Cardiac cycle timing intervals in university varsity athletes. Eur J Sport Sci 2023:1-6. [PMID: 36752085 DOI: 10.1080/17461391.2023.2178329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Cardiac cycle timing events in varsity athletes serve an important function for baseline assessment but are not reported in the literature. The purpose of this study was to characterise the cardiac cycle timing intervals and contractility parameters in university-level varsity athletes. 152 males and 93 females were assessed using a non-invasive seismocardiography cardiac sensor attached to the sternum for 1-minute. Shorter isovolumic relaxation time (IVRT), systolic time, mitral valve open to E-wave (MVO to E) time, rapid ejection period (REP), atrial systole to mitral valve closure (AS to MVC) time, and diastolic performance index (IVRT/systolic time) were found in females, while heart rate was lower in males. Varying differences in timing intervals were found between sports. Systolic times were longer in male and female basketball players, while diastole was shortest in male football players, who also had higher heart rates than the other male sport athletes. These results add reference cardiac cycle timing data to the literature and imply that male and female athletes show different cardiac characteristics. Team differences suggest that different training for different sports can result in unique cardiac function changes, however, these appear to be related to the sex of the participants. The addition of these cardiac cycle timing intervals adds a valuable comparative tool to better understand cardiac physiology in the varsity athletic population.HIGHLIGHTS Given the lack of data in the literature on athlete's cardiac cycle timing intervals, we provide normative values for healthy, university varsity athletes, including stratification by sex and sport.Male and female athletes show different cardiac cycle timing intervals, including the systolic and isovolumic relaxation timing intervals.Differences in cardiac cycle timing intervals are also present when comparing different sports.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Chase J Ellingson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Cody A Ellingson
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
| | - Parker Scott
- College of Kinesiology, University of Saskatchewan, Saskatoon, Canada
| | - J Patrick Neary
- Faculty of Kinesiology and Health Studies, University of Regina, Regina, Canada
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6
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Olsen FJ, Bjerregaard CL, Skaarup KG, Lassen MCH, Johansen ND, Modin D, Jensen GB, Schnohr P, Søgaard P, Gislason G, Svendsen JH, Møgelvang R, Biering-Sørensen T. Impact of echocardiographic analyses of valvular event timing on myocardial work indices. Eur Heart J Cardiovasc Imaging 2023; 24:314-323. [PMID: 35981965 DOI: 10.1093/ehjci/jeac171] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/11/2022] [Accepted: 08/04/2022] [Indexed: 11/14/2022] Open
Abstract
AIMS Valvular event timing is an integral part of echocardiographic pressure-strain loop (PSL) analyses. The impact that different event timing modalities may have on myocardial work indices is unknown. METHODS AND RESULTS A methodological study was performed on 200 subjects, including 50 healthy subjects, 50 with aortic valve sclerosis, 50 with atrial fibrillation, and 50 with reduced left ventricular ejection fraction. Valvular event timing was estimated by visual assessment, spectral Doppler, and colour tissue Doppler imaging (TDI) M-mode. These valvular event timings were added to the same PSL analyses sequentially to acquire myocardial work indices, including global work index (GWI). For the 200 participants, the median age was 72 years, 50% were men, and mean blood pressure was 143/80 mmHg. Valvular event timings differed between all three modalities and so did all myocardial work indices. Compared with visual assessment, spectral Doppler resulted in a significantly higher GWI (mean difference: 114 ± 93 mmHg%, P < 0.001), and so did TDI (mean difference: 83 ± 90 mmHg%, P < 0.001). A higher GWI by spectral Doppler than by TDI was also observed (mean difference: 30 ± 53 mmHg%, P < 0.001). In the healthy subgroup, a systematic bias was observed for spectral Doppler compared with visual assessment (mean difference: 160 ± 77 mmHg%, P < 0.001), and a similar trend was noted for TDI vs. visual assessment (mean difference: 124 ± 74 mmHg%, P < 0.001). CONCLUSION Myocardial work indices differ depending on the event timing modality used, with visual assessment yielding lower GWI values compared with Doppler-based methods. Serial PSL analyses should apply the same event timing method.
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Affiliation(s)
- Flemming Javier Olsen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Caroline Løkke Bjerregaard
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Kristoffer Grundtvig Skaarup
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Mats Christian Højbjerg Lassen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Niklas Dyrby Johansen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Daniel Modin
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Copenhagen University Hospital-North Zealand, 3400 Hilleroed, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark
| | - Jesper Hastrup Svendsen
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark.,Department of Cardiology, Copenhagen University Hospital-Rigshospitalet, 2100 Copenhagen, Denmark.,Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, 5230 Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Copenhagen University Hospital-Herlev and Gentofte, 2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Copenhagen University Hospital-Bispebjerg and Frederiksberg, 2000 Copenhagen, Denmark.,Department of Biomedical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark
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7
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Nag P, Chowdhury SR, Behera SK, Das M, Narayan P. Levosimendan or Milrinone for Ventricular Septal Defect Repair With Pulmonary Arterial Hypertension. J Cardiothorac Vasc Anesth 2023; 37:972-979. [PMID: 36906394 DOI: 10.1053/j.jvca.2023.01.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 01/10/2023] [Accepted: 01/27/2023] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Both milrinone and levosimendan have been used in patients undergoing surgical closure of ventricular septal defects (VSD) with pulmonary artery hypertension (PAH); however, the evidence base for their use is limited. In the present study, the authors sought to compare the role of levosimendan and milrinone in the prevention of low-cardiac-output syndrome in the early postoperative period. DESIGN A prospective, randomized, controlled trial. SETTING At a tertiary-care center. PARTICIPANTS Children between 1 month and 12 years presenting with VSD and PAH between 2018 and 2020. INTERVENTIONS A total of 132 patients were randomized into the following 2 groups: Group L (levosimendan group) and Group M (milrinone group). MEASUREMENTS AND MAIN RESULTS In addition to conventional hemodynamic parameters, the authors also included a myocardial performance index assessment to compare the groups. The levosimendan group had significantly lower mean arterial pressure while coming off cardiopulmonary bypass, after shifting to intensive therapy unit, as well as at 3 and 6 hours postoperatively. The duration of ventilation (29.6 ± 13.9 hours v 23.2 ± 13.3 hours; p = 0.012), as well as postoperative intensive care unit stay, were significantly prolonged in the levosimendan group (5.48 ± 1.2 v 4.7 ± 1.3 days, p = 0.003). There were 2 (1.6%) in-hospital deaths in the entire cohort, 1 in each arm. There was no difference in the myocardial performance index of the left or right ventricle. CONCLUSIONS In patients undergoing surgical repair for VSD with PAH, levosimendan does not confer any additional benefit compared to milrinone. Both milrinone and levosimendan appear to be safe in this cohort.
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Affiliation(s)
- Prachi Nag
- Department of Cardiac Anesthesia, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Saibal Roy Chowdhury
- Department of Cardiac Anesthesia, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Sukanta Kumar Behera
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Mrinalendu Das
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India
| | - Pradeep Narayan
- Department of Cardiac Surgery, Rabindranath Tagore International Institute of Cardiac Sciences, Narayana Health, Kolkata, India.
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8
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Myocardial performance index as a measure of global left ventricular function improves following isometric exercise training in hypertensive patients. Hypertens Res 2023; 46:468-474. [PMID: 36109599 DOI: 10.1038/s41440-022-01019-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/18/2022] [Accepted: 08/13/2022] [Indexed: 02/07/2023]
Abstract
As the leading cause of cardiovascular disease and mortality, hypertension remains a global health problem. Isometric exercise training (IET) has been established as efficacious in reducing resting blood pressure (BP); however, no research to date has investigated its effects on the myocardial performance index (MPI). Twenty-four unmedicated hypertensive patients were randomized to 4 weeks of IET and a control period in a crossover design. Tissue Doppler imaging was used to acquire cardiac time intervals pre- and post-IET and during the control periods. IET significantly improved all measures of cardiac time intervals, including isovolumic relaxation time (83.1 ± 10.3 vs. 76.1 ± 11.2 ms, p = 0.006), isovolumic contraction time (84.8 ± 10.3 vs. 72.8 ± 6.4 ms, p < 0.001), ejection time (304.6 ± 30.2 vs. 321.4 ± 20.8 ms, p = 0.015) and the MPI (0.56 ± 0.09 vs. 0.47 ± 0.05, p < 0.001). This is the first study to demonstrate that IET significantly improves cardiac time intervals. These findings may have important clinical implications, highlighting the potential utility of IET in the management of cardiac health in hypertensive patients.
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9
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Carleton RN, McCarron M, Krätzig GP, Sauer-Zavala S, Neary JP, Lix LM, Fletcher AJ, Camp RD, Shields RE, Jamshidi L, Nisbet J, Maguire KQ, MacPhee RS, Afifi TO, Jones NA, Martin RR, Sareen J, Brunet A, Beshai S, Anderson GS, Cramm H, MacDermid JC, Ricciardelli R, Rabbani R, Teckchandani TA, Asmundson GJG. Assessing the impact of the Royal Canadian Mounted Police (RCMP) protocol and Emotional Resilience Skills Training (ERST) among diverse public safety personnel. BMC Psychol 2022; 10:295. [PMID: 36494748 PMCID: PMC9733219 DOI: 10.1186/s40359-022-00989-0] [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: 09/13/2022] [Accepted: 11/13/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Public safety personnel (PSP; e.g., border services personnel, correctional workers, firefighters, paramedics, police, public safety communicators) are frequently exposed to potentially psychologically traumatic events. Such events contribute to substantial and growing challenges from posttraumatic stress injuries (PTSIs), including but not limited to posttraumatic stress disorder. METHODS The current protocol paper describes the PSP PTSI Study (i.e., design, measures, materials, hypotheses, planned analyses, expected implications, and limitations), which was originally designed to evaluate an evidence-informed, proactive system of mental health assessment and training among Royal Canadian Mounted Police for delivery among diverse PSP (i.e., firefighters, municipal police, paramedics, public safety communicators). Specifically, the PSP PTSI Study will: (1) adapt, implement, and assess the impact of a system for ongoing (i.e., annual, monthly, daily) evidence-based assessments; (2) evaluate associations between demographic variables and PTSI; (3) longitudinally assess individual differences associated with PTSI; and, (4) assess the impact of providing diverse PSP with a tailored version of the Emotional Resilience Skills Training originally developed for the Royal Canadian Mounted Police in mitigating PTSIs based on the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders. Participants are assessed pre- and post-training, and then at a follow-up 1-year after training. The assessments include clinical interviews, self-report surveys including brief daily and monthly assessments, and daily biometric data. The current protocol paper also describes participant recruitment and developments to date. DISCUSSION The PSP PTSI Study is an opportunity to implement, test, and improve a set of evidence-based tools and training as part of an evidence-informed solution to protect PSP mental health. The current protocol paper provides details to inform and support translation of the PSP PTSI Study results as well as informing and supporting replication efforts by other researchers. TRIAL REGISTRATION Hypotheses Registration: aspredicted.org, #90136. Registered 7 March 2022-Prospectively registered. TRIAL REGISTRATION ClinicalTrials.gov, NCT05530642. Registered 1 September 2022-Retrospectively registered. The subsequent PSP PTSI Study results are expected to benefit the mental health of all participants and, ultimately, all PSP.
