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Cavarretta E, D'Ascenzi F, Bianco M, Castelletti S, Cavigli L, Cecchi F, D'Andrea A, De Luca A, Di Salvo G, Nistri S, Palamà Z, Palmieri V, Ricci F, Sinagra G, Zorzi A, Biffi A, Pelliccia A, Romano S, Dello Russo A, Zeppilli P, Patrizi G, Sciarra L. The role of echocardiography in sports cardiology: An expert opinion statement of the Italian Society of Sports Cardiology (SIC sport). Int J Cardiol 2024; 410:132230. [PMID: 38852859 DOI: 10.1016/j.ijcard.2024.132230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Revised: 05/09/2024] [Accepted: 06/03/2024] [Indexed: 06/11/2024]
Abstract
Transthoracic echocardiography (TTE) is routinely required during pre-participation screening in the presence of symptoms, family history of sudden cardiac death or cardiomyopathies <40-year-old, murmurs, abnormal ECG findings or in the follow-up of athletes with a history of cardiovascular disease (CVD). TTE is a cost-effective first-line imaging modality to evaluate the cardiac remodeling due to long-term, intense training, previously known as the athlete's heart, and to rule out the presence of conditions at risk of sudden cardiac death, including cardiomyopathies, coronary artery anomalies, congenital, aortic and heart valve diseases. Moreover, TTE is useful for distinguishing physiological cardiac adaptations during intense exercise from pathological behavior due to an underlying CVD. In this expert opinion statement endorsed by the Italian Society of Sports Cardiology, we discussed common clinical scenarios where a TTE is required and conditions falling in the grey zone between the athlete's heart and underlying cardiomyopathies or other CVD. In addition, we propose a minimum dataset that should be included in the report for the most common indications of TTE in sports cardiology clinical practice.
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Affiliation(s)
- Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Advanced Cardiovascular Therapies Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | - Flavio D'Ascenzi
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Siena, Italy
| | - Massimiliano Bianco
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy; Unit of Sports Medicine, Faculty of Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Silvia Castelletti
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Luna Cavigli
- Department of Medical Biotechnologies, Sports Cardiology and Rehab Unit, University of Siena, Siena, Italy
| | - Franco Cecchi
- Department of Cardiology, Istituto Auxologico Italiano IRCCS, Piazzale Brescia 20, 20149 Milan, Italy
| | - Antonello D'Andrea
- Department of Cardiology and Intensive Coronary Care, Umberto I Hospital, 84014 Nocera Inferiore, Italy
| | - Antonio De Luca
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, 34149 Trieste, Italy
| | - Giovanni Di Salvo
- Department of Woman and Child Health, Paediatric Cardiology and Congenital Heart Disease, University of Padova, 35128 Padova, Italy
| | - Stefano Nistri
- CMSR Veneto Medica, 36077 Altavilla Vicentina, VI, Italy
| | - Zefferino Palamà
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito, Italy; Electrophysiology Unit, Casa di Cura "Villa Verde", Taranto, Italy
| | - Vincenzo Palmieri
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy; Unit of Sports Medicine, Faculty of Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G.d'Annunzio University of Chieti-Pescara, Via Luigi Polacchi, 11, 66100 Chieti, Italy; Heart Department, SS. Annunziata Hospital, ASL 2 Abruzzo, 66100 Chieti, Italy; Department of Clinical Sciences, Lund University, Jan Waldenströms gata 35, 214 28 Malmö, Sweden
| | - Gianfranco Sinagra
- Cardiothoracovascular Department, Division of Cardiology, Azienda Sanitaria Universitaria Giuliano Isontina and University of Trieste, 34149 Trieste, Italy
| | - Alessandro Zorzi
- Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, 35128 Padova, Italy
| | - Alessandro Biffi
- Med-Ex, Medicine and Exercise srl, Medical Partner Scuderia Ferrari, RomeMaranello, MO, Italy
| | - Antonio Pelliccia
- Institute of Sport Medicine and Science, National Italian Olympic Committee, Rome, Italy
| | - Silvio Romano
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
| | - Antonio Dello Russo
- Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Azienda Ospedaliero Universitaria delle Marche, Ancona, Italy
| | - Paolo Zeppilli
- Sports Medicine Unit, Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy; Unit of Sports Medicine, Faculty of Medicine and Surgery, Sacred Heart Catholic University, Rome, Italy.
| | - Giampiero Patrizi
- Department of Cardiology, B. Ramazzini Hospital, Ausl Modena, Carpi, Italy
| | - Luigi Sciarra
- Department of Clinical Medicine, Public Health, Life and Environmental Sciences, University of L'Aquila, piazzale Salvatore Tommasi 1, 67100 Coppito, Italy
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Kandels J, Denk V, Pedersen MW, Kragholm KH, Søgaard P, Tayal B, Marshall RP, Denecke T, Lindgren FL, Hagendorff A, Stöbe S. Echocardiographic assessment of left ventricular volumes: a comparison of different methods in athletes. Clin Res Cardiol 2024:10.1007/s00392-024-02504-4. [PMID: 39102001 DOI: 10.1007/s00392-024-02504-4] [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: 06/20/2024] [Accepted: 07/22/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Cardiac magnetic resonance imaging (cMRI) is considered the gold standard for the assessment of left ventricular (LV) systolic function. However, discrepancies have been reported in the literature between LV volumes assessed by transthoracic echocardiography (TTE) and cMRI. The objective of this study was to analyze the differences in LV volumes between different echocardiographic techniques and cMRI. METHODS AND RESULTS In 64 male athletes (21.1 ± 4.9 years), LV volumes were measured by TTE using the following methods: Doppler echocardiography, anatomical M-Mode, biplane/triplane planimetry and 3D volumetry. In addition, LV end-diastolic (LVEDV), end-systolic (LVESV), and stroke volumes (LVSV) were assessed in 11 athletes by both TTE and cMRI. There was no significant difference between LVEDV and LVESV determined by biplane/triplane planimetry and 3D volumetry. LVEDV and LVESV measured by M-Mode were significantly lower compared to 3D volumetry. LVSV determined by Doppler with 3D planimetry of LV outflow tract was significantly higher than 2D planimetry and 3D volumetry, whereas none of the planimetric or volumetric methods for determining LVSV differed significantly. There were no significant differences for LVEDV, LVESV, LVSV and LVEF between cMRI and TTE determined by biplane planimetry in the subgroup of 11 athletes. CONCLUSION The choice of echocardiographic method used has an impact on LVSV in athletes, so the LVSV should always be checked for plausibility. The same echocardiographic method should be used to assess LVSV at follow-ups to ensure good comparability. The data suggest that biplane LV planimetry by TTE is not inferior to cMRI.
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Affiliation(s)
- Joscha Kandels
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany.
| | - Verena Denk
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Maria Weinkouff Pedersen
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Department of Cardiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark
| | - Kristian Hay Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Unit of Clinical Biostatistics and Epidemiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Peter Søgaard
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
| | - Bhupendar Tayal
- Cleveland Medical Center, Harrington Heart and Vascular Institute, University Hospitals, Cleveland, OH, USA
| | - Robert Percy Marshall
- RasenBallsport Leipzig GmbH, Cottaweg 3, 04177, Leipzig, Germany
- Department of Orthopedic and Trauma Surgery, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Timm Denecke
- Department of Diagnostic and Interventional Radiology, University Hospital Leipzig, 04103, Leipzig, Germany
| | - Filip Lyng Lindgren
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000, Aalborg, Denmark
- Department of Cardiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark
| | - Andreas Hagendorff
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
| | - Stephan Stöbe
- Department of Cardiology, Leipzig University Hospital, Liebigstr. 20, 04103, Leipzig, Germany
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Askani E, Rospleszcz S, Lorbeer R, Wintergerst C, Müller-Peltzer K, Nattenmüller J, Hasic D, von Krüchten R, Kellner E, Reisert M, Rathmann W, Peters A, Schlett CL, Bamberg F, Storz C. MRI-based adrenal gland volume is associated with cardiovascular alterations in individuals without prior cardiovascular disease. Sci Rep 2024; 14:14664. [PMID: 38918570 PMCID: PMC11199666 DOI: 10.1038/s41598-024-65673-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 06/24/2024] [Indexed: 06/27/2024] Open
Abstract
Aim of this study was to analyse the associations of cardiovascular health and adrenal gland volume as a rather new imaging biomarker of chronic hypothalamic-pituitary-adrenal (HPA) axis activation. The study population originates from the KORA population-based cross-sectional prospective cohort. 400 participants without known cardiovascular disease underwent a whole-body MRI. Manual segmentation of adrenal glands was performed on VIBE-Dixon gradient-echo sequence. MRI based evaluation of cardiac parameters was achieved semi-automatically. Cardiometabolic risk factors were obtained through standardized interviews and medical examination. Univariate and multivariate associations were derived. Bi-directional causal mediation analysis was performed. 351 participants were eligible for analysis (56 ± 9.1 years, male 58.7%). In multivariate analysis, significant associations were observed between adrenal gland volume and hypertension (outcome hypertension: Odds Ratio = 1.11, 95% CI [1.01, 1.21], p = 0.028), left ventricular remodelling index (LVRI) (outcome LVRI: β = 0.01, 95% CI [0.00, 0.02], p = 0.011), and left ventricular (LV) wall thickness (outcome LV wall thickness: β = 0.06, 95% CI [0.02, 0.09], p = 0.005). In bi-directional causal mediation analysis adrenal gland volume had a borderline significant mediating effect on the association between hypertension and LVRI (p = 0.052) as well as wall thickness (p = 0.054). MRI-based assessment of adrenal gland enlargement is associated with hypertension and LV remodelling. Adrenal gland volume may serve as an indirect cardiovascular imaging biomarker.