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Affiliation(s)
- R. Nicholas Carleton
- grid.57926.3f0000 0004 1936 9131Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - Michelle McCarron
- grid.412733.00000 0004 0480 4970Research Department, Saskatchewan Health Authority, Regina, SK S4S 0A5 Canada
| | - Gregory P. Krätzig
- grid.57926.3f0000 0004 1936 9131Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - Shannon Sauer-Zavala
- grid.266539.d0000 0004 1936 8438Treatment Innovation for Psychological Services Research Program, Department of Psychology, University of Kentucky, Lexington, KY 40506 USA
| | - J. Patrick Neary
- grid.57926.3f0000 0004 1936 9131Faculty of Kinesiology and Health Studies, University of Regina, Regina, SK S4S 0A2 Canada
| | - Lisa M. Lix
- grid.21613.370000 0004 1936 9609Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W3 Canada
| | - Amber J. Fletcher
- grid.57926.3f0000 0004 1936 9131Department of Sociology and Social Studies, University of Regina, Regina, SK S4S 0A2 Canada
| | - Ronald D. Camp
- grid.266876.b0000 0001 2156 9982Faculty of Business and Economics, University of Northern British Columbia, Prince George, BC V2N 4Z9 Canada
| | - Robyn E. Shields
- grid.57926.3f0000 0004 1936 9131University of Regina, Regina, SK S4S 0A2 Canada
| | - Laleh Jamshidi
- grid.57926.3f0000 0004 1936 9131Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Jolan Nisbet
- grid.57926.3f0000 0004 1936 9131Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Kirby Q. Maguire
- grid.57926.3f0000 0004 1936 9131Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Renée S. MacPhee
- grid.268252.90000 0001 1958 9263Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, ON N2L 3C5 Canada
| | - Tracie O. Afifi
- grid.21613.370000 0004 1936 9609Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W5 Canada
| | - Nicholas A. Jones
- grid.57926.3f0000 0004 1936 9131Department of Justice Studies, University of Regina, Regina, SK S4S 0A2 Canada
| | - Ronald R. Martin
- grid.57926.3f0000 0004 1936 9131Faculty of Education, University of Regina, Regina, SK S4S 0A2 Canada
| | - Jitender Sareen
- grid.21613.370000 0004 1936 9609Department of Psychiatry, Department of Community Health Sciences, University of Manitoba, Winnipeg, MB R3E 0W5 Canada
| | - Alain Brunet
- grid.459278.50000 0004 4910 4652McGill’s Psychiatry Department and Douglas Institute Research Center, 6875 Lasalle Boulevard, Verdun, QC H4H 1R3 Canada
| | - Shadi Beshai
- grid.57926.3f0000 0004 1936 9131Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
| | - Gregory S. Anderson
- grid.265014.40000 0000 9945 2031Faculty of Science, Thompson Rivers University, Kamloops, BC V2C 0C8 Canada
| | - Heidi Cramm
- grid.410356.50000 0004 1936 8331School of Rehabilitation Therapy, Faculty of Health Sciences, Queen’s University, Kingston, ON K7L 3N6 Canada
| | - Joy C. MacDermid
- grid.39381.300000 0004 1936 8884School of Physiotherapy, Western University, London, ON N6A 3K7 Canada
| | - Rosemary Ricciardelli
- grid.25055.370000 0000 9130 6822School of Maritime Studies, Fisheries and Marine Institute, Memorial University of Newfoundland, St. John’s, NL A1C 5R3 Canada
| | - Rasheda Rabbani
- grid.21613.370000 0004 1936 9609George & Fay Yee Centre for Healthcare Innovation, Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Taylor A. Teckchandani
- grid.57926.3f0000 0004 1936 9131Canadian Institute for Public Safety Research and Treatment, University of Regina, Regina, SK S4S 0A2 Canada
| | - Gordon J. G. Asmundson
- grid.57926.3f0000 0004 1936 9131Anxiety and Illness Behaviours Laboratory, Department of Psychology, University of Regina, Regina, SK S4S 0A2 Canada
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10
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The Role of Tei Index added to the GRACE risk score for prediction of in-hospital MACE after acute myocardial infarction. ROMANIAN JOURNAL OF INTERNAL MEDICINE 2022; 60:222-228. [DOI: 10.2478/rjim-2022-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Indexed: 11/21/2022] Open
Abstract
Abstract
Introduction: The Global Registry of Acute Coronary Events (GRACE) risk score is widely recommended for risk assessment in patients with acute myocardial infarction (AMI). Variable degrees of impairment in left ventricular (LV) systolic and diastolic function might be found after AMI. Tei Index is an echocardiography parameter that represents both systolic and diastolic LV performance. Previous studies demonstrate Tei Index as an independent predictor of Major Adverse Cardiovascular Events (MACE) after AMI. This study investigates whether the addition of Tei Index could improve the GRACE risk score performance to predict inhospital MACE after AMI.
Methods: A prospective cohort study was conducted on 75 patients who presented with AMI. Total GRACE score was calculated on patient admission and echocardiography was conducted within 72 hours of hospitalization for measurement of MPI. All patients were observed for the incidence of MACE during hospitalization. The incremental predictive value of the GRACE risk score alone and combined with Tei Index was assessed by the change in area under the curve (AUC) by DeLong’s method, likelihood ratio test (LRT), and continuous net reclassification improvement (cNRI).
Results: The addition of Tei Index to the GRACE risk score significantly improves the predictive value of the GRACE risk score (increase in AUC from 0.753 for the GRACE risk score to 0.801 for the GRACE score combine with Tei Index, p=0.354; LRT=4.65, p=0.030; cNRI=0.515, p=0.046).
Conclusions: Adjustment of Tei Index to GRACE risk score might improve risk prediction of in-hospital MACE after AMI.
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11
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Singh J, Bhagaloo L, Sy E, Lavoie AJ, Dehghani P, Bardutz HA, Mang CS, Buttigieg J, Neary JP. Cardiac impairments in postacute COVID-19 with sustained symptoms: A review of the literature and proof of concept. Physiol Rep 2022; 10:e15430. [PMID: 35993433 PMCID: PMC9393908 DOI: 10.14814/phy2.15430] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 11/25/2022] Open
Abstract
Although acute COVID-19 is known to cause cardiac damage in some cases, there is still much to learn about the duration and relative permanence of the damage that may occur. Long COVID is a condition that can occur when COVID-19 symptoms remain in the postviral acute period. Varying accounts of long COVID have been described across the literature, however, cardiac impairments are sustained in many individuals and cardiovascular assessment is now considered to be an expected follow-up examination. The purpose of this review and proof of concept is to summarize the current research related to the assessment of cardiac function, including echocardiography and blood biomarker data, during the follow-up period in patients who recovered from COVID-19. Following a literature review, it was found that right ventricular dysfunction along with global longitudinal strain and diastolic dysfunction are common findings. Finally, more severe acute myocardial injury during the index hospitalization appears to exacerbate cardiac function. The available literature implies that cardiac function must be monitored in patients recovered from COVID-19 who remain symptomatic and that the impairments and severity vary from person-to-person. The proof-of-concept analysis of patients with cardiac disease and respiratory disease in comparison to those with sustained symptoms from COVID-19 suggests elevated systolic time interval in those with sustained symptoms from COVID-19, thus reducing heart performance indices. Future research must consider the details of cardiac complications during the acute infection period and relate this to the cardiac function in patients with long COVID during mid- and long-term follow-up.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Lanishen Bhagaloo
- Gateway Alliance MedicalReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
- Department of Family MedicineSaskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Eric Sy
- Department of Critical CareSaskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
- College of Graduate and Postdoctoral StudiesUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Andrea J. Lavoie
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Payam Dehghani
- Department of CardiologyPrairie Vascular Research Inc, Saskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Holly A. Bardutz
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Cameron S. Mang
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Josef Buttigieg
- Faculty of Science, Department of BiologyUniversity of ReginaReginaSaskatchewanCanada
| | - J. Patrick Neary
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
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12
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Diagnostic Value and Clinical Performance of Cardiac Ultrasound in Patients with Chronic Heart Failure with Hypertension. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4238284. [PMID: 35571729 PMCID: PMC9098295 DOI: 10.1155/2022/4238284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/08/2022] [Accepted: 04/11/2022] [Indexed: 11/17/2022]
Abstract
Objective To assess the diagnostic value and clinical performance of cardiac ultrasound in patients with chronic heart failure and hypertension. Methods In this prospective study, between August 2017 and January 2020, 50 patients with chronic heart failure and hypertension were recruited and assigned to the study group and 50 healthy individuals during the same period after physical examinations were included in the control group. Cardiac ultrasound examinations were performed on the participants, and the results were compared and analyzed. Results The study group had a higher left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), left ventricular ejection fraction (LVEF), and late diastolic peak flow velocity (A wave) and showed lower early diastolic peak flow velocity (E wave) and late diastolic peak flow velocity/lower early diastolic peak flow velocity (E/A) ratio levels than in the control group. The study group had 15 patients with grade I cardiac function (ultrasound detection rate of 100%), 18 patients with grade II cardiac function (ultrasound detection rate of 100%), and 17 patients with grade III cardiac function (ultrasound detection rate of 100%). Grade I cardiac function patients showed the lowest LVEDD, LVESD, and E/A and the highest LVEF than grade II patients, followed by grade III patients. The study group showed higher LVEF and echocardiographic estimation of the pulmonary arterial systolic pressure (PASP) and lower right ventricular lateral wall systolic excursion velocity and tricuspid annular plane systolic excursion (TAPSE) than the control group. Chronic heart failure with hypertension was associated with high levels of right atrial total emptying volume (RAVIt), right atrial passive emptying volume (RAVIp), right atrial active emptying volume (RAVIa), and right atrial active emptying fraction (RAVIaEF) and low levels of right atrial total emptying fraction (RAVItEF) and right atrial passive emptying fraction (RAVIpEF) versus the healthy status (all P < 0.05). Conclusion Cardiac ultrasound is a noninvasive operation with low cost, high repeatability, and accurate detection, which can identify right heart function impairment at an early stage, assist clinical treatment, and improve patient prognosis, so it is worthy of promotion and application.