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Affiliation(s)
- Esther Askani
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Susanne Rospleszcz
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany
| | - Roberto Lorbeer
- Department of Radiology, Ludwig-Maximilans-University Hospital, Munich, Germany
| | - Charlotte Wintergerst
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Katharina Müller-Peltzer
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Johanna Nattenmüller
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dunja Hasic
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ricarda von Krüchten
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Marco Reisert
- Medical Physics, Department of Radiology, Medical Centre - University of Freiburg, Freiburg, Germany
| | - Wolfgang Rathmann
- Institute of Biometrics and Epidemiology, German Diabetes Center, Duesseldorf, Germany
- German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Annette Peters
- Department of Epidemiology, Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilians-University Munich, Munich, Germany
- Institute of Epidemiology, Helmholtz Centre Munich, German Research Center for Environmental Health, Neuherberg, Germany
- German Center for Cardiovascular Disease Research (DZHK E.V.), Munich, Germany
- German Center for Diabetes Research (DZD), Partner Site Neuherberg, Neuherberg, Germany
| | - Christopher L Schlett
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Fabian Bamberg
- Department of Diagnostic and Interventional Radiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Corinna Storz
- Department of Neuroradiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Breisacher Str. 64, 79106, Freiburg, Germany.
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Ngiam JN, Chew N, Jou E, Ho JS, Pramotedham T, Liong TS, Kuntjoro I, Yeo TC, Sia CH, Kong WKF, Poh KK. Increased left ventricular remodelling index in paradoxical low-flow severe aortic stenosis with preserved left ventricular ejection fraction compared to normal-flow severe aortic stenosis. Singapore Med J 2024:00077293-990000000-00094. [PMID: 38363650 DOI: 10.4103/singaporemedj.smj-2022-107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 08/01/2022] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Patients with paradoxical low-flow (LF) severe aortic stenosis (AS) despite preserved left ventricular ejection fraction (LVEF) appear distinct from normal-flow (NF) patients, showing worse prognosis, more concentric hypertrophy and smaller left ventricular (LV) cavities. The left ventricular remodelling index (LVRI) has been demonstrated to reliably discriminate between physiologically adapted athlete's heart and pathological LV remodelling. METHODS We studied patients with index echocardiographic diagnosis of severe AS (aortic valve area <1 cm2) with preserved LVEF (>50%). The LVRI was determined by the ratio of the LV mass to the end-diastolic volume, as previously reported, and was compared between patients with LF and NF AS. Patients were prospectively followed up for at least 3 years, and clinical outcomes were examined in association with LVRI. RESULTS Of the 450 patients studied, 112 (24.9%) had LF AS. While there were no significant differences in baseline clinical profile between LF and NF patients, LVRI was significantly higher in the LF group. Patients with high LVRI (>1.56 g/mL) had increased all-cause mortality (log-rank 9.18, P = 0.002) and were more likely to be admitted for cardiac failure (log-rank 7.61, P = 0.006) or undergo aortic valve replacement (log-rank 18.4, P < 0.001). After adjusting for the effect of age, hypertension, aortic valve area and mean pressure gradient on multivariate Cox regression, high LVRI remained independently associated with poor clinical outcomes (hazard ratio 1.64, 95% confidence interval 1.19-2.25, P = 0.002). CONCLUSION Pathological LV remodelling (increased LVRI) was more common in patients with LF AS, and increased LVRI independently predicts worse clinical outcomes.
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Affiliation(s)
| | - Nicholas Chew
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Eric Jou
- MRC Laboratory of Molecular Biology, Cambridge Biomedical Campus, Cambridge, United Kingdom
| | - Jamie Sy Ho
- Academic Foundation Programme, Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Tze Sian Liong
- Department of Medicine, National University Health System, Singapore
| | - Ivandito Kuntjoro
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
| | - Tiong-Cheng Yeo
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - William Kok Fai Kong
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Hundemer GL, Agharazii M, Madore F, Vaidya A, Brown JM, Leung AA, Kline GA, Larose E, Piché ME, Crean AM, Shaw JLV, Ramsay T, Hametner B, Wassertheurer S, Sood MM, Hiremath S, Ruzicka M, Goupil R. Subclinical Primary Aldosteronism and Cardiovascular Health: A Population-Based Cohort Study. Circulation 2024; 149:124-134. [PMID: 38031887 PMCID: PMC10841691 DOI: 10.1161/circulationaha.123.066389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023]
Abstract
BACKGROUND Primary aldosteronism, characterized by overt renin-independent aldosterone production, is a common but underrecognized form of hypertension and cardiovascular disease. Growing evidence suggests that milder and subclinical forms of primary aldosteronism are highly prevalent, yet their contribution to cardiovascular disease is not well characterized. METHODS This prospective study included 1284 participants between the ages of 40 and 69 years from the randomly sampled population-based CARTaGENE cohort (Québec, Canada). Regression models were used to analyze associations of aldosterone, renin, and the aldosterone-to-renin ratio with the following measures of cardiovascular health: arterial stiffness, assessed by central blood pressure (BP) and pulse wave velocity; adverse cardiac remodeling, captured by cardiac magnetic resonance imaging, including indexed maximum left atrial volume, left ventricular mass index, left ventricular remodeling index, and left ventricular hypertrophy; and incident hypertension. RESULTS The mean (SD) age of participants was 54 (8) years and 51% were men. The mean (SD) systolic and diastolic BP were 123 (15) and 72 (10) mm Hg, respectively. At baseline, 736 participants (57%) had normal BP and 548 (43%) had hypertension. Higher aldosterone-to-renin ratio, indicative of renin-independent aldosteronism (ie, subclinical primary aldosteronism), was associated with increased arterial stiffness, including increased central BP and pulse wave velocity, along with adverse cardiac remodeling, including increased indexed maximum left atrial volume, left ventricular mass index, and left ventricular remodeling index (all P<0.05). Higher aldosterone-to-renin ratio was also associated with higher odds of left ventricular hypertrophy (odds ratio, 1.32 [95% CI, 1.002-1.73]) and higher odds of developing incident hypertension (odds ratio, 1.29 [95% CI, 1.03-1.62]). All the associations were consistent when assessing participants with normal BP in isolation and were independent of brachial BP. CONCLUSIONS Independent of brachial BP, a biochemical phenotype of subclinical primary aldosteronism is negatively associated with cardiovascular health, including greater arterial stiffness, adverse cardiac remodeling, and incident hypertension.
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Affiliation(s)
- Gregory L. Hundemer
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Mohsen Agharazii
- Department of Medicine, Division of Nephrology, CHU de Québec-Université Laval, Quebec City, QC, Canada
| | - François Madore
- Department of Medicine, Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
| | - Anand Vaidya
- Center for Adrenal Disorders, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Jenifer M. Brown
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander A. Leung
- Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Gregory A. Kline
- Department of Medicine, Division of Endocrinology and Metabolism, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Eric Larose
- Department of Medicine, Division of Cardiology, Université Laval, Quebec City, QC, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Marie-Eve Piché
- Department of Medicine, Division of Cardiology, Université Laval, Quebec City, QC, Canada
- Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec City, QC, Canada
| | - Andrew M. Crean
- Division of Cardiovascular Medicine, Ottawa Heart Institute, Ottawa, ON, Canada
| | - Julie L. V. Shaw
- Department of Pathology and Laboratory Medicine, Division of Biochemistry, Ottawa Hospital, Ottawa, ON, Canada
- Eastern Ontario Regional Laboratories Association, Ottawa, ON, Canada
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Bernhard Hametner
- Center for Health & Bioresources, AIT Austrian Institute of Technology, Vienna, Austria
| | | | - Manish M. Sood
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Swapnil Hiremath
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Marcel Ruzicka
- Department of Medicine, Division of Nephrology, University of Ottawa, Ottawa, ON, Canada
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Rémi Goupil
- Department of Medicine, Division of Nephrology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montreal, QC, Canada
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Kan A, Fang Q, Li S, Liu W, Tao X, Huang K, Hu M, Feng Z, Gong L. The potential predictive value of cardiac mechanics for left ventricular reverse remodelling in dilated cardiomyopathy. ESC Heart Fail 2023; 10:3340-3351. [PMID: 37697922 PMCID: PMC10682859 DOI: 10.1002/ehf2.14529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/21/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS Left ventricular reverse remodelling (LVRR) is an important objective of optimal medical management for dilated cardiomyopathy (DCM) patients, as it is associated with favourable long-term outcomes. Cardiac magnetic resonance (CMR) can comprehensively assess cardiac structure and function. We aimed to assess the CMR parameters at baseline and investigate independent variables to predict LVRR in DCM patients. METHODS AND RESULTS Nighty-eight initially diagnosed DCM patients who underwent CMR and echocardiography examinations at baseline were included. CMR parameters and feature tracking (FT) based left ventricular (LV) global strain (nStrain) and nStrain indexed to LV cardiac mass index (rStrain) were measured. The predictors of LVRR were determined by multivariate logistic regression analyses. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of CMR parameters and were compared by the DeLong test. At a median follow-up time of 9 [interquartile range, 7-12] months, 35 DCM patients (36%) achieved LVRR. The patients with LVRR had lower LV volume, mass, LGE extent and stroke volume index (LVSVi) and higher left ventricular remodelling index (LVRI), nStrains, rStrains, and peak systolic strain rate (PSSR) in the longitudinal direction and rStrains in the circumferential direction at baseline (all P < 0.05). In the multivariate logistic regression analyses, LVRI [per SD, odds ratio (OR) 1.79; 95% confidence interval (CI) 1.08-2.98; P = 0.024] and the ratio of global longitudinal peak strain (rGLPS) (per SD, OR 1.88; 95% CI 1.18-3.01; P = 0.008) were independent predictors of LVRR. The combination of LVSVi, LVRI, and rGLPS had a greater area under the curve (AUC) than the combination of LVSVi and LVRI (0.75 vs. 0.68), but not significantly (P = 0.09). CONCLUSIONS Patients with LVRR had a lower LV volume index, lower LVSV index, lower LGE extent, higher LVRI, and preserved myocardial deformation in the longitudinal direction at baseline. LVRI and rGLPS at baseline were independent determinants of LVRR.