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13
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Andersen DM, Sengeløv M, Olsen FJ, Marott JL, Jensen GB, Schnohr P, Platz E, Schou M, Mogelvang R, Biering-Sørensen T. Measures of left atrial function predict incident heart failure in a low-risk general population: the Copenhagen City Heart Study. Eur J Heart Fail 2022; 24:483-493. [PMID: 34931395 PMCID: PMC8986599 DOI: 10.1002/ejhf.2406] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 11/24/2021] [Accepted: 12/17/2021] [Indexed: 11/06/2022] Open
Abstract
AIMS This study investigated left atrial (LA) parameters as measured on transthoracic echocardiography as predictors of incident heart failure (HF) in a community cohort. METHODS AND RESULTS In a large general population study (n = 2221), participants underwent a health examination with echocardiography. The maximum and minimum LA volumes indexed to body surface area (LAVImax and LAVImin) were measured and the LA emptying fraction (LAEF) and LA expansion index (LAEI) were calculated. Among 1951 participants without atrial fibrillation or significant valve disease, the mean age was 59 ± 16 years and 58% were women. At baseline, 1% (n = 16) had a left ventricular ejection fraction of <50%, 44% had hypertension, and 10% had diabetes. During follow-up (median 15.8 years, interquartile range: 11.3-16.2 years), 187 (10%) participants were diagnosed with incident HF. Participants who were diagnosed with HF during follow-up had a larger LAVImax and LAVImin and a lower LAEF and LAEI compared to participants without HF. In unadjusted analysis, LAVImax, LAVImin, LAEF and LAEI were predictors of incident HF. After multivariable adjustment for clinical and echocardiographic parameters, only LAVImin remained an independent predictor of incident HF (hazard ratio per 1 standard deviation increase: 1.22 [95% confidence interval 1.01-1.47], p = 0.038). CONCLUSION In the general population, LAVImin is an independent predictor of incident HF. LAVImax, currently the only LA measure in a routine echocardiographic examination, was not an independent predictor of incident HF.
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Affiliation(s)
- Ditte Madsen Andersen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark,Corresponding author. Cardiovascular Non-Invasive Imaging Research Laboratory, Department of Cardiology, Herlev & Gentofte Hospital, Gentofte Hospitalsvej 8, Post 835, DK-2900 Hellerup, Denmark. Tel: +45 40375736, Fax: +45 39777381,
| | - Morten Sengeløv
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Louis Marott
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Peter Schnohr
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Elke Platz
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Morten Schou
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Cardiovascular Research Unit, Svendborg, University of Southern Denmark, Odense, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark,The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark,Institute of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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14
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Salimi S, Pettan-Brewer C, Ladiges W. PathoClock and PhysioClock in mice recapitulate human multimorbidity and heterogeneous aging. AGING PATHOBIOLOGY AND THERAPEUTICS 2021; 3:107-126. [PMID: 35083456 PMCID: PMC8789194 DOI: 10.31491/apt.2021.12.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Multimorbidity is a public health concern and an essential component of aging and healthspan but understudied because investigative tools are lacking that can be translatable to capture similarities and differences of the aging process across species and variability between individuals and individual organs. METHODS To help address this need, body organ disease number (BODN) borrowed from human studies was applied to C57BL/6 (B6) and CB6F1 mouse strains at 8, 16, 24, and 32 months of age, as a measure of systems morbidity based on pathology lesions to develop a mouse PathoClock resembling clinically-based Body Clock in humans, using Bayesian inference. A mouse PhysioClock was also developed based on measures of physiological domains including cardiovascular, neuromuscular, and cognitive function in the same two mouse strains so that alignment with BODN was predictable. RESULTS Between- and within-age variabilities in PathoClock and PhysioClock, as well as between-strain variabilities. Both PathoClock and PhysioClock correlated with chronological age more strongly in CB6F1 than C57BL/6. Prediction models were then developed, designated as PathoAge and PhysioAge, using regression models of pathology and physiology measures on chronological age. PathoAge better predicted chronological age than PhysioAge as the predicted chronological and observed chronological age for PhysioAge were complex rather than linear. CONCLUSION PathoClock and PhathoAge can be used to capture biological changes that predict BODN, a metric developed in humans, and compare multimorbidity across species. These mouse clocks are potential translational tools that could be used in aging intervention studies.
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Affiliation(s)
- Shabnam Salimi
- Department of Epidemiology and Public Health, University of Maryland Baltimore, School of Medicine, Baltimore, MD, USA
| | - Christina Pettan-Brewer
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Warren Ladiges
- Department of Comparative Medicine, School of Medicine, University of Washington, Seattle, WA 98195, USA
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15
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Singh J, Bhagaloo L, Sy E, Lavoie AJ, Dehghani P, Neary P. Novel effects of acute COVID-19 on cardiac mechanical function: Two case studies. Physiol Rep 2021; 9:e14998. [PMID: 34448551 PMCID: PMC8391984 DOI: 10.14814/phy2.14998] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/10/2021] [Accepted: 07/16/2021] [Indexed: 11/24/2022] Open
Abstract
The spread of the novel coronavirus 2019 (COVID-19) has caused a global pandemic. The disease has spread rapidly, and research shows that COVID-19 can induce long-lasting cardiac damage. COVID-19 can result in elevated cardiac biomarkers indicative of acute cardiac injury, and research utilizing echocardiography has shown that there is mechanical dysfunction in these patients as well, especially when observing the isovolumic, systolic, and diastolic portions of the cardiac cycle. The purpose of this study was to present two case studies on COVID-19 positive patients who had their cardiac mechanical function assessed every day during the acute period to show that cardiac function in these patients was altered, and the damage occurring can change from day-to-day. Participant 1 showed compromised cardiac function in the systolic time, diastolic time, isovolumic time, and the calculated heart performance index (HPI), and these impairments were sustained even 23 days post-symptom onset. Furthermore, Participant 1 showed prolonged systolic periods that lasted longer than the diastolic periods, indicative of elevated pulmonary artery pressure. Participant 2 showed decreases in systole and consequently, increases in HPI during the 3 days post-symptom onset, and these changes returned to normal after day 4. These results showed that daily observation of cardiac function can provide detailed information about the overall mechanism by which cardiac dysfunction is occurring and that COVID-19 can induce cardiac damage in unique patterns and thus can be studied on a case-by-case basis, day-to-day during infection. This could allow us to move toward more personalized cardiovascular medical treatment.
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Affiliation(s)
- Jyotpal Singh
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
| | - Lanishen Bhagaloo
- Gateway Alliance Medical ClinicReginaSaskatchewanCanada
- Faculty of MedicineUniversity of SaskatchewanSaskatoonSaskatchewanCanada
| | - Eric Sy
- Department of Critical CareSaskatchewan Health AuthorityReginaSaskatchewanCanada
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
| | - Andrea J. Lavoie
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
- Department of CardiologyPrairie Vascular Research IncSaskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Payam Dehghani
- College of MedicineUniversity of SaskatchewanReginaSaskatchewanCanada
- Department of CardiologyPrairie Vascular Research IncSaskatchewan Health AuthorityReginaSaskatchewanCanada
| | - Patrick Neary
- Faculty of Kinesiology and Health StudiesUniversity of ReginaReginaSaskatchewanCanada
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16
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Brainin P, Biering-Sørensen SR, Møgelvang R, Jensen JS, Biering-Sørensen T. Duration of early systolic lengthening: prognostic potential in the general population. Eur Heart J Cardiovasc Imaging 2021; 21:1283-1290. [PMID: 31628809 DOI: 10.1093/ehjci/jez262] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 08/01/2019] [Accepted: 10/01/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND When the left ventricle pressure rises during early systole, myocardial fibres with reduced contractility tend to stretch instead of shortening. This interval is known as duration of early systolic lengthening (DESL). We sought to investigate if DESL provides prognostic information on cardiovascular events. METHODS AND RESULTS In this prospective study we included 1210 participants from a low-risk general population who underwent speckle tracking echocardiography (men 41%, mean age 56 years, SD 16). Primary endpoints were incident heart failure (HF), myocardial infarction (MI), and cardiovascular death (CVD). We defined DESL as time from onset of Q-wave on the electrocardiogram to peak positive systolic strain. In addition, we assessed the ratio between DESL and duration of cardiac systole, DESLsystole.During median follow-up of 16 years, 90 (7%) developed HF, 50 (4%) MI, and 70 (6%) experienced CVD. Both DESL [hazard ratio (HR) 1.58 95%CI 1.16-2.15, P = 0.004 per 10 ms increase] and DESLsystole (HR 1.74 95%CI 1.24-2.47, P = 0.001 per 1% increase) were predictors of HF. Similarly, DESL (HR 1.40 95%CI 1.09-1.78, P = 0.007 per 10 ms increase) and DESLsystole (HR 1.58 95%CI 1.01-2.49, P = 0.047 per 1% increase) were predictors of MI. No associations were found with CVD. After adjusting for clinical and echocardiographic parameters, the associations remained significant. DESLsystole was superior to systolic echocardiographic parameters for predicting HF (P = 0.012). CONCLUSION DESL and the novel index of DESLsystole provide independent and novel prognostic information on the risk of HF and MI in the general population. Evaluation of DESL should be explored in future echocardiographic studies.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark
| | - Sofie Reumert Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Niels Andersens Vej 65, Post 835, DK-2900 Hellerup, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark
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17
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Banga S, Heinze-Milne SD, Godin J, Howlett SE. Signs of diastolic dysfunction are graded by serum testosterone levels in aging C57BL/6 male mice. Mech Ageing Dev 2021; 198:111523. [PMID: 34166687 DOI: 10.1016/j.mad.2021.111523] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/01/2021] [Accepted: 06/17/2021] [Indexed: 01/08/2023]
Abstract
We investigated whether maladaptive, age-associated changes in heart structure and function were linked to circulating testosterone levels. Male C57BL/6 mice had a gonadectomy (GDX) or sham surgery at 4 weeks and effects of GDX on the heart were examined with echocardiography. Serum testosterone was measured with ELISA. Left ventricular (LV) mass increased with age but was smaller in GDX mice than sham at 18 months (144.0 ± 8.7 vs 118.2 ± 11.9 mg; p = 0.009). The isovolumic relaxation time (IVRT) declined with age but was prolonged in GDX mice at 18 months (10.5 ± 0.8 vs 12.5 ± 0.5 msec, p = 0.008). Ejection fraction did not change with age or GDX, but E/A ratios were lower in GDX mice than controls at 18 months (1.6 ± 0.2 vs 1.3 ± 0.1, p = 0.021). When links between serum testosterone and cardiac parameters were examined longitudinally in 18-24-month-old mice, LV mass declined with decreasing testosterone (β = 37.70, p = 0.016), however IVRT increased as testosterone decreased (β=-2.69, p = 0.036). Since longer IVRT and lower E/A ratios are signs of diastolic dysfunction, low circulating testosterone may promote or exacerbate diastolic dysfunction in older males. These findings suggest that lower testosterone directly modifies heart structure and function to promote maladaptive remodeling and diastolic dysfunction in the aging heart.