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Affiliation(s)
- Ao Kan
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Qimin Fang
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Shuhao Li
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Wenying Liu
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | | | - Kaiyao Huang
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Mengyao Hu
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Zhaofeng Feng
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
| | - Lianggeng Gong
- Department of RadiologyThe Second Affiliated Hospital of Nanchang UniversityNanchangChina
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7
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Zhao Y, Li C, Tang D, Luo Y, Xiang C, Huang L, Zhou X, Fang J, Wei X, Xia L. Early reverse remodeling of left heart morphology and function evaluated by cardiac magnetic resonance in hypertrophic obstructive cardiomyopathy after transapical beating-heart septal myectomy. J Cardiovasc Magn Reson 2023; 25:70. [PMID: 38008762 PMCID: PMC10680272 DOI: 10.1186/s12968-023-00987-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023] Open
Abstract
PURPOSE This study aimed to evaluate the early morphology and function of the left heart in hypertrophic obstructive cardiomyopathy (HOCM) after transapical beating-heart septal myectomy (TA-BSM) using cardiovascular magnetic resonance (CMR). MATERIALS AND METHODS Between April 2022 and January 2023, HOCM patients who underwent CMR before and 3 months after TA-BSM were prospectively and consecutively enrolled in the study. Preoperative and postoperative cardiac morphological and functional parameters, including those for the left atrium (LA) and left ventricle (LV), were compared. The left ventricular remodeling index (LVRI) was defined as the ratio between left ventricular mass (LVM) and left ventricular end-diastolic volume (LVEDV). Healthy participants with a similar age and sex distribution were enrolled for comparison. Pearson or Spearman correlation analysis was used to investigate the relationships between the parameters and LVRI. Last, univariate and multivariate linear regression identified variables associated with the LVM index (LVMI) and LVRI. RESULTS Forty-one patients (mean age ± standard deviation, 46 ± 2 years; 27 males) and 41 healthy control participants were evaluated. Eighteen (44%) HOCM patients were classified as having a sigmoid septum, and 23 patients had a reverse septal curvature. LA volume, diameter and function were significantly improved postoperatively, but still worse than healthy controls (all p < 0.001). Compared to before the operation, left ventricular wall thickness, left ventricular ejection fraction (LVEF), LVMI, and LVRI decreased after TA-BSM (all p < 0.001). The left ventricular end-diastolic volume index (LVEDVI) and left ventricular end-diastolic diameter (LVEDD) decreased in patients with a sigmoid septum. However, LVEDVI and LVEDD increased in those with a reverse septal curvature (both p < 0.001). In addition, both preoperative and postoperative LVRI was positively correlated with LVMI (r = 0.734 and 0.853, both p < 0.001) and maximum wall thickness (r = 0.679 and 0.676, both p < 0.001), respectively. In the multivariable analysis, the weight of the resected myocardium (adjusted β = 0.476, p = 0.005) and △mitral regurgitation degree (adjusted β = - 0.245, p = 0.040) were associated with △LVRI. Last, the △LVOTG (adjusted β = 0.436, p = 0.018) and baseline LVMI (adjusted β = 0.323, p = 0.040) were independently associated with greater left ventricular mass regression after TA-BSM. CONCLUSION CMR confirmed early reverse remodeling of left heart morphology and function in HOCM patients following TA-BSM.
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Affiliation(s)
- Yun Zhao
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chenhe Li
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Dazhong Tang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Luo
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Chunlin Xiang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Lu Huang
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoyue Zhou
- MR Collaboration, Siemens Healthineers Ltd., Shanghai, China
| | - Jing Fang
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Wei
- Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Liming Xia
- Department of Radiology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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Al Saikhan L, Park C, Tillin T, Jones S, Francis D, Mayet J, Chaturvedi N, Hughes AD. Sex-differences in associations of LV structure and function measured by echocardiography with long-term risk of mortality and cardiovascular morbidity. Front Cardiovasc Med 2023; 10:1144964. [PMID: 37180770 PMCID: PMC10166834 DOI: 10.3389/fcvm.2023.1144964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Three-dimensional echocardiography (3DE) measures of the left ventricle (LV) predict outcomes in high risk individuals, but their prognostic value in the general population is unknown. We aimed to establish whether 3DE was associated with mortality and morbidity in a multi-ethnic community-based sample, if associations differed by sex, and explored potential mechanisms explaining sex differences. Methods 922 individuals (69.7 ± 6.2 years; 717 men) from the SABRE study underwent a health examination including echocardiography. Associations between 3DE LV measures (ejection fraction (EF), end-diastolic volume (EDV), end-systolic volume (ESV), LV remodeling index (LVRI) and LV sphericity index (LVSI), and all-cause mortality and a composite cardiovascular endpoint [comprising new onset (non)fatal coronary heart disease, heart failure hospitalization, new-onset arrhythmias and cardiovascular mortality] were determined using multivariable Cox regression over a median follow-up of 8 years (all-cause mortality) and 7 years (composite cardiovascular endpoint). Results There were 123 deaths and 151 composite cardiovascular endpoints. Lower EF, higher LV volumes and LVSI were associated with increased all-cause mortality, and higher LV volumes were associated with the composite cardiovascular endpoint independent of potential confounders. Associations between LV volumes, LVRI, LVSI, and mortality differed by sex (p interaction <0.1). In men increased LV volumes and LVSI and decreased LVRI and EF were associated with higher mortality, but associations were null or reversed in women (hazard ratios (95% CI) men vs. women: EDV 1.25 (1.05, 1.48) vs. 0.54 (0.26, 1.10); ESV, 1.36 (1.12, 1.63) vs. 0.59 (0.33, 1.04); LVRI, 0.79 (0.64, 0.96) vs. 1.70 (1.03, 2.80); LVSI, 1.27 (1.05, 1.54) vs. 0.61 (0.32, 1.15); and EF, 0.78 (0.66, 0.93) vs. 1.27 (0.69, 2.33). Similar sex differences were observed for associations with the composite cardiovascular outcome. Adjustment for LV diastolic stiffness and arterial stiffness marginally attenuated these differences. Conclusions 3DE measures of LV volume and remodeling are associated with all-cause mortality and cardiovascular morbidity; however, some associations differ by sex. Sex-differences in LV remodeling patterns may influence mortality and morbidity risk in the general population.
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Affiliation(s)
- Lamia Al Saikhan
- Department of Cardiac Technology, College of Applied Medial Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Chloe Park
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Therese Tillin
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Siana Jones
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Darrel Francis
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Jamil Mayet
- National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Nish Chaturvedi
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
| | - Alun D. Hughes
- MRC Unit for Lifelong Health and Ageing, UCL Institute of Cardiovascular Science, University College London, London, United Kingdom
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9
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Fan G, Zhou C, Hou T, Li X, Wang L, Wang C. Effects of Sacubitril/Valsartan on cardiac function, blood biochemistry and clinical efficacy in early ventricular remodeling after acute myocardial infarction. Biotechnol Genet Eng Rev 2023:1-16. [PMID: 37043670 DOI: 10.1080/02648725.2023.2197312] [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: 04/14/2023]
Abstract
Ventricular remodeling (VR) after acute ST-elevation myocardial infarction (STEMI) is an important predictor for medium- and long-term prognosis. This study focuses on the relevant indexes of VR in patients with AMI, in which, the intervention effects of sacubitril/valsartan and enalapril were compared, guiding the clinical treatment. 58 patients with acute STEMI treated with PCI were divided into research group and control group. UCG was performed at 1 week, 1 month and 3 months after MI, and the patients' indexes were collected to compare VR and adverse reactions in the two groups. The test results showed that there was no statistical difference in the baseline data of patients in the two groups, which were comparable. In the blood biochemical index examination, no statistical difference was found in cTnI and NT-proBNP between the two groups. At 1 week after operation, the levels of cTnI and NT-proBNP in research group were lower than those in the control group. In ECG examination, there was no statistical significance in the levels of LVEF, LVEDD and LVESD at admission between the two groups. After 1 week, the results of LVEF, LVEDD, LVESD in the research group were higher than those in the control group. The results of this study show that sacubitril/valsartan can be used in patients with AMI instead of enalapril. Sacubitril/valsartan improves cardiac function in patients with emergency percutaneous coronary intervention (PCI) for AMI, inhibits ventricular remodeling, and has a low incidence of adverse cardiac events and adverse drug reactions.
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Affiliation(s)
- Guangci Fan
- Department of Cardiovascular (II), Hiser Medical Center of Qingdao, Qingdao Hiser Hospital Affiliated to Qingdao University, Qingdao, Shandong, China
| | - Chunyan Zhou
- Department of Pharmacy, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, Shandong, China
| | - Tingting Hou
- Department of Pharmacy, Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital, Qingdao, Shandong, China
| | - Xiaowen Li
- Department of Endoscopy Room, Zhangqiu District People's Hospital, Jinan, Shandong, China
| | - Liang Wang
- Department of Trauma Orthopedics, Zhangqiu District People's Hospital, Jinan, Shandong, China
| | - Chenghong Wang
- Department of Clinical Laboratory, Yantaishan Hospital of Yantai, Yantai, Shandong China
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10
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Hagendorff A, Kandels J, Metze M, Tayal B, Stöbe S. Valid and Reproducible Quantitative Assessment of Cardiac Volumes by Echocardiography in Patients with Valvular Heart Diseases-Possible or Wishful Thinking? Diagnostics (Basel) 2023; 13:1359. [PMID: 37046577 PMCID: PMC10093440 DOI: 10.3390/diagnostics13071359] [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: 03/12/2023] [Revised: 03/24/2023] [Accepted: 04/03/2023] [Indexed: 04/14/2023] Open
Abstract
The analysis of left ventricular function is predominantly based on left ventricular volume assessment. Especially in valvular heart diseases, the quantitative assessment of total and effective stroke volumes as well as regurgitant volumes is necessary for a quantitative approach to determine regurgitant volumes and regurgitant fraction. In the literature, there is an ongoing discussion about differences between cardiac volumes estimated by echocardiography and cardiac magnetic resonance tomography. This viewpoint focuses on the feasibility to assess comparable cardiac volumes with both modalities. The former underestimation of cardiac volumes determined by 2D and 3D echocardiography is presumably explained by methodological and technical limitations. Thus, this viewpoint aims to stimulate an urgent and critical rethinking of the echocardiographic assessment of patients with valvular heart diseases, especially valvular regurgitations, because the actual integrative approach might be too error prone to be continued in this form. It should be replaced or supplemented by a definitive quantitative approach. Valid quantitative assessment by echocardiography is feasible once echocardiography and data analysis are performed with methodological and technical considerations in mind. Unfortunately, implementation of this approach cannot generally be considered for real-world conditions.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Joscha Kandels
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Michael Metze
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
| | - Bhupendar Tayal
- Harrington Heart and Vascular Center, Department of Cardiology, University Hospitals, Cleveland, OH 44106, USA;
| | - Stephan Stöbe
- Department of Cardiology, University Hospital Leipzig, 04103 Leipzig, Germany; (J.K.); (M.M.); (S.S.)
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11
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Yan WF, Xu HY, Jiang L, Zhang L, Guo YK, Li Y, Shen LT, Min CY, Yang ZG. Early longitudinal changes in left ventricular function and morphology in diabetic pigs: evaluation by 3.0T magnetic resonance imaging. Cardiovasc Diabetol 2023; 22:6. [PMID: 36627647 PMCID: PMC9830732 DOI: 10.1186/s12933-022-01734-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 12/30/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Previous researches on large animal models of diabetic cardiomyopathy were insufficient. The aim of this study was to evaluate early changes in left ventricular (LV) function and morphology in diabetic pigs using a cardiac magnetic resonance (CMR) time-volume curve and feature tracking technique. METHODS Streptozotocin (STZ) was used to induce diabetic in sixteen pigs. 3.0T MRI scanned the pig's heart before and 2, 6, 10 and 16 months after modelling. CMR biomarkers, including time-volume curve and myocardial strain, were compared to analyse the longitudinal changes in LV function and morphology. Pearson correlation was used to evaluate the relationship between LV strain and remodelling. Cardiac specimens were obtained at 6, 10, and 16 months after modelling to observe the myocardial ultrastructural and microstructure at different courses of diabetes. RESULTS Twelve pigs developed diabetes. The 80% diastolic volume recovery rate (DVR) at 6 months after modelling was significantly higher than that before modelling (0.78 ± 0.08vs. 0.67 ± 0.15). The LV global longitudinal peak strain (GLPS) (- 10.21 ± 3.15 vs. - 9.74 ± 2.78 vs. - 9.38 ± 3.71 vs. - 8.71 ± 2.68 vs. - 6.59 ± 2.90%) altered gradually from the baseline data to 2, 6, 10 and 16 months after modelling. After 16 months of modelling, the LV remodelling index (LVRI) of pigs increased compared with that before modelling (2.19 ± 0.97 vs. 1.36 ± 0.45 g/ml). The LVRI and myocardial peak strain were correlated in diabetic pigs (r= - 0.40 to - 0.54), with GLPS being the most significant. Electron microscopy and Masson staining showed that myocardial damage and fibrosis gradually increased with the progression of the disease. CONCLUSION Intravenous injection of STZ can induce a porcine diabetic cardiomyopathy model, mainly characterized by decreased LV diastolic function and strain changes accompanied by myocardial remodelling. The changes in CMR biomarkers could reflect the early myocardial injury of diabetic cardiomyopathy.
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Affiliation(s)
- Wei-Feng Yan
- grid.13291.380000 0001 0807 1581Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 China
| | - Hua-Yan Xu
- grid.13291.380000 0001 0807 1581Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Li Jiang
- grid.13291.380000 0001 0807 1581Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 China
| | - Lu Zhang
- grid.13291.380000 0001 0807 1581Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Ying-Kun Guo
- grid.13291.380000 0001 0807 1581Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yuan Li
- grid.13291.380000 0001 0807 1581Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 China
| | - Li-Ting Shen
- grid.13291.380000 0001 0807 1581Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 China
| | - Chen-Yan Min
- grid.13291.380000 0001 0807 1581Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan 610041 China
| | - Zhi-Gang Yang
- Department of Radiology, West China Hospital, Sichuan University, 37# Guo Xue Xiang, Chengdu, Sichuan, 610041, China.
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12
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Hagendorff A, Helfen A, Brandt R, Altiok E, Breithardt O, Haghi D, Knierim J, Lavall D, Merke N, Sinning C, Stöbe S, Tschöpe C, Knebel F, Ewen S. Expert proposal to characterize cardiac diseases with normal or preserved left ventricular ejection fraction and symptoms of heart failure by comprehensive echocardiography. Clin Res Cardiol 2023; 112:1-38. [PMID: 35660948 PMCID: PMC9849322 DOI: 10.1007/s00392-022-02041-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/10/2022] [Indexed: 01/22/2023]
Abstract
Currently, the term "heart failure with preserved left ventricular ejection fraction (HFpEF)" is based on echocardiographic parameters and clinical symptoms combined with elevated or normal levels of natriuretic peptides. Thus, "HFpEF" as a diagnosis subsumes multiple pathophysiological entities making a uniform management plan for "HFpEF" impossible. Therefore, a more specific characterization of the underlying cardiac pathologies in patients with preserved ejection fraction and symptoms of heart failure is mandatory. The present proposal seeks to offer practical support by a standardized echocardiographic workflow to characterize specific diagnostic entities associated with "HFpEF". It focuses on morphological and functional cardiac phenotypes characterized by echocardiography in patients with normal or preserved left ventricular ejection fraction (LVEF). The proposal discusses methodological issues to clarify why and when echocardiography is helpful to improve the diagnosis. Thus, the proposal addresses a systematic echocardiographic approach using a feasible algorithm with weighting criteria for interpretation of echocardiographic parameters related to patients with preserved ejection fraction and symptoms of heart failure. The authors consciously do not use the diagnosis "HFpEF" to avoid misunderstandings. Central illustration: Scheme illustrating the characteristic echocardiographic phenotypes and their combinations in patients with "HFpEF" symptoms with respect to the respective cardiac pathology and pathophysiology as well as the underlying typical disease.
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Affiliation(s)
- A. Hagendorff
- Department of Cardiology, University of Leipzig, Liebigstraße 20, 04103 Leipzig, Germany
| | - A. Helfen
- Department of Cardiology, Kath. St. Paulus Gesellschaft, St-Marien-Hospital Lünen, Altstadtstrasse 23, 44534 Lünen, Germany
| | - R. Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231 Bad Nauheim, Germany
| | - E. Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074 Aachen, Germany
| | - O. Breithardt
- Klinik für Innere Medizin-Kardiologie and Rhythmologie, Agaplesion Diakonie Kliniken Kassel, Herkulesstrasse 34, 34119 Kassel, Germany
| | - D. Haghi
- Kardiologische Praxisklinik Ludwigshafen-Akademische Lehrpraxis der Universität Mannheim-Ludwig-Guttmann, Strasse 11, 67071 Ludwigshafen, Germany
| | - J. Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Paulinenkrankenhaus Berlin, Klinik Für Innere Medizin Und Kardiologie, Dickensweg 25-39, 14055 Berlin, Germany
| | - D. Lavall
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - N. Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, 13353 Berlin, Germany
| | - C. Sinning
- Department of Cardiology, University Heart and Vascular Center Hamburg, German Centre of Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Martinistrasse 52, 20251 Hamburg, Germany
| | - S. Stöbe
- Department of Cardiology, University of Leipzig, Liebigstrasse 20, 04103 Leipzig, Germany
| | - C. Tschöpe
- Berlin Institute of Health at Charité (BIH), Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,BIH Center for Regenerative Therapies (BCRT), Augustenburger Platz 1, 13353 Berlin, Germany ,German Centre for Cardiovascular Research DZHK, Partner Site Berlin, Augustenburger Platz 1, 13353 Berlin, Germany ,Department of Cardiology, Charité University Medicine Berlin, Campus Virchow Klinikum, Augustenburger Platz 1, 13353 Berlin, Germany
| | - F. Knebel
- Klinik Für Innere Medizin II, Kardiologie, Sana Klinikum Lichtenberg, Fanningerstrasse 32, 10365 Berlin, Germany ,Department of Cardiology, University of Berlin, Campus Charité Mitte, Charitéplatz 1, 10117 Berlin, Germany
| | - S. Ewen
- Zentrale Notaufnahme and Klinik Für Innere Medizin III, Kardiologie, Angiologie Und Internistische Intensivmedizin, Universitätsklinikum Des Saarlandes, Kirrberger Strasse, 66421 Homburg, Germany
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13
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Calvieri C, Cataldi C, Cavarretta E. Sacubitril/Valsartan, left ventricular reverse remodeling and advanced echocardiographic imaging: is it a resolved conundrum? Minerva Cardiol Angiol 2022; 70:428-430. [PMID: 35080359 DOI: 10.23736/s2724-5683.21.05953-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Camilla Calvieri
- Department of Clinical, Internal, Anesthesiological and Cardiovascular Sciences, La Sapienza University of Rome, Rome, Italy
| | - Claudia Cataldi
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
| | - Elena Cavarretta
- Department of Medical-Surgical Sciences and Biotechnologies, La Sapienza University of Rome, Latina, Italy - .,Mediterranea Cardiocentro, Napoli, Italy
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14
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Palermi S, Serio A, Vecchiato M, Sirico F, Gambardella F, Ricci F, Iodice F, Radmilovic J, Russo V, D'Andrea A. Potential role of an athlete-focused echocardiogram in sports eligibility. World J Cardiol 2021; 13:271-297. [PMID: 34589165 PMCID: PMC8436685 DOI: 10.4330/wjc.v13.i8.271] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/27/2021] [Accepted: 07/14/2021] [Indexed: 02/06/2023] Open
Abstract
Sudden cardiac death (SCD) of an athlete is a rare but tragic event and sport activity might play a trigger role in athletes with underlying structural or electrical heart diseases. Preparticipation screenings (PPs) have been conceived for the potential to prevent SCD in young athletes by early identification of cardiac diseases. The European Society of Cardiology protocol for PPs includes history collection, physical examination and baseline electrocardiogram, while further examinations are reserved to individuals with abnormalities at first-line evaluation. Nevertheless, transthoracic echocardiography has been hypothesized to have a primary role in the PPs. This review aims to describe how to approach an athlete-focused echocardiogram, highlighting what is crucial to focus on for the different diseases (cardiomyopathies, valvulopathies, congenital heart disease, myocarditis and pericarditis) and when is needed to pay attention to overlap diagnostic zone ("grey zone") with the athlete's heart. Once properly tested, focused echocardiography by sports medicine physicians may become standard practice in larger screening practices, potentially available during first-line evaluation.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Alessandro Serio
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | - Marco Vecchiato
- Sport and Exercise Medicine Division, Department of Medicine, University Hospital of Padova, Padova 35128, Italy
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, Naples 80131, Italy
| | | | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti 66100, Italy
| | - Franco Iodice
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Juri Radmilovic
- Unit of Cardiology and Intensive Coronary Care, "Umberto I" Hospital, Nocera Inferiore 84014, Italy
| | - Vincenzo Russo
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy
| | - Antonello D'Andrea
- Unit of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Monaldi Hospital, Naples 80131, Italy.