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Affiliation(s)
- Shubham Banga
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada.
| | | | - Judith Godin
- Geriatric Medicine Research, Division of Geriatric Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Susan E Howlett
- Department of Pharmacology, Dalhousie University, Halifax, NS, Canada; Department of Medicine (Geriatric Medicine), Dalhousie University, Halifax, NS, Canada.
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18
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Kidney function and the prognostic value of myocardial performance index. Int J Cardiovasc Imaging 2021; 37:1637-1647. [PMID: 33475871 DOI: 10.1007/s10554-020-02149-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 12/24/2020] [Indexed: 10/22/2022]
Abstract
A decreased glomerular filtration rate (GFR) is a risk factor for cardiovascular disease even after adjustment for conventional risk factors. The myocardial performance index (MPI) is defined as (isovolumetric relaxation time (IVRT) + isovolumetric contraction time (IVCT))/ejection time (ET). It has been shown to be an independent predictor of cardiovascular events. We hypothesized the MPI could prove valuable for assessing cardiac risk in subjects of the general population with decreased estimated GFR (eGFR). MPI was measured in 1915 subjects from a large general population prospective cohort study using color tissue Doppler imaging (TDI) M-mode through the mitral valve. We compared the prognostic capabilities of the MPI between subjects with eGFR ≥ 75 mL/min/1.73 m2 and subjects with eGFR < 75 mL/min/1.73 m2 using multivariable adjusted Cox regression models. The composite endpoint was heart failure, myocardial infarction or cardiovascular death. Mean age was 58 years (SD 16.2), 58% were women, 42% had hypertension and 8.3% diabetes. During a median follow-up time of 12.4 years [IQR 10.6-12.7 years] 269 participants reached the combined endpoint. eGFR modified the prognostic capability of MPI (p-value for interaction < 0.001): After multivariable adjustment, MPI remained an independent predictor of the composite endpoint only in participants with eGFR < 75 mL/min/1.73 m2: HR 1.18 (95% CI 1.02-1.38), p = 0.03, vs. in subjects with eGFR ≥ 75 mL/min/1.73 m2: HR 1.14 (95% CI 0.94-1.39), p = 0.17. These results suggest the MPI could be particularly valuable for identifying elevated cardiac risk in individuals from the general population with decreased eGFR.
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19
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Georgiopoulos G, Aimo A, Barison A, Magkas N, Emdin M, Masci PG. Imaging predictors of incident heart failure: a systematic review and meta-analysis. J Cardiovasc Med (Hagerstown) 2020; 22:378-387. [PMID: 33136816 DOI: 10.2459/jcm.0000000000001133] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Preventing the evolution of subclinical cardiac disease into overt heart failure is of paramount importance. Imaging techniques, particularly transthoracic echocardiography (TTE), are well suited to identify abnormalities in cardiac structure and function that precede the development of heart failure. METHODS This meta-analysis provides a comprehensive evaluation of 32 studies from 11 individual cohorts, which assessed cardiac indices from TTE (63%), cardiovascular magnetic resonance (CMR; 34%) or cardiac computed tomography (CCT; 16%). Eligible studies focused on measures of left ventricular geometry and function and were highly heterogeneous. RESULTS Among the variables that could be assessed through a meta-analytic approach, left ventricular systolic dysfunction, defined as left ventricular ejection fraction (LVEF) lower than 50%, and left ventricular dilation were associated with a five-fold [hazard ratio (HR) 4.76, 95% confidence interval (95% CI) 1.85-12.26] and three-fold (HR 3.14, 95% CI 1.37 -7.19) increased risk of heart failure development, respectively. Any degree of diastolic dysfunction conveyed an independent, albeit weaker, association with heart failure (HR 1.48, 95% CI 1.11-1.96), although there was only a trend for left ventricular hypertrophy in predicting incident heart failure (hazard ratio 2.85, 95% CI 0.82-9.85). CONCLUSION LVEF less than 50%, left ventricular dilation and diastolic dysfunction are independent predictors of incident heart failure among asymptomatic individuals, while left ventricular hypertrophy seems less predictive. These findings may serve as a framework for implementing imaging-based screening strategies in patients at risk of heart failure and inform future studies testing preventive or therapeutic approaches aiming at thwarting or halting the progression from asymptomatic (preclinical) to overt heart failure.
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Affiliation(s)
- Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.,Department of Clinical Therapeutics, National and Kapodistrian University of Athens, Athens, Greece
| | - Alberto Aimo
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Division, University Hospital of Pisa
| | - Andrea Barison
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Nikolaos Magkas
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Michele Emdin
- Institute of Life Science, Scuola Superiore Sant'Anna.,Cardiology Department, Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Pier-Giorgio Masci
- School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
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20
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Olsen FJ, Lassen MCH, Brainin P, Bech J, Alhakak AS, Pedersen S, Claggett B, Fritz-Hansen T, Folke F, Gislason GH, Biering-Sørensen T. Myocardial performance index is associated with cardiac computed tomography findings in patients with suspected coronary artery disease. Echocardiography 2020; 37:1741-1748. [PMID: 33070395 DOI: 10.1111/echo.14897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 09/21/2020] [Accepted: 09/29/2020] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Studies suggest cardiac time intervals to be associated with cardiac ischemia. A novel method to assess cardiac time intervals by tissue Doppler echocardiography has been proposed. Cardiac time intervals can assess the myocardial performance index (MPI), which quantifies the proportion of time spent contributing effective myocardial work. We hypothesized that MPI associates with coronary artery lesions detected by cardiac computed tomography (CT) in patients suspected of coronary artery disease (CAD). METHODS We investigated patients referred for cardiac CT under suspicion of CAD who had an echocardiogram performed. Curved m-mode tissue Doppler imaging was used to measure cardiac time intervals and MPI. The outcome was coronary artery lesions, defined as a calcium score > 400 and/or coronary artery stenosis (>70% luminal narrowing). Logistic regression was applied with multivariable models including: (a) SCORE chart risk factors and (b) SCORE chart risk factors, body mass index, dyslipidemia, familial history of CAD, diabetes mellitus, LVEF, and left ventricular mass index. RESULTS Of 404 patients, 41 (10%) had a coronary artery lesion. Overall, 42% were male, mean age was 58 years, and LVEF was 58%. Patients with coronary artery lesions exhibited higher MPI than those without (0.52 vs. 0.44, P < .001). MPI associated with coronary artery lesions in unadjusted analyses (OR = 1.69 [1.30-2.19], per 0.1 increase), and this association persisted when adjusted for SCORE chart risk factors (OR = 1.55 [1.16-2.07], P = .003, per 0.1 increase), and additional risk factors (OR = 1.64 [1.11-2.41], P = .013, per 0.1 increase). CONCLUSION Curved m-mode-derived MPI is associated with coronary artery lesions detected by cardiac CT in suspected CAD patients.