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15
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Kübler J, Burgstahler C, Brendel JM, Gassenmaier S, Hagen F, Klingel K, Olthof SC, Blume K, Wolfarth B, Mueller KAL, Greulich S, Krumm P. Cardiac MRI findings to differentiate athlete's heart from hypertrophic (HCM), arrhythmogenic right ventricular (ARVC) and dilated (DCM) cardiomyopathy. Int J Cardiovasc Imaging 2021; 37:2501-2515. [PMID: 34019206 PMCID: PMC8302518 DOI: 10.1007/s10554-021-02280-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 05/05/2021] [Indexed: 12/25/2022]
Abstract
To provide clinically relevant criteria for differentiation between the athlete’s heart and similar appearing hypertrophic (HCM), dilated (DCM), and arrhythmogenic right-ventricular cardiomyopathy (ARVC) in MRI. 40 top-level athletes were prospectively examined with cardiac MR (CMR) in two university centres and compared to retrospectively recruited patients diagnosed with HCM (n = 14), ARVC (n = 18), and DCM (n = 48). Analysed MR imaging parameters in the whole study cohort included morphology, functional parameters and late gadolinium enhancement (LGE). Mean left-ventricular enddiastolic volume index (LVEDVI) was high in athletes (105 ml/m2) but significantly lower compared to DCM (132 ml/m2; p = 0.001). Mean LV ejection fraction (EF) was 61% in athletes, below normal in 7 (18%) athletes vs. EF 29% in DCM, below normal in 46 (96%) patients (p < 0.0001). Mean RV-EF was 54% in athletes vs. 60% in HCM, 46% in ARVC, and 41% in DCM (p < 0.0001). Mean interventricular myocardial thickness was 10 mm in athletes vs. 12 mm in HCM (p = 0.0005), 9 mm in ARVC, and 9 mm in DCM. LGE was present in 1 (5%) athlete, 8 (57%) HCM, 10 (56%) ARVC, and 21 (44%) DCM patients (p < 0.0001). Healthy athletes’ hearts are characterized by both hypertrophy and dilation, low EF of both ventricles at rest, and increased interventricular septal thickness with a low prevalence of LGE. Differentiation of athlete’s heart from other non-ischemic cardiomyopathies in MRI can be challenging due to a significant overlap of characteristics also seen in HCM, ARVC, and DCM.
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Affiliation(s)
- J Kübler
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - C Burgstahler
- Department of Internal Medicine V, Sports Medicine, University of Tübingen, Tübingen, Germany.
| | - J M Brendel
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - S Gassenmaier
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - F Hagen
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - K Klingel
- Cardiopathology, Molecular Pathology, University of Tübingen, Tübingen, Germany
| | - S-C Olthof
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
| | - K Blume
- Department of Sports Medicine, Humboldt-University/Charité University Medicine, Berlin, Germany.,Department of Preventive and Rehabilitative Sports Medicine, Technical University Munich (TUM), Munich, Germany
| | - B Wolfarth
- Department of Sports Medicine, Humboldt-University/Charité University Medicine, Berlin, Germany.,Department of Preventive and Rehabilitative Sports Medicine, Technical University Munich (TUM), Munich, Germany
| | - K A L Mueller
- Department of Internal Medicine III, Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
| | - S Greulich
- Department of Internal Medicine III, Cardiology and Cardiovascular Medicine, University of Tübingen, Tübingen, Germany
| | - P Krumm
- Department of Radiology, Diagnostic and Interventional Radiology, University of Tübingen, Tübingen, Germany
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Hagendorff A, Knebel F, Helfen A, Stöbe S, Haghi D, Ruf T, Lavall D, Knierim J, Altiok E, Brandt R, Merke N, Ewen S. Echocardiographic assessment of mitral regurgitation: discussion of practical and methodologic aspects of severity quantification to improve diagnostic conclusiveness. Clin Res Cardiol 2021; 110:1704-1733. [PMID: 33839933 PMCID: PMC8563569 DOI: 10.1007/s00392-021-01841-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 03/08/2021] [Indexed: 12/28/2022]
Abstract
The echocardiographic assessment of mitral valve regurgitation (MR) by characterizing specific morphological features and grading its severity is still challenging. Analysis of MR etiology is necessary to clarify the underlying pathological mechanism of the valvular defect. Severity of mitral regurgitation is often quantified based on semi-quantitative parameters. However, incongruent findings and/or interpretations of regurgitation severity are frequently observed. This proposal seeks to offer practical support to overcome these obstacles by offering a standardized workflow, an easy means to identify non-severe mitral regurgitation, and by focusing on the quantitative approach with calculation of the individual regurgitant fraction. This work also indicates main methodological problems of semi-quantitative parameters when evaluating MR severity and offers appropriateness criteria for their use. It addresses the diagnostic importance of left-ventricular wall thickness, left-ventricular and left atrial volumes in relation to disease progression, and disease-related complaints to improve interpretation of echocardiographic findings. Finally, it highlights the conditions influencing the MR dynamics during echocardiographic examination. These considerations allow a reproducible, verifiable, and transparent in-depth echocardiographic evaluation of MR patients ensuring consistent haemodynamic plausibility of echocardiographic results.
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Affiliation(s)
- Andreas Hagendorff
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| | - Fabian Knebel
- Department of Cardiology, University of Berlin, Charité Universitätsmedizin Berlin, Campus Mitte, Medizinische Klinik mit Schwerpunkt Kardiologie und Angiologie, Charitéplatz 1, 10117, Berlin, Germany
| | - Andreas Helfen
- Department of Cardiology, Katholisches Klinikum Lünen Werne GmbH, St-Marien-Hospital Lünen, Altstadtstrasse 23, 44534, Lünen, Germany
| | - Stephan Stöbe
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Dariush Haghi
- Kardiologische Praxisklinik Ludwigshafen, Akademische Lehrpraxis der Universität Mannheim, Ludwig-Guttmann-Strasse 11, 67071, Ludwigshafen, Germany
| | - Tobias Ruf
- Department of Cardiology, Center of Cardiology, Heart Valve Center, University Medical Center Mainz, University of Mainz, Langenbeckstrasse 1, 55131, Mainz, Germany
| | - Daniel Lavall
- Department of Cardiology, Klinik und Poliklinik für Kardiologie, University of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Jan Knierim
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Ertunc Altiok
- Department of Cardiology, University of Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Roland Brandt
- Department of Cardiology, Kerckhoff Heart Center, Benekestr. 2-8, 61231, Bad Nauheim, Germany
| | - Nicolas Merke
- Department of Cardiothoracic and Vascular Surgery, German Heart Center Berlin, Augustenburger Platz 1, Berlin, 13353, Germany
| | - Sebastian Ewen
- Klinik für Innere Medizin III - Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Kirrberger Str, IMED, 66421, Homburg, Germany
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Kucukseymen S, Neisius U, Rodriguez J, Tsao CW, Nezafat R. Negative synergism of diabetes mellitus and obesity in patients with heart failure with preserved ejection fraction: a cardiovascular magnetic resonance study. Int J Cardiovasc Imaging 2020; 36:2027-2038. [PMID: 32533279 DOI: 10.1007/s10554-020-01915-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/05/2020] [Indexed: 12/11/2022]
Abstract
In patients with heart failure with preserved ejection fraction (HFpEF), diabetes mellitus (DM) and obesity are important comorbidities as well as major risk factors. Their conjoint impact on the myocardium provides insight into the HFpEF aetiology. We sought to investigate the association between obesity, DM, and their combined effect on alterations in the myocardial tissue in HFpEF patients. One hundred and sixty-two HFpEF patients (55 ± 12 years, 95 men) and 45 healthy subjects (53 ± 12 years, 27 men) were included. Patients were classified according to comorbidity prevalence (36 obese patients without DM, 53 diabetic patients without obesity, and 73 patients with both). Myocardial remodeling, fibrosis, and longitudinal contractility were quantified with cardiovascular magnetic resonance imaging using cine and myocardial native T1 images. Patients with DM and obesity had impaired global longitudinal strain (GLS) and increased myocardial native T1 compared to patients with only one comorbidity (DM + Obesity vs. DM and Obesity; GLS, - 15 ± 2.1 vs - 16.5 ± 2.4 and - 16.7 ± 2.2%; native T1, 1162 ± 37 vs 1129 ± 25 and 1069 ± 29 ms; P < 0.0001 for all). A negative synergistic effect of combined obesity and DM prevalence was observed for native T1 (np2 = 0.273, p = 0.002) and GLS (np2 = 0.288, p < 0.0001). Additionally, severity of insulin resistance was associated with GLS (R = 0.590, P < 0.0001), and native T1 (R = 0.349, P < 0.0001). The conjoint effect of obesity and DM in HFpEF patients is associated with diffuse myocardial fibrosis and deterioration in GLS. The negative synergistic effects observed on the myocardium may be related to severity of insulin resistance.
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Affiliation(s)
- Selcuk Kucukseymen
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Ulf Neisius
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Jennifer Rodriguez
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Connie W Tsao
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA
| | - Reza Nezafat
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center and Harvard Medical School, 330 Brookline Ave., Boston, MA, 02215, USA.
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18
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Wang L, Zhang F, Duan F, Huang R, Chen X, Ming J, Na J. Homozygous MESP1 knock-in reporter hESCs facilitated cardiovascular cell differentiation and myocardial infarction repair. Theranostics 2020; 10:6898-6914. [PMID: 32550911 PMCID: PMC7295063 DOI: 10.7150/thno.42347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Accepted: 05/09/2020] [Indexed: 12/15/2022] Open
Abstract
Different populations of cardiovascular progenitor cells have been shown to possess varying differentiation potentials. They have also been used to facilitate heart repair. However, sensitive reporter cell lines that mark the human cardiovascular progenitors are in short supply. Methods: MESP1 marks the earliest population of cardiovascular progenitor cells during embryo development. Here, we generated a homozygous MESP1 knock-in reporter hESC line where mTomato gene joined to the MESP1 coding region via a 2A peptide, in which both MESP1 alleles were preserved. We performed transcriptome and functional analysis of human MESP1+ cardiovascular progenitor cells and tested their therapeutic potential using a rat model of myocardial infarction. Results: MESP1-mTomato knock-in reporter faithfully recapitulated the endogenous level of MESP1. Transcriptome analysis revealed that MESP1+ cells highly expressed early cardiovascular genes and heart development genes. The activation of MESP1 relied on the strength of canonical Wnt signaling, peak MESP1-mTomato fluorescence correlated with the window of canonical Wnt inhibition during in vitro differentiation. We further showed that MESP1 bound to the promoter of the WNT5A gene and the up-regulation of WNT5A expression suppressed canonical Wnt/β-CATENIN signaling. Moreover, induced MESP1 expression could substitute the canonical Wnt inhibition step and promote robust cardiomyocyte formation. We used a configurable, chemically defined, tri-lineage differentiation system to obtain cardiomyocytes, endothelial cells, and smooth muscle cells from MESP1+ cells at high efficiency. Finally, we showed that the engraftment of MESP1+ cells repaired rat myocardial infarction model. Conclusions: MESP1-mTomato reporter cells offered a useful platform to study cardiovascular differentiation from human pluripotent stem cells and explore their therapeutic potential in regenerative medicine.
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Zhou Y, Yu M, Yuan J, Hu F, Liu S, Yang Z, Cui J, Qiao S. Sex-Related Differences in the Impact of Systemic Hypertension on Left Ventricular Remodeling in Patients with Hypertrophic Obstructive Cardiomyopathy. Cardiology 2020; 145:203-214. [PMID: 32069453 DOI: 10.1159/000505680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/30/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND The clinical condition of hypertrophic obstructive cardiomyopathy (HOCM) and concomitant systemic hypertension is growing more and more prevalent, and it brings about a challenging diagnostic and therapeutic dilemma. However, whether systemic hypertension has an impact on HOCM, and whether sex-related differences exist in this impact, remains unclear. METHODS A total of 453 HOCM patients (age 48.7 ± 12.8 years, 252 [55.6%] males) were recruited in this study. There were 150 patients (33.1%, 81 males and 69 females) with a history of controlled systemic hypertension. Cardiac magnetic resonance (CMR) imaging was performed in all patients. Left ventricular (LV) remodeling index (LVRI) was determined by CMR. LVRI >1.3 g/mL was defined as pathological LV remodeling. RESULTS Men had significantly greater LVRI (1.40 ± 0.54 vs. 1.15 ± 0.38 g/mL, p < 0.001) and LVRI >1.3 g/mL (p = 0.002), compared with women. The incidence of syncope and 5-year sudden cardiac death risk score were significantly lower in HOCM with hypertension than those without hypertension. LVRI (p = 0.003) and LVRI >1.3 g/mL (p = 0.007) were significantly smaller in males with hypertension, but not in females with hypertension. However, log cardiac troponin I and log N-terminal pro-B-type natriuretic peptide were positively correlated with LVRI in men and women. On multivariable logistic analysis, hypertension (OR 0.172, 95% CI 0.056-0.528, p = 0.002) remained an independent determinant of pathological LV remodeling in males, whereas not in females. CONCLUSIONS There were significant sex differences in the impact of systemic hypertension on LV remodeling in patients with HOCM. Controlled systemic hypertension may contribute to improving LV remodeling in male patients with HOCM, but not in females.
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Affiliation(s)
- Yue Zhou
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Miao Yu
- Department of Arrhythmia, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jiansong Yuan
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Fenghuan Hu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengwen Liu
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhuoxuan Yang
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jingang Cui
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China,
| | - Shubin Qiao
- Department of Cardiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Pelliccia A, Caselli S, Sharma S, Basso C, Bax JJ, Corrado D, D'Andrea A, D'Ascenzi F, Di Paolo FM, Edvardsen T, Gati S, Galderisi M, Heidbuchel H, Nchimi A, Nieman K, Papadakis M, Pisicchio C, Schmied C, Popescu BA, Habib G, Grobbee D, Lancellotti P. European Association of Preventive Cardiology (EAPC) and European Association of Cardiovascular Imaging (EACVI) joint position statement: recommendations for the indication and interpretation of cardiovascular imaging in the evaluation of the athlete's heart. Eur Heart J 2019; 39:1949-1969. [PMID: 29029207 DOI: 10.1093/eurheartj/ehx532] [Citation(s) in RCA: 187] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/23/2017] [Indexed: 12/14/2022] Open
Affiliation(s)
- Antonio Pelliccia
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Stefano Caselli
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Cristina Basso
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Jeroen J Bax
- Departmentt of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Domenico Corrado
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy
| | - Antonello D'Andrea
- Department of Cardiology, Monaldi Hospital, Second University of Naples, Naples, Italy
| | - Flavio D'Ascenzi
- Division of Cardiology, Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Fernando M Di Paolo
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | - Thor Edvardsen
- Department of Cardiology, Center of Cardiologic Innovation, Oslo University Hospital, University of Oslo, Oslo, Norway
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University of Naples, Naples, Italy
| | - Hein Heidbuchel
- Jessa Hospital, Hasselt University and Heart Center Hasselt, Hasselt, Belgium
| | | | - Koen Nieman
- Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Cataldo Pisicchio
- Institute of Sports Medicine and Science, Largo Piero Gabrielli, 1, 00197 Rome, Italy
| | | | - Bogdan A Popescu
- Institute of Cardiovascular Diseases, University of Medicine and Pharmacy 'Carol Davila', Bucharest, Romania
| | - Gilbert Habib
- Department of Cardiology, Hôpital La Timone, Marseille, France
| | - Diederick Grobbee
- Department of Epidemiology, University Medical Center, Utrecht, The Netherlands
| | - Patrizio Lancellotti
- Department of Cardiology, GIGA Cardiovascular Sciences, University of Liège Hospital, Valvular Disease Clinic, Belgium
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Perry R, Swan AL, Hecker T, De Pasquale CG, Selvanayagam JB, Joseph MX. The Spectrum of Change in the Elite Athlete's Heart. J Am Soc Echocardiogr 2019; 32:978-986. [DOI: 10.1016/j.echo.2019.04.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 04/10/2019] [Accepted: 04/11/2019] [Indexed: 01/07/2023]
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Three-dimensional echocardiographic ventricular mass/end-diastolic volume ratio in native hypertensive patients: relation between stroke volume and geometry. J Hypertens 2019; 36:1697-1704. [PMID: 29570513 DOI: 10.1097/hjh.0000000000001717] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Elevated left ventricular (LV) mass/end-diastolic volume ratio (LVM/EDV) has been associated with higher evidence of myocardial fibrosis and dysfunction in hypertensive patients by cardiac magnetic resonance, a technique with limited availability. OBJECTIVES We investigated the ability of three-dimensional (3D) echocardiography in identifying a phenotype of LV concentric geometry according to LVM/EDV ratio, possibly detecting early myocardial damage in native-hypertensive patients. METHODS One hundred and twenty-eight native-hypertensive patients underwent 2D and 3D-echocardiography. The population was divided into two groups, according to cut-off point values of 3D-LVM/EDV ratio corresponding to its upper 95% confidence interval in a population of 90 healthy normotensive individuals: LVM/EDV ratio cut-off was 1.22 in men and 1.23 in women. RESULTS An increased 3D-LVM/EDV ratio identified a higher rate of LV concentric geometry in comparison with 2D-derived relative wall thickness (37 versus 24%, P = 0.03). Patients with LVM/EDV ratio of 1.22 or more in men and 1.23 or more in women were significantly older, had smaller 3D-LV end-diastolic and end-systolic volumes and higher LV mass index, without difference in ejection fraction. 3D-stroke volume (P < 0.0001) was lower in patients with elevated LVM/EDV ratio. By a multilinear regression analysis, after adjusting for sex, age, heart rate, mean blood pressure and BMI, stroke volume was independently and negatively associated to LVM/EDV ratio (β = -0.55, P < 0.0001). CONCLUSION In native hypertensive patients, 3D-echo-derived LVM/EDV ratio identifies a higher prevalence of LV concentric geometry than 2D-relative wall thickness. Stroke volume is independently and negatively associated with LVM/EDV ratio and its reduction represents an early marker of myocardial dysfunction in hypertensives with LV concentric geometry.
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Eichhorn C, Bière L, Schnell F, Schmied C, Wilhelm M, Kwong RY, Gräni C. Myocarditis in Athletes Is a Challenge: Diagnosis, Risk Stratification, and Uncertainties. JACC Cardiovasc Imaging 2019; 13:494-507. [PMID: 31202742 DOI: 10.1016/j.jcmg.2019.01.039] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/10/2018] [Accepted: 01/05/2019] [Indexed: 12/12/2022]
Abstract
Presentation of myocarditis in athletes is heterogeneous and establishing the diagnosis is challenging with no current uniform clinical gold standard. The combined information from symptoms, electrocardiography, laboratory testing, echocardiography, cardiac magnetic resonance imaging, and in certain cases endomyocardial biopsy helps to establish the diagnosis. Most patients with myocarditis recover spontaneously; however, athletes may be at higher risk of adverse cardiac events. Based on scarce evidence and mainly autopsy studies and expert's opinions, current recommendations generally advise abstinence from competitive sports ranging from a minimum of 3 to 6 months. However, the dilemma poses that (un)necessary prolonged disqualification of athletes to avoid adverse cardiac events can cause considerable disruption to training schedules and tournament preparation and lead to a decline in performance and ability to compete. Therefore, better risk stratification tools are imperatively needed. Using latest available data, this review contrasts existing recommendations and presents a new proposed diagnostic flowchart putting a greater focus on the use of cardiac magnetic resonance imaging in athletes with suspected myocarditis. This may enable cardiac caregivers to counsel athletes with suspected myocarditis more systematically and furthermore allow for pooling of more unified data. To modify recommendations regarding sports behavior in athletes with myocarditis, evidence, based on large multicenter registries including cardiac magnetic resonance imaging and endomyocardial biopsy, is needed. In the future, physicians might rely on combined novel risk stratification methods, by implementing both noninvasive and invasive tissue characterization methods.