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Affiliation(s)
| | | | - Philip Brainin
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Jan Bech
- Department of Cardiology, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alia Saed Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Sune Pedersen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Brian Claggett
- Department of Cardiovascular Medicine, Cardiac Imaging Core Laboratory, Brigham and Women's Hospital, Boston, MA, USA
| | | | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Gunnar H Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Copenhagen, Denmark.,Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Lundorff I, Modin D, Mogelvang R, Godsk Jørgensen P, Schnohr P, Gislason G, Biering-Sørensen T. Echocardiographic predictors of cardiovascular morbidity and mortality in women from the general population. Eur Heart J Cardiovasc Imaging 2020; 22:1026-1034. [PMID: 32864697 DOI: 10.1093/ehjci/jeaa167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/14/2020] [Indexed: 01/23/2023] Open
Abstract
AIMS Global longitudinal strain (GLS) is a strong predictor of adverse cardiovascular outcome in men. However, studies have indicated that GLS may not predict cardiovascular outcomes as effectively in women. The aim of this study was to identify echocardiographic predictors of cardiovascular morbidity and mortality in women from the general population. METHODS AND RESULTS A total of 1245 women from the general population free of heart failure (HF) and atrial fibrillation had an echocardiographic examination performed including tissue Doppler imaging. In this subset, 747 women had images eligible for strain analysis. Endpoint was a composite of acute myocardial infarction, HF, and cardiovascular death. During follow-up (median 12.5 years), 162 women (13.0%) reached the composite outcome. These women had higher left ventricular (LV) mass index (LVMI), more LV hypertrophy, lower E/A, higher E/e', larger LV dimensions, and longer deceleration time. LVMI and e' remained as significant predictors of the composite outcome [LVMI: hazard ratio (HR) 1.10, 95% confidence interval (CI) 1.03-1.17, P = 0.004, per 5 g/m2 increase] (e': HR 1.53, 95% CI 1.07-2.20, P = 0.020, per 1 cm/s decrease) after adjusting for age, hypertension, systolic blood pressure, diabetes mellitus, total cholesterol, smoking status, prevalent ischaemic heart disease, LV ejection fraction, E/e', E, E/A, interventricular septum thickness in diastole, left ventricular posterior wall in diastole, a', body surface area, and pro-brain natriuretic peptide. GLS was not an independent predictor of outcome after multivariable adjustment. CONCLUSION The degree of LV hypertrophy assessed as LVMI and diastolic dysfunction evaluated by e' are associated with adverse cardiovascular outcome in women from the general population.
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Affiliation(s)
- Ingrid Lundorff
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, Post 835, DK-2900 Copenhagen, Denmark.,Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, Post 835, DK-2900 Copenhagen, Denmark.,Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, Post 835, DK-2900 Copenhagen, Denmark.,Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Peter Godsk Jørgensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, Post 835, DK-2900 Copenhagen, Denmark
| | - Peter Schnohr
- Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, Post 835, DK-2900 Copenhagen, Denmark.,Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Blegdamsvej 3B, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital, University of Copenhagen, Niels Andersens Vej 65, Post 835, DK-2900 Copenhagen, Denmark.,Copenhagen City Heart Study, Bispebjerg and Frederiksberg Hospital, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
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22
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Sanderson JE, Fang F. Cardiac cycle time intervals are back again. Int J Cardiol 2020; 312:87-88. [DOI: 10.1016/j.ijcard.2020.04.059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 10/24/2022]
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23
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The cardiac isovolumetric contraction time is an independent predictor of incident heart failure in the general population. Int J Cardiol 2020; 312:81-86. [DOI: 10.1016/j.ijcard.2020.03.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/29/2020] [Accepted: 03/18/2020] [Indexed: 11/18/2022]
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24
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Dimitroglou Y, Aggeli C, Alexopoulou A, Mavrogeni S, Tousoulis D. Cardiac Imaging in Liver Transplantation Candidates: Current Knowledge and Future Perspectives. J Clin Med 2019; 8:E2132. [PMID: 31817014 PMCID: PMC6947158 DOI: 10.3390/jcm8122132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 11/23/2019] [Accepted: 11/26/2019] [Indexed: 12/12/2022] Open
Abstract
Cardiovascular dysfunction in cirrhotic patients is a recognized clinical entity commonly referred to as cirrhotic cardiomyopathy. Systematic inflammation, autonomic dysfunction, and activation of vasodilatory factors lead to hyperdynamic circulation with high cardiac output and low peripheral vascular resistance. Counter acting mechanisms as well as direct effects on cardiac cells led to systolic or diastolic dysfunction and electromechanical abnormalities, which are usually masked at rest but exposed at stress situations. While cardiovascular complications and mortality are common in patients undergoing liver transplantation, they cannot be adequately predicted by conventional cardiac examination including transthoracic echocardiography. Newer echocardiography indices and other imaging modalities such as cardiac magnetic resonance have shown increased diagnostic accuracy with predictive implications in cardiovascular diseases. The scope of this review was to describe the role of cardiac imaging in the preoperative assessment of liver transplantation candidates with comprehensive analysis of the future perspectives anticipated by the use of newer echocardiography indices and cardiac magnetic resonance applications.
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Affiliation(s)
- Yannis Dimitroglou
- Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.)
| | - Constantina Aggeli
- Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.)
| | - Alexandra Alexopoulou
- Department of Internal Medicine and Research Laboratory, National and Kapodistrian University of Athens Medical School, Hippokration General Hospital, 115 27 Athens, Greece
| | - Sophie Mavrogeni
- Onassis Cardiac Center and National and Kapodistrian University of Athens, 176 74 Athens, Greece;
| | - Dimitris Tousoulis
- Department of Cardiology, National and Kapodistrian University of Athens Medical School, Hippokration General Hospital, 115 27 Athens, Greece; (C.A.); (D.T.)
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25
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Myers J, Christle JW, Tun A, Yilmaz B, Moneghetti KJ, Yuen E, Soofi M, Ashley E. Cardiopulmonary Exercise Testing, Impedance Cardiography, and Reclassification of Risk in Patients Referred for Heart Failure Evaluation. J Card Fail 2019; 25:961-968. [DOI: 10.1016/j.cardfail.2019.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/28/2019] [Accepted: 08/19/2019] [Indexed: 10/26/2022]
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26
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Pena A, Michelsen MM, Mygind ND, Gustafsson I, Høst N, Bech J, Kastrup J, Hansen HS, Hansen PR, Prescott E. Coronary microvascular dysfunction is associated with cardiac time intervals in women with angina and no obstructive coronary artery disease: An iPOWER substudy. Echocardiography 2019; 36:1110-1117. [PMID: 31012159 DOI: 10.1111/echo.14356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 03/31/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Coronary microvascular dysfunction (CMD) may cause angina in the absence of obstructive coronary artery disease (CAD) and increases the risk of future adverse cardiovascular events. Transthoracic Doppler echocardiography (TTDE) with pharmacological stress can assess coronary flow velocity reserve (CFVR), a measure of coronary microvascular function. However, simpler methods would be preferable for diagnosing CMD. Therefore, we examined the relationship between CFVR and cardiac time intervals measured by TTDE in a cohort of women with angina and no obstructive CAD. METHODS In a prospective cohort study, we included 389 women with angina, left ventricular ejection fraction > 45%, and no obstructive CAD. CMD was defined as CFVR < 2.0. The study population was divided into three groups according to cutoff values of CFVR < 2, 2 ≤ CFVR ≤ 2.5, and CFVR > 2.5. Isovolumic contraction time (IVCT), ejection time (ET), and isovolumic relaxation time (IVRT) were measured by tissue Doppler M-mode, and the myocardial performance index (MPI = (IVCT + IVRT)/ET) was calculated. RESULTS Coronary microvascular dysfunction was associated with increasing age, hypertension, higher resting heart rate, and lower diastolic blood pressure. Moreover, CMD was associated with higher E/e' ratio (P = 0.002) and longer IVCT (P < 0.001), higher MPI (P < 0.001) and shorter ET (P = 0.002), but not with IVRT or conventional measures of left ventricular geometry, mass, and function. In multivariable analysis, longer IVCT (P < 0.001) and higher MPI (P = 0.002) remained associated with CMD. CONCLUSION In women with angina and no obstructive CAD, CMD is associated with longer IVCT and higher MPI indicating a link between CMD and subtle alternations of systolic and combined measures of cardiac time intervals.
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Affiliation(s)
- Adam Pena
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark.,Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | | | - Naja Dam Mygind
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Ida Gustafsson
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Nis Høst
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jan Bech
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Jens Kastrup
- Department of Cardiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | | | - Peter Riis Hansen
- Department of Cardiology, Herlev-Gentofte University Hospital, Copenhagen, Denmark
| | - Eva Prescott
- Department of Cardiology, Bispebjerg University Hospital, Copenhagen, Denmark
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27
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Alhakak AS, Brainin P, Møgelvang R, Jensen GB, Jensen JS, Biering-Sørensen T. The cardiac isovolumetric contraction time is an independent predictor of incident atrial fibrillation and adverse outcomes following first atrial fibrillation event in the general population. Eur Heart J Cardiovasc Imaging 2019; 21:49-57. [DOI: 10.1093/ehjci/jez059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 03/11/2019] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Colour tissue Doppler imaging (TDI) M-mode through the mitral leaflet is an easy and precise method to obtain cardiac time intervals including the isovolumic contraction time (IVCT), isovolumic relaxation time (IVRT), and ejection time (ET). The myocardial performance index (MPI) was defined as [(IVCT + IVRT)/ET]. Our aim was to investigate if cardiac time intervals can be used to predict atrial fibrillation (AF) in the general population.
Methods and results
A total of 1915 participants from the general population underwent a health examination including TDI echocardiography. The primary endpoint was AF, and the secondary endpoint was complicated AF as assessed by the occurrence of either stroke or heart failure (HF) after the diagnosis of AF. Participants with known AF were excluded (n = 54). During a median follow-up of 11 years, 166 participants (9%) were diagnosed with AF and of these 44 participants (27%) developed HF or stroke. Assessing the association between IVCT and incident AF, the risk increased with 27% per 10 ms increase in IVCT [per 10 ms increase: hazard ratio (HR) 1.27, 95% confidence interval (CI) (1.17–1.38); P < 0.001]. The association remained significant after multivariable adjustment [per 10 ms increase: HR 1.22, 95% CI (1.09–1.35); P < 0.001]. No associations between the IVRT, ET, MPI, and AF remained significant after multivariable adjustment. The IVCT also predicted complicated AF and the association remained significant even after multivariable adjustment [per 10 ms increase: HR 1.39, 95% CI (1.06–1.81); P = 0.015].
Conclusion
In the general population, the IVCT provides novel and independent prognostic information on the long-term risk of AF. Additionally, the IVCT can identify persons in risk of complicated AF.