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Affiliation(s)
- Christian Eichhorn
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - Loïc Bière
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts; Institut MitoVasc, Laboratoire Cardioprotection, Remodelage et Thrombose, University of Angers, Angers, France; Department of Cardiology, University Hospital of Angers, Angers, France
| | - Frédéric Schnell
- Rennes University Health Centre, Sports Medicine Division, Physiology Laboratories, Rennes-1 University, Rennes, France
| | - Christian Schmied
- Department of Cardiology, University Heart Center, Zurich, Switzerland
| | - Matthias Wilhelm
- Department of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland
| | - Raymond Y Kwong
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christoph Gräni
- Noninvasive Cardiovascular Imaging Section, Cardiovascular Division, Department of Medicine, Brigham and Womens Hospital, Harvard Medical School, Boston, Massachusetts; Department of Cardiology, Swiss Cardiovascular Center, University Hospital Berne, Berne, Switzerland; Cardiac Imaging, Department of Nuclear Medicine, University Hospital Zurich, Zurich, Switzerland.
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Lairez O. Les cardiomyopathies hypertrophiques. Rev Med Interne 2019; 40:380-388. [DOI: 10.1016/j.revmed.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/27/2018] [Accepted: 01/10/2019] [Indexed: 12/25/2022]
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Tian H, Cui J, Yang C, Hu F, Yuan J, Liu S, Yang W, Jiang X, Qiao S. Left ventricular remodeling in hypertrophic cardiomyopathy patients with atrial fibrillation. BMC Cardiovasc Disord 2018; 18:207. [PMID: 30390664 PMCID: PMC6215688 DOI: 10.1186/s12872-018-0945-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/22/2018] [Indexed: 11/10/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common complication in hypertrophic cardiomyopathy (HCM). The mechanisms of AF is associated with left atrial (LA) structural remodeling in HCM patients. However, the impact of left ventricular (LV) remodeling on the presence of AF in HCM patients has not been evaluated yet. We sought to investigate effect of LV remodeling on the presence of AF assessed by cardiovascular magnetic resonance (CMR) in HCM patients. Methods A total of 394 HCM patients were enrolled into this study, including HOCM patients (n = 293) and NOHCM patients (n = 101). Patients were divided into HCM with AF (50) and HCM without AF (n = 344). Data were collected from hospital records. Results LA diameter and LV remodeling index (LVRI) were significantly higher in HCM patients with AF than that of HCM patients without AF (46.6 ± 7.4 mm versus 39.9 ± 8.0 mm, p < 0.001, and 1.46 ± 0.6 versus 1.2 ± 0.4, p = 0.002, respectively). HCM patients with AF were older than HCM patients without AF (53.6 ± 11.7 years versus 47.7 ± 13.6 years, p = 0.002). Additionally, LVRI positively correlated to LA size (r = 0.12, p = 0.02). In a multivariable logistic regression analysis, when adjusting for age and LV end diastolic mass index, LVRI and LA size remained an independent determinant of AF in HCM patients (OR = 4.7, p = 0.001 and OR = 1.13, P < 0.001). Conclusion HCM patients with AF showed significantly more LA diameter, LVRI and age than HCM patients without AF. LVRI and LA size were strong independent predictor of AF in HCM, suggesting LV remodeling may contribute to the occurrence of AF in HCM patients.
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Affiliation(s)
- Hongwei Tian
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jingang Cui
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Chengzhi Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Fenghuan Hu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Jiansong Yuan
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shengwen Liu
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Weixian Yang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Xiaowei Jiang
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Shubin Qiao
- State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
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Cavarretta E, Maffessanti F, Sperandii F, Guerra E, Quaranta F, Nigro A, Minati M, Rebecchi M, Fossati C, Calò L, Pigozzi F. Reference values of left heart echocardiographic dimensions and mass in male peri-pubertal athletes. Eur J Prev Cardiol 2018; 25:1204-1215. [DOI: 10.1177/2047487318776084] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Several articles have proposed reference values in healthy paediatric subjects, but none of them has evaluated a large population of healthy trained adolescents. Design The study purpose was to establish normal echocardiographic measurements of left heart (aortic root, left atrium and left ventricular dimensions and mass) in relation to age, weight, height, body mass index, body surface area and training hours in this specific population. Methods We retrospectively evaluated 2151 consecutive, healthy, peri-pubertal athletes (100% male, mean age 12.4 ± 1.4 years, range 8–18) referred to a single centre for pre-participation screening. All participants were young soccer athletes who trained for a mean of 7.2 ± 1.1 h per week. Results Left ventricular internal diameters, wall thickness, left ventricular mass, aortic root and left atrium diameters were significantly correlated to age, body surface area, height and weight ( p < 0.01). Age, height, weight and body surface area were found associated with chamber size, while body mass index and training hours were not. Inclusion of both age and body size parameters in the statistical models resulted in improved overall explained variance for diameters and left ventricular mass. Conclusion Equations, mean values and percentile charts for the different age groups may be useful as reference data in efficiently assessing left ventricular parameters in young athletes.
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Affiliation(s)
- Elena Cavarretta
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
- Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Francesco Maffessanti
- Centre for Computational Medicine in Cardiology, Institute of Computational Sciences, Università della Svizzera Italiana, Lugano, Switzerland
| | - Fabio Sperandii
- Department of Health Sciences, University of Rome ‘Foro Italico’, Italy
| | - Emanuele Guerra
- Department of Health Sciences, University of Rome ‘Foro Italico’, Italy
- Unit of Sports Medicine, Department of Public Health, AUSL Modena, Italy
| | - Federico Quaranta
- Department of Health Sciences, University of Rome ‘Foro Italico’, Italy
| | - Antonia Nigro
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
- Department of Health Sciences, University of Rome ‘Foro Italico’, Italy
| | - Monia Minati
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Marco Rebecchi
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Chiara Fossati
- Department of Health Sciences, University of Rome ‘Foro Italico’, Italy
| | - Leonardo Calò
- Villa Stuart Sport Clinic, FIFA Medical Centre of Excellence, Rome, Italy
- Department of Health Sciences, University of Rome ‘Foro Italico’, Italy
- Division of Cardiology, Policlinico Casilino, Rome, Italy
| | - Fabio Pigozzi
- Department of Health Sciences, University of Rome ‘Foro Italico’, Italy
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Two-dimensional and three-dimensional left ventricular deformation analysis: a study in competitive athletes. Int J Cardiovasc Imaging 2016; 32:1697-1705. [DOI: 10.1007/s10554-016-0961-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Accepted: 08/08/2016] [Indexed: 10/21/2022]
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Differentiating hypertrophic cardiomyopathy from athlete's heart: An electrocardiographic and echocardiographic approach. J Electrocardiol 2016; 49:539-44. [PMID: 27016258 DOI: 10.1016/j.jelectrocard.2016.03.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Indexed: 11/22/2022]
Abstract
Differential diagnosis of hypertrophic cardiomyopathy (HCM) vs athlete's heart is challenging in individuals with mild-moderate left-ventricular hypertrophy. This study aimed to assess ECG and echocardiographic parameters proposed for the differential diagnosis of HCM. The study included 75 men in three groups: control (n=30), "gray zone" athletes with interventricular septum (IVS) measuring 13-15mm (n=25) and HCM patients with IVS of 13-18mm (n=20). The most significant differences were found in relative septal thickness (RST), calculated as the ratio of 2 x IVS to left ventricle end-diastolic diameter (LV-EDD) (0.37, 0.51, 0.71, respectively; p<0.01) and in spatial QRS-T angle as visually estimated (9.8, 33.6, 66.2, respectively; p<0.01). The capacity for differential HCM diagnosis of each of the 5 criteria was assessed using the area under the curve (AUC), as follows: LV-EDD<54 (0.60), family history (0.61), T-wave inversion (TWI) (0.67), spatial QRS-T angle>45 (0.75) and RST>0.54 (0.92). Pearson correlation between spatial QRS-T angle>45 and TWI was 0.76 (p 0.01). The combination of spatial QRS-T angle>45 and RST>0.54 for diagnosis of HCM had an AUC of 0.79. The best diagnostic criteria for HCM was RST>0.54. The spatial QRS-T angle>45 did not add sensitivity if TWI was present. No additional improvement in differential diagnosis was obtained by combining parameters.