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Affiliation(s)
- Alia Saed Alhakak
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Post 835, DK Copenhagen, Denmark
| | - Philip Brainin
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Post 835, DK Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Post 835, DK Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Gorm Boje Jensen
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Post 835, DK Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Kildegårdsvej 28, Post 835, DK Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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28
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The association between physical activity and cardiac performance is dependent on age: the Copenhagen City Heart Study. Int J Cardiovasc Imaging 2019; 35:1249-1258. [PMID: 30825135 PMCID: PMC6598956 DOI: 10.1007/s10554-019-01566-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/15/2019] [Indexed: 10/31/2022]
Abstract
This study aimed to test the hypothesis that regular physical activity is associated with improved cardiac function measured by tissue Doppler imaging (TDI) in the general population. Within a large prospective community-based population study, cardiac function was assessed in 2221 persons by TDI. Longitudinal displacement (LD), early diastolic velocity (e'), and myocardial performance index (MPI) was obtained by TDI. Linear univariable and multivariable regression analyses were performed in relation to age groups (< 50 years, 50-65 years, > 65 years) and self-reported level of physical activity: I (inactivity), II (light activity), III (moderate activity), and IV (high-level activity). Participants < 50 years in the most active group had significantly better cardiac performance when compared to all other activity levels (higher levels of e', LD, and lower levels of MPI). The findings remained with statistical significance after adjustment for sex, ischemic heart disease, diabetes, hypertension, and body mass index (e' = 11.0, 95% CI (10.4-11.6), p < 0.001; LD = 12.8 (12.3-13.4), p < 0.003; MPI: 0.40 (0.38-0.42), p = 0.02). In age > 65 years, there was a tendency of impaired cardiac function in higher levels of exercise. Interaction analysis revealed that age significantly modified the association between physical activity and cardiac function (p < 0.001). We found a positive association between higher level of physical activity and improved cardiac function in younger persons (< 50 years). In the general population, however, the association interacted with age and amongst persons above 65 years there was a negative association between higher level of physical activity and cardiac function.
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29
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Embryonic programming of heart disease in response to obesity during pregnancy. Biochim Biophys Acta Mol Basis Dis 2019; 1866:165402. [PMID: 30759362 DOI: 10.1016/j.bbadis.2019.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/19/2019] [Accepted: 01/28/2019] [Indexed: 12/20/2022]
Abstract
Obesity during pregnancy programs adult-onset heart disease in the offspring. Clinical studies indicate that exposure to an adverse environment in utero during early, as compared to late, gestation leads to a higher prevalence of adult-onset heart disease. This suggests that the early developing heart is particularly sensitive to an adverse environment. Accordingly, growing evidence from clinical studies and animal models demonstrates that obesity during pregnancy alters the function of the fetal heart, programming a higher risk of cardiovascular disease later in life. Moreover, gene expression patterns and signaling pathways that promote initiation and progression of cardiovascular disease are altered in the hearts in offspring born to obese mothers. However, the mechanisms mediating the long-term effects of an adverse environment in utero on the developing heart leading to adult-onset disease are not clear. Here, we review clinical and experimental evidence documenting the effects of maternal obesity during pregnancy on the fetal and post-natal heart and emphasize on the potential mechanisms of disease programming.
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30
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Zhyvotovska A, Yusupov D, Kamran H, Al-Bermani T, Abdul R, Kumar S, Mogar N, Hartt A, Salciccioli L, McFarlane SI. Diastolic Dysfunction in Patients with Chronic Obstructive Pulmonary Disease: A Meta-Analysis of Case Controlled Studies. INTERNATIONAL JOURNAL OF CLINICAL RESEARCH & TRIALS 2019; 4:137. [PMID: 31650092 PMCID: PMC6812536 DOI: 10.15344/2456-8007/2019/137] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and left ventricular diastolic dysfunction (LVDD) are major causes of morbidity and mortality and have overlapping symptomatology including cough and dyspnea. Whether COPD is a risk factor for LVDD remains largely unclear.The objective of this meta-analysis was to determine if the prevalence of the LVDD as determined by echocardiographic parameters is increased in COPD patients. METHODS We used a time-and-language-restricted search strategy resulting in identification of 4,912 studies of which 15 studies met our apriori inclusion criteria; 4,897 were excluded, such duplicates, foreign language articles were excluded. We performed a meta-analysis of standard echo parameters on the fifteen case control studies related to diastolic dysfunction. The meta-analysis was performed using Review Manager, version 5.3 (Cochrane Collaboration). RESULTS A total of 15 studies with 1,403 subjects were included. There were no differences in left ventricular ejection fraction between COPD and non-COPD population. Patients with COPD had prolonged isovolumetric relaxation time (IVRT) (mean difference 20.84 [95% CI 12.21, 29.47]; P< 0.00001), lower E/A ratio (mean difference - 0.24 [95% CI -0.34, 00.14]; P < 0.00001), higher transmitral A wave peak velocity (Apv) (mean difference 11.71 [95% CI 4.80, 18.62]; P< 0.00001), higher E/e' ratio (mean difference 1.88 [95% CI 1.23, 2.53]; P< 0.00001), lower mitral E wave peak velocity (Epv) (mean difference -8.74 [95% CI -13.63, -3.85]; P< 0.0005), prolonged deceleration time (DT) (mean difference 50.24 [95% CI 15.60, 84,89]; P< 0.004), a higher right ventricular end diastolic diameter (RVEDD) (mean difference 8.02 [95% CI 3.45, 12.60]; P< 0.0006) compared to controls. COPD patients had a higher pulmonary arterial pressure (mean difference 10.52 [95% CI 3.98, 17.05]; P< 0.002). Differences in septal e' velocity (mean difference -2.69 [95% CI -6.07, 0.69]; P< 0.12) and in lateral e' velocity (mean difference -2.84 [95% CI 5.91, 0.24]; P< 0.07) trended towards significance but did not meet our cutoff for statistical significance (p < 0.05). CONCLUSIONS Patients with COPD are more likely to have LVDD as established by echocardiographic parameters. Our findings are likely explainable, in part, by factors such as lung hyperinflation, chronic hypoxia, hypercapnia, systemic inflammation, increased arterial stiffness, subendocardial ischemia, as well as ventricular interdependence; all of which might contribute to the pathogenesis of diastolic dysfunction. Further research is needed to elucidate the pathophysiologic mechanisms of increased LVDD in the COPD population with the potential impact on developing effective therapeutic interventions for these serious disorders.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Samy I. McFarlane
- Corresponding Author: Prof. Samy I. McFarlane, Division of Endocrinology, Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, New York, 11203, USA, Tel: 718-270-6707, Fax: 718-270-4488;
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31
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Modin D, Biering-Sørensen SR, Møgelvang R, Jensen JS, Biering-Sørensen T. Prognostic Importance of Left Ventricular Mechanical Dyssynchrony in Predicting Cardiovascular Death in the General Population. Circ Cardiovasc Imaging 2018; 11:e007528. [DOI: 10.1161/circimaging.117.007528] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Daniel Modin
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
| | - Sofie Reumert Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev & Gentofte Hospital (D.M., S.R.B.-S., R.M., J.S.J., T.B.-S.), University of Copenhagen, Denmark
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Salvi P, Grillo A, Tan I, Simon G, Salvi L, Gao L, Rovina M, Butlin M, Yang Y, Meneghin E, Meng L, Faini A, Barin E, Pini A, Carretta R, Huo Y, Avolio A, Parati G. Systolic time intervals assessed from analysis of the carotid pressure waveform. Physiol Meas 2018; 39:084002. [PMID: 30033934 DOI: 10.1088/1361-6579/aad51b] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The timing of mechanical cardiac events is usually evaluated by conventional echocardiography as an index of cardiac systolic function and predictor of cardiovascular outcomes. We aimed to measure the systolic time intervals, namely the isovolumetric contraction time (ICT) and pre-ejection period (PEP), by arterial tonometry. APPROACH Sixty-two healthy volunteers (age 47 ± 17 years) and 42 patients with heart failure and reduced ejection fraction were enrolled (age 66 ± 14 years). Pulse waves were recorded at the carotid artery by arterial tonometry together with simultaneous aortic transvalvular flow by Doppler-echocardiography, synchronized by electrocardiographic gating. The ICT was determined from the time delay between the electrical R wave and the carotid pressure waveform, after adjustment for the pulse transit time from the aortic valve to the carotid artery site, estimated by an algorithm based on the carotid-femoral pulse wave velocity. The PEP was evaluated by adding the electrical QR duration to the ICT. MAIN RESULTS The ICT derived from carotid pulse wave analysis was closely related to that measured by echocardiography (r = 0.90, p < 0.0001), with homogeneous distribution in Bland-Altman analysis (mean difference and 95% confidence interval = 0.2 from -14.2 to 14.5 ms). ICT and PEP were higher in cardiac patients than in healthy volunteers (p < 0.0001). The ratio between PEP and left ventricular ejection time was related to the ejection fraction measured with echocardiography (r = 0.555, p < 0.0001). SIGNIFICANCE The timing of electro-mechanical cardiac events can be reliably obtained from the carotid pulse waveform and carotid-femoral PWV, evaluated using arterial tonometry. Systolic time intervals assessed with this approach showed good agreement with measurements performed with conventional echocardiography and may represent a promising additional application of arterial tonometry.
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Affiliation(s)
- Paolo Salvi
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, Milan, Italy
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Costello BT, Qadri M, Price B, Papapostolou S, Thompson M, Hare JL, La Gerche A, Rudman M, Taylor AJ. The ventricular residence time distribution derived from 4D flow particle tracing: a novel marker of myocardial dysfunction. Int J Cardiovasc Imaging 2018; 34:1927-1935. [PMID: 29951729 DOI: 10.1007/s10554-018-1407-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 06/22/2018] [Indexed: 11/28/2022]
Abstract
4D flow cardiac magnetic resonance (CMR) imaging allows visualisation of blood flow in the cardiac chambers and great vessels. Post processing of the flow data allows determination of the residence time distribution (RTD), a novel means of assessing ventricular function, potentially providing additional information beyond ejection fraction. We evaluated the RTD measurement of efficiency of left and right ventricular (LV and RV) blood flow. 16 volunteers and 16 patients with systolic dysfunction (LVEF < 50%) underwent CMR studies including 4D flow. The RTDs were created computationally by seeding virtual 'particles' at the inlet plane in customised post-processing software, moving these particles with the measured blood velocity, recording and counting how many exited per unit of time. The efficiency of ventricular flow was determined from the RTDs based on the time constant (RTDc = - 1/B) of the exponential decay. The RTDc was compared to ejection fraction, T1 mapping and global longitudinal strain (GLS). There was a significant difference between groups in LV RTDc (healthy volunteers 1.2 ± 0.13 vs systolic dysfunction 2.2 ± 0.80, p < 0.001, C-statistic = 1.0) and RV RTDc (1.5 ± 0.15 vs 2.0 ± 0.57, p = 0.013, C-statistic = 0.799). The LV RTDc correlated significantly with LVEF (R = - 0.84, P < 0.001) and the RV RTDc had significant correlation with RVEF (R = - 0.402, p = 0.008). The correlation between LV RTDc and LVEF was similar to GLS and LVEF (0.926, p < 0.001). The ventricular residence time correlates with ejection fraction and can distinguish normal from abnormal systolic function. Further assessment of this method of assessment of chamber function is warranted.
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Affiliation(s)
- Benedict T Costello
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Mateen Qadri
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia
| | - Bradley Price
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia
| | - Stavroula Papapostolou
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Mark Thompson
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia
| | - James L Hare
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Andre La Gerche
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia
- Baker Heart and Diabetes Institute, Melbourne, Australia
- Department of Cardiovascular Medicine, University of Leuven, Leuven, Belgium
| | - Murray Rudman
- Department of Mechanical and Aerospace Engineering, Monash University, Clayton, VIC, 3800, Australia
| | - Andrew J Taylor
- Department of Cardiovascular Medicine, Alfred Hospital, Melbourne, VIC, Australia.
- Baker Heart and Diabetes Institute, Melbourne, Australia.
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34
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Brainin P, Biering-Sørensen SR, Møgelvang R, Søgaard P, Jensen JS, Biering-Sørensen T. Postsystolic Shortening by Speckle Tracking Echocardiography Is an Independent Predictor of Cardiovascular Events and Mortality in the General Population. J Am Heart Assoc 2018. [PMID: 29519813 PMCID: PMC5907576 DOI: 10.1161/jaha.117.008367] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Postsystolic shortening (PSS) has been proposed as a novel marker of contractile dysfunction in the myocardium. Our objective was to assess the prognostic potential of PSS on cardiovascular events and death in the general population. Methods and Results The study design consisted of a prospective cohort study of 1296 low‐risk participants from the general population, who were examined by speckle tracking echocardiography. The primary end point was the composite of heart failure, myocardial infarction, and cardiovascular death, defined as major adverse cardiovascular events (MACEs). The secondary end point was all‐cause death. The postsystolic index (PSI) was defined as follows: [(maximum strain in cardiac cycle−peak systolic strain)/(maximum strain in cardiac cycle)]×100. PSS was regarded as present if PSI >20%. During a median follow‐up of 11 years, 149 participants (12%) were diagnosed as having MACEs and 236 participants (18%) died. Increasing number of walls with PSS predicted both end points, an association that persisted after adjustment for age, sex, estimated glomerular filtration rate, global longitudinal strain, hypertension, heart rate, left ventricular ejection fraction, LV mass index, pro‐B‐type natriuretic peptide, previous ischemic heart disease, systolic blood pressure, average peak early diastolic longitudinal mitral annular velocity (e′), ratio between peak transmitral early and late diastolic inflow velocity (E/A), and left atrial volume index: MACEs (hazard ratio, 1.35; 95% confidence interval, 1.09–1.67; P=0.006 per 1 increase in walls displaying PSS) and death (hazard ratio, 1.30; 95% confidence interval, 1.08–1.57; P=0.006 per 1 increase in walls displaying PSS). The strongest predictor of end points was ≥2 walls exhibiting PSS. The PSI also predicted increased risk of the end points, and the associations remained significant in multivariable models: MACEs (per 1% increase in PSI: hazard ratio, 1.18; 95% confidence interval, 1.02–1.36; P=0.024) and death (per 1% increase in PSI: hazard ratio, 1.18; 95% confidence interval, 1.05–1.33; P=0.005). Conclusions Presence of PSS in the general population provides independent and long‐term prognostic information on the occurrence of MACEs and death.
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Affiliation(s)
- Philip Brainin
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Sofie Reumert Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital University of Copenhagen, Denmark
| | - Rasmus Møgelvang
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital University of Copenhagen, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital University of Aalborg, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark.,The Copenhagen City Heart Study, Frederiksberg Hospital University of Copenhagen, Denmark
| | - Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark .,The Copenhagen City Heart Study, Frederiksberg Hospital University of Copenhagen, Denmark
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35
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Zhang CJ, Pei XL, Song FY, Guo Y, Zhang QL, Shu XH, Hsi DH, Cheng LL. Early anthracycline-induced cardiotoxicity monitored by echocardiographic Doppler parameters combined with serum hs-cTnT. Echocardiography 2017; 34:1593-1600. [PMID: 28942608 DOI: 10.1111/echo.13704] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE As growing numbers of long-term cancer survivors faced with the cardiac side effects by anthracycline treatment, it is necessary to explore the optimal monitoring method for the early detection of cardiac toxicity. METHODS We conducted a retrospective analysis of 82 consecutive patients with diffuse large B-cell lymphoma treated with chemotherapy. Echocardiographic Doppler imaging-derived Tei index and mitral annular peak systolic velocity (Sm) measured by tissue Doppler imaging TDI, serum high-sensitivity cardiac troponin T (hs-cTnT) levels, and left ventricular ejection fraction (LVEF) by multigated radionuclide angiography (MUGA) were obtained before, after 2-4, and after 6-8 chemotherapy cycles. Cardiotoxicity was defined as a relative reduction of LVEF ≥10% from the baseline or LVEF <50% as measured by MUGA. RESULTS Following chemotherapy, 24 (29.3%) patients developed detectable cardiac abnormality during the treatment. Five (6.1%) patients' cardiac function changed from normal baseline LVEF to <50% after the chemotherapy. Echocardiographic pulse wave Doppler Tei index (PW Tei index) (baseline 0.347 ± 0.115 vs 2-4 cycles 0.459 ± 0.161 vs 6-8 cycles 0.424 ± 0.139, P = .000) inversely correlated with systolic (P < .001) and diastolic dysfunction (P < .001). Serum hs-cTnT levels increased significantly following chemotherapy after 2-4 cycles of chemotherapy with anthracycline. The increase in PW Tei index of 0.095 [sensitivity, 69.2%; specificity, 64.5%; area under the curve (AUC) = 0.697; P = .005] and the Sm < 13.65 cm/s (sensitivity, 66.7%; specificity, 71%; AUC = 0.682; P = .009) combined with elevation of serum hs-cTnT level of 0.0075 ng/mL (sensitivity, 69.2%; specificity, 83.9%; AUC = 0.790; P < .001) after 2-4 chemotherapy cycles from the baseline values can reliably predict cardiotoxicity. CONCLUSIONS We demonstrated that echocardiographic PW Doppler-derived Tei index, and TDI-derived Sm, combined with serum hs-cTnT level can be obtained in outpatient settings to monitor early cardiac toxicity induced by anthracycline therapy.
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Affiliation(s)
- Chu-Jie Zhang
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Xiao-Li Pei
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China.,Department of Cardiology, Kashgar Prefecture Second People's Hospital, Xinjiang, China
| | - Fei-Yan Song
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Ye Guo
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Qun-Ling Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xian-Hong Shu
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
| | - David H Hsi
- Department of Cardiology, Columbia University College of Physicians & Surgeons, Stamford Hospital, Stamford, CT, USA
| | - Lei-Lei Cheng
- Department of Echocardiography, Shanghai Institute of Cardiovascular Diseases, Shanghai Institute of Medical Imaging, Zhongshan Hospital, Fudan University, Shanghai, China
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36
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Biering-Sørensen T, Querejeta Roca G, Hegde SM, Shah AM, Claggett B, Mosley TH, Butler KR, Solomon SD. Left ventricular ejection time is an independent predictor of incident heart failure in a community-based cohort. Eur J Heart Fail 2017; 20:1106-1114. [PMID: 28872225 DOI: 10.1002/ejhf.928] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 01/10/2023] Open
Abstract
AIMS Systolic time intervals change in the progress of cardiac dysfunction. The usefulness of left ventricular ejection time (LVET) to predict cardiovascular morbidity, however, is unknown. METHODS AND RESULTS We studied middle-aged African-Americans from one of four cohorts of the Atherosclerosis Risk in Communities study (Jackson cohort, n=1980) who underwent echocardiography between 1993 and 1995. Left ventricular ejection time was measured by pulsed-wave Doppler of the left ventricular outflow tract and related to outcomes. A shorter LVET was associated with younger age, male sex, higher diastolic blood pressure, higher proportion of diabetes, higher heart rate, higher blood glucose levels and worse fractional shortening. During a median follow-up of 17.6 years, 384 (19%) had incident heart failure (HF), 158 (8%) had a myocardial infarction, and 587 (30%) died. In univariable analysis, a lower LVET was significantly associated with increased risk of all events (P<0.05 for all). However, after multivariable adjustment for age, sex, hypertension, diabetes, body mass index, heart rate, systolic and diastolic blood pressure, fractional shortening and left atrial diameter, LVET remained an independent predictor only of incident HF [hazard ratio 1.07 (1.02-1.14), P=0.010 per 10 ms decrease]. In addition, LVET provided incremental prognostic information to the known risk factors included in the Framingham risk score, in regard to predicting all outcomes except for myocardial infarction. CONCLUSION Left ventricular ejection time is an independent predictor of incident HF in a community-based cohort and provides incremental prognostic information on the risk of future HF and death when added to known risk prediction models.
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Affiliation(s)
- Tor Biering-Sørensen
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Gabriela Querejeta Roca
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sheila M Hegde
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Amil M Shah
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Brian Claggett
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Thomas H Mosley
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Kenneth R Butler
- Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Scott D Solomon
- Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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37
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Biering-Sørensen T, Biering-Sørensen SR, Olsen FJ, Sengeløv M, Jørgensen PG, Mogelvang R, Shah AM, Jensen JS. Global Longitudinal Strain by Echocardiography Predicts Long-Term Risk of Cardiovascular Morbidity and Mortality in a Low-Risk General Population: The Copenhagen City Heart Study. Circ Cardiovasc Imaging 2017; 10:CIRCIMAGING.116.005521. [PMID: 28264868 DOI: 10.1161/circimaging.116.005521] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Accepted: 01/20/2017] [Indexed: 12/31/2022]
Abstract
BACKGROUND Global longitudinal strain (GLS) is prognostic of adverse cardiovascular outcomes in various patient populations, but the prognostic utility of GLS for long-term cardiovascular morbidity and mortality in the general population is unknown. METHODS AND RESULTS A total of 1296 participants in a general population study underwent a health examination, including echocardiography measurement of GLS. The primary end point was the composite of incident heart failure, acute myocardial infarction, or cardiovascular death. During a median follow-up of 11 years, 149 (12%) participants were diagnosed with heart failure, acute myocardial infarction, or cardiovascular death. Lower GLS was associated with a higher risk of the composite end point (hazard ratio, 1.12; 95% confidence interval, 1.08-1.17; P<0.001 per 1% decrease), an association that persisted after multivariable adjustment for age, sex, heart rate, hypertension, systolic blood pressure, left ventricular ejection fraction, left ventricular mass index, left ventricular dimension, deceleration time, left atrium dimension, E/e', and pro B-type natriuretic peptide (hazard ratio, 1.05; 95% confidence interval, 1.00-1.11; P=0.045 per 1% decrease). GLS provided incremental prognostic information beyond the Framingham Risk Score, the Systemic Coronary Evaluation risk chart, and the modified American College of Cardiology/American Heart Association Pooled Cohort Equation for the composite outcome and incident heart failure. Sex modified the relationship between GLS and outcome such that after multivariable adjustment, GLS was an independent predictor of outcomes in men but not in women (hazard ratio, 1.14; 95% confidence interval, 1.06-1.24; P=0.001, and hazard ratio, 0.99; 95% confidence interval, 0.92-1.07; P=0.81, respectively; P for interaction =0.032). CONCLUSIONS In the general population, GLS provides independent and incremental prognostic information regarding long-term risk of cardiovascular morbidity and mortality. GLS seems to be a stronger prognosticator in men than in women.
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Affiliation(s)
- Tor Biering-Sørensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.).
| | - Sofie Reumert Biering-Sørensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Flemming Javier Olsen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Morten Sengeløv
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Peter Godsk Jørgensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Rasmus Mogelvang
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Amil M Shah
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
| | - Jan Skov Jensen
- From the Department of Cardiology, Herlev and Gentofte Hospital (T.B.-S., S.R.B.-S., F.J.O., M.S., P.G.J., R.M., J.S.J.), The Copenhagen City Heart Study, Frederiksberg Hospital (T.B.-S., S.R.B.-S., P.G.J., R.M., J.S.J.), and Institute of Clinical Medicine, Faculty of Health Sciences (J.S.J.), University of Copenhagen, Denmark; and Department of Medicine, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA (T.B.-S., A.M.S.)
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Lopez-Candales A, Hernandez-Suarez DF. Strain Imaging Echocardiography: What Imaging Cardiologists Should Know. Curr Cardiol Rev 2017; 13:118-129. [PMID: 27799029 PMCID: PMC5452148 DOI: 10.2174/1573403x12666161028122649] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/06/2016] [Accepted: 10/18/2016] [Indexed: 01/30/2023] Open
Abstract
Despite recent advances in clinical imaging, echocardiography remains as the most accessi-ble and reliable noninvasive. Since knowledge of left ventricular systolic function remains so critically important in determining prognosis; every effort should be made to prevent subjective estimations. The advent of strain imaging echocardiography now offers a readily available and portable imaging tool that not only offers an objective characterization of myocardial dynamics; but also allows for early detection of subclinical left ventricular dysfunction. This review outlines the basic concepts of strain imaging to better understand the mechanism of myocardial function as well their applicability in the least common cardiac diagnosis among current clinical practice.
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Affiliation(s)
- Angel Lopez-Candales
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences Building, PO Box 365067, San Juan, Puerto Rico
| | - Dagmar F Hernandez-Suarez
- Cardiovascular Medicine Division, University of Puerto Rico School of Medicine, Medical Sciences Building, PO Box 365067, San Juan, Puerto Rico
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39
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Characterization of myocardial motion patterns by unsupervised multiple kernel learning. Med Image Anal 2017; 35:70-82. [DOI: 10.1016/j.media.2016.06.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Revised: 06/03/2016] [Accepted: 06/09/2016] [Indexed: 11/18/2022]
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40
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Biering-Sørensen T, Mogelvang R, de Knegt MC, Olsen FJ, Galatius S, Jensen JS. Cardiac Time Intervals by Tissue Doppler Imaging M-Mode: Normal Values and Association with Established Echocardiographic and Invasive Measures of Systolic and Diastolic Function. PLoS One 2016; 11:e0153636. [PMID: 27093636 PMCID: PMC4836694 DOI: 10.1371/journal.pone.0153636] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 04/01/2016] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To define normal values of the cardiac time intervals obtained by tissue Doppler imaging (TDI) M-mode through the mitral valve (MV). Furthermore, to evaluate the association of the myocardial performance index (MPI) obtained by TDI M-mode (MPITDI) and the conventional method of obtaining MPI (MPIConv), with established echocardiographic and invasive measures of systolic and diastolic function. METHODS In a large community based population study (n = 974), where all are free of any cardiovascular disease and cardiovascular risk factors, cardiac time intervals, including isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET) were obtained by TDI M-mode through the MV. IVCT/ET, IVRT/ET and the MPI ((IVRT+IVCT)/ET) were calculated. We also included a validation population (n = 44) of patients who underwent left heart catheterization and had the MPITDI and MPIConv measured. RESULTS IVRT, IVRT/ET and MPI all increased significantly with increasing age in both genders (p<0.001 for all). IVCT, ET, IVRT/ET, and MPI differed significantly between males and females, displaying that women, in general exhibit better cardiac function. MPITDI was significantly associated with invasive (dP/dt max) and echocardiographic measures of systolic (LVEF, global longitudinal strain and global strainrate s) and diastolic function (e', global strainrate e)(p<0.05 for all), whereas MPIConv was significantly associated with LVEF, e' and global strainrate e (p<0.05 for all). CONCLUSION Normal values of cardiac time intervals differed between genders and deteriorated with increasing age. The MPITDI (but not MPIConv) is associated with most invasive and established echocardiographic measures of systolic and diastolic function.
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Affiliation(s)
- Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Martina Chantal de Knegt
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Javier Olsen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Søren Galatius
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen City Heart Study, Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
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Biering-Sørensen T, Olsen FJ, Storm K, Fritz-Hansen T, Olsen NT, Jøns C, Vinther M, Søgaard P, Risum N. Prognostic value of tissue Doppler imaging for predicting ventricular arrhythmias and cardiovascular mortality in ischaemic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2016; 17:722-31. [DOI: 10.1093/ehjci/jew066] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 03/07/2016] [Indexed: 12/24/2022] Open
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Biering-Sørensen T, Mogelvang R, Schnohr P, Jensen JS. Cardiac Time Intervals Measured by Tissue Doppler Imaging M-mode: Association With Hypertension, Left Ventricular Geometry, and Future Ischemic Cardiovascular Diseases. J Am Heart Assoc 2016; 5:JAHA.115.002687. [PMID: 26786544 PMCID: PMC4859387 DOI: 10.1161/jaha.115.002687] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND We hypothesized that the cardiac time intervals reveal reduced myocardial function in persons with hypertension and are strong predictors of future ischemic cardiovascular diseases in the general population. METHODS AND RESULTS In a large community-based population study, cardiac function was evaluated in 1915 participants by using both conventional echocardiography and tissue Doppler imaging (TDI). The cardiac time intervals, including the isovolumic relaxation time (IVRT), isovolumic contraction time (IVCT), and ejection time (ET), were obtained by TDI M-mode through the mitral leaflet. IVCT/ET, IVRT/ET, and myocardial performance index [MPI=(IVRT+IVCT)/ET] were calculated. After multivariable adjustment for clinical variables the IVRT, IVRT/ET, and MPI, remained significantly impaired in persons with hypertension (n=826) compared with participants without hypertension (n=1082). Additionally, they displayed a significant dose-response relationship, between increasing severity of elevated blood pressure and increasing left ventricular mass index (P<0.001 for all). Further, during follow-up of a median of 10.7 years, 435 had an ischemic cardiovascular disease (ischemic heart disease, peripheral arterial disease, or stroke). The IVRT/ET and MPI were powerful and independent predictors of future cardiovascular disease, especially in participants with known hypertension. They provide prognostic information incremental to clinical variables from the Framingham Risk Score, the SCORE risk chart, and the European Society of Hypertension/European Society of Cardiology risk chart. CONCLUSION The cardiac time intervals identify impaired cardiac function in individuals with hypertension, not only independent of conventional risk factors but also in participants with a normal conventional echocardiographic examination. The IVRT/ET and MPI are independent predictors of future cardiovascular disease especially in participants with known hypertension.
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Affiliation(s)
- Tor Biering-Sørensen
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (T.B., R.M., J.S.J.) The Copenhagen City Heart Study, Bispebjerg Hospital, University of Copenhagen, Denmark (T.B., R.M., P.S., J.S.J.) Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B., J.S.J.)
| | - Rasmus Mogelvang
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (T.B., R.M., J.S.J.) The Copenhagen City Heart Study, Bispebjerg Hospital, University of Copenhagen, Denmark (T.B., R.M., P.S., J.S.J.)
| | - Peter Schnohr
- The Copenhagen City Heart Study, Bispebjerg Hospital, University of Copenhagen, Denmark (T.B., R.M., P.S., J.S.J.)
| | - Jan Skov Jensen
- Department of Cardiology, Herlev and Gentofte Hospital, Denmark (T.B., R.M., J.S.J.) The Copenhagen City Heart Study, Bispebjerg Hospital, University of Copenhagen, Denmark (T.B., R.M., P.S., J.S.J.) Institute of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Denmark (T.B., J.S.J.)
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