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Mushemi-Blake S, Melikian N, Drasar E, Bhan A, Lunt A, Desai SR, Greenough A, Monaghan MJ, Thein SL, Shah AM. Pulmonary Haemodynamics in Sickle Cell Disease Are Driven Predominantly by a High-Output State Rather Than Elevated Pulmonary Vascular Resistance: A Prospective 3-Dimensional Echocardiography/Doppler Study. PLoS One 2015; 10:e0135472. [PMID: 26270484 PMCID: PMC4535955 DOI: 10.1371/journal.pone.0135472] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 07/22/2015] [Indexed: 01/07/2023] Open
Abstract
AIMS Patients with sickle cell disease have significant morbidity and mortality. Pulmonary hypertension is suggested to be an important contributor but its nature and severity in these patients and how best to non-invasively assess it are controversial. We hypothesised that a high-output state rather than primary pulmonary vascular pathology may be the major abnormality in sickle cell disease. This study aimed to evaluate the characteristics and severity of pulmonary hypertension in patients with sickle cell disease using detailed echocardiography. METHODS AND RESULTS We undertook a prospective study in 122 consecutive stable outpatients with sickle cell disease and 30 age, gender and ethnicity-matched healthy controls. Echocardiographic evaluation included 3D ventricular volumes, sphericity, tissue Doppler, and non-invasive estimation of pulmonary vascular resistance. 36% of patients had a tricuspid regurgitant velocity ≥2.5 m.s(-1) but only 2% had elevated pulmonary vascular resistance and the prevalence of right ventricular dysfunction was very low. Patients with raised tricuspid regurgitant velocity had significantly elevated biventricular volumes and globular left ventricular remodelling, related primarily to anaemia. In a subgroup of patients who underwent cardiac catheterization, invasive pulmonary haemodynamics confirmed the echocardiographic findings. CONCLUSIONS Elevated cardiac output and left ventricular volume overload secondary to chronic anaemia may be the dominant factor responsible for abnormal cardiopulmonary haemodynamics in patients with sickle cell disease. 3D echocardiography with non-invasive estimation of pulmonary vascular resistance represents a valuable approach for initial evaluation of cardiopulmonary haemodynamics in sickle cell disease.
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Affiliation(s)
- Sitali Mushemi-Blake
- King’s College London British Heart Foundation Centre, Cardiovascular Division, London, United Kingdom
- Department of Cardiology, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Narbeh Melikian
- King’s College London British Heart Foundation Centre, Cardiovascular Division, London, United Kingdom
- Department of Cardiology, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Emma Drasar
- Department of Haematological Medicine, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Amit Bhan
- Department of Cardiology, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Alan Lunt
- Department of Paediatrics, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Sujal R. Desai
- Department of Radiology, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Anne Greenough
- Department of Paediatrics, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Mark J. Monaghan
- King’s College London British Heart Foundation Centre, Cardiovascular Division, London, United Kingdom
- Department of Cardiology, King’s College Hospital, Denmark Hill, London, United Kingdom
| | - Swee Lay Thein
- Department of Haematological Medicine, King’s College Hospital, Denmark Hill, London, United Kingdom
- NIH / National Institute of Heart, Lung and Blood Diseases, Sickle Cell Branch, Bethesda, Maryland, United States of America
| | - Ajay M. Shah
- King’s College London British Heart Foundation Centre, Cardiovascular Division, London, United Kingdom
- Department of Cardiology, King’s College Hospital, Denmark Hill, London, United Kingdom
- * E-mail:
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Heggemann F, Grotz H, Welzel G, Dösch C, Hansmann J, Kraus-Tiefenbacher U, Attenberger U, Schönberg SO, Borggrefe M, Wenz F, Papavassiliu T, Lohr F. Cardiac Function After Multimodal Breast Cancer Therapy Assessed With Functional Magnetic Resonance Imaging and Echocardiography Imaging. Int J Radiat Oncol Biol Phys 2015; 93:836-44. [PMID: 26530752 DOI: 10.1016/j.ijrobp.2015.07.2287] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 07/13/2015] [Accepted: 07/29/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE Breast intensity modulated radiation therapy (IMRT) reduces high-dose heart volumes but increases low-dose volumes. We prospectively assessed heart changes after 3D conformal RT (3DCRT) and IMRT for left-sided breast cancer. Heart dose was analyzed individually, 3DCRT patients were moderately exposed, and IMRT was performed only in patients with unacceptably high heart doses upon 3DCRT planning. METHODS AND MATERIALS In 49 patients (38 patients received 3DCRT; 11 patients received IMRT; and 20 patients received neoadjuvant or adjuvant chemotherapy) magnetic resonance imaging (MRI) and echocardiography were performed before and at 6, 12, and 24 months after treatment. RESULTS Mean heart dose for IMRT was 12.9 ± 3.9 Gy versus 4.5 ± 2.4 Gy for 3DCRT. Heart volumes receiving >40 Gy were 2.6% (3DCRT) versus 1.3% (IMRT); doses were >50 Gy only with 3DCRT. Temporary ejection fraction (EF) decrease was observed on MRI after 6 months (63%-59%, P=.005) resolving at 24 months. Only 3 patients had pronounced largely transient changes of EF and left ventricular enddiastolic diameter (LVEDD). Mitral (M) and tricuspid (T) annular plane systolic excursion (MAPSE and TAPSE) were reduced over the whole cohort (still within normal range). After 24 months left ventricular remodeling index decreased in patients receiving chemotherapy (0.80 vs 0.70, P=.028). Neither wall motion abnormalities nor late enhancements were found. On echocardiography, in addition to EF findings that were similar to those on MRI, global strain was unchanged over the whole cohort at 24 months after a transient decrease at 6 and 12 months. Longitudinal strain decreased in the whole cohort after 24 months in some segments, whereas it increased in others. CONCLUSIONS Until 24 months after risk-adapted modern multimodal adjuvant therapy, only subclinical cardiac changes were observed in both 3DCRT patients with inclusion of small to moderate amounts of heart volume in RT tangents and in the patients treated with IMRT and reduced high-dose heart exposure.
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Affiliation(s)
- Felix Heggemann
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; German Center for Cardiovascular Research, Mannheim, Germany.
| | - Hanna Grotz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Christina Dösch
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; German Center for Cardiovascular Research, Mannheim, Germany
| | - Jan Hansmann
- Institute of Diagnostic Radiology and Nuclear Medicine, University Medical Center Mannheim University of Heidelberg, Mannheim, Germany
| | - Uta Kraus-Tiefenbacher
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ulrike Attenberger
- German Center for Cardiovascular Research, Mannheim, Germany; Institute of Diagnostic Radiology and Nuclear Medicine, University Medical Center Mannheim University of Heidelberg, Mannheim, Germany
| | - Stephan Oswald Schönberg
- German Center for Cardiovascular Research, Mannheim, Germany; Institute of Diagnostic Radiology and Nuclear Medicine, University Medical Center Mannheim University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; German Center for Cardiovascular Research, Mannheim, Germany
| | - Frederik Wenz
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
| | - Theano Papavassiliu
- First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; German Center for Cardiovascular Research, Mannheim, Germany
| | - Frank Lohr
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany
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D'Andrea A, Bossone E, Radmilovic J, Caso P, Calabrò R, Russo MG, Galderisi M. The role of new echocardiographic techniques in athlete's heart. F1000Res 2015; 4:289. [PMID: 26664708 PMCID: PMC4654447 DOI: 10.12688/f1000research.6745.1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/15/2015] [Indexed: 01/15/2023] Open
Abstract
‘Athlete’s heart’ is a common term for the various adaptive changes induced by intensive exercise. Exercise causes alterations of the heart in hemodynamic response to the increased systemic and pulmonary demand during exercise. The understanding of these adaptations is of high importance, since they may overlap with those caused by pathological conditions. Cardiac imaging assessment of the athlete’s heart should begin with a complete echocardiographic examination. In recent years classical echocardiographic surveys have been joined by new developments: tissue Doppler imaging, strain rate echocardiography, and real-time 3-dimensional echocardiography. This review paper focuses on the importance of these new echocardiographic techniques in delineating the morphological characteristics and functional properties of the athlete’s heart.
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Affiliation(s)
- Antonello D'Andrea
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | | | - Juri Radmilovic
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | - Pio Caso
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | - Raffaele Calabrò
- Second University of Naples, Monaldi Hospital, Caserta, CE, 81100, Italy
| | | | - Maurizio Galderisi
- Department of Advanced Biomedical Sciences, Federico II University Hospital, Naples, 80138, Italy
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Doesch C, Sperb A, Sudarski S, Lossnitzer D, Rudic B, Tülümen E, Heggemann F, Schimpf R, Schoenberg SO, Borggrefe M, Papavassiliu T. Mitral annular plane systolic excursion is an easy tool for fibrosis detection by late gadolinium enhancement cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Arch Cardiovasc Dis 2015; 108:356-66. [PMID: 25863428 DOI: 10.1016/j.acvd.2015.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 11/13/2014] [Accepted: 01/26/2015] [Indexed: 01/19/2023]
Abstract
BACKGROUND Hypertrophic cardiomyopathy (HCM) causes various degrees of fibrosis resulting in left ventricular function impairment, which can be measured using mitral annular plane systolic excursion (MAPSE). AIMS To determine the values for septal, lateral and average MAPSE using cardiovascular magnetic resonance (CMR) in healthy controls and patients with HCM; and to investigate whether MAPSE correlated with the extent of fibrosis. METHODS Patients with HCM and healthy controls underwent CMR. RESULTS In 50 healthy controls, septal and lateral MAPSE were comparable and showed excellent intra- and inter-observer reliability. Patients with HCM had significantly reduced septal, lateral and average MAPSE compared to healthy controls. Furthermore, in patients with HCM, septal MAPSE measurements were significantly reduced compared to lateral ones. Correspondingly, the septal myocardial segments showed significantly more late gadolinium enhancement (LGE) than lateral ones. No significant differences were found between echocardiographic and CMR MAPSE measurements in healthy controls and patients with HCM. Patients who suffered a major adverse cardiac event or stroke revealed a significantly reduced MAPSE and a significantly greater LGE extent compared to event-free patients with HCM. CONCLUSIONS MAPSE measurement using CMR is feasible, reproducible and comparable to echocardiography in healthy controls and patients with HCM. The asymmetric and mainly septal distribution of myocardial hypertrophy and fibrosis detected by LGE in patients with HCM was reflected by significantly reduced septal versus lateral MAPSE. Therefore, reduced MAPSE seems to be an easily determinable marker of fibrosis accumulation leading to left ventricular mechanical dysfunction and also seems to have a prognostic implication.
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Affiliation(s)
- Christina Doesch
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany.
| | - Amelie Sperb
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Sonja Sudarski
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Dirk Lossnitzer
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Boris Rudic
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Erol Tülümen
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Felix Heggemann
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Rainer Schimpf
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Stefan O Schoenberg
- DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany; Institute of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Martin Borggrefe
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine Cardiology, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany; DZHK (German Centre for Cardiovascular Research) partner site Mannheim, Mannheim, Germany
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Lee JM, Park SJ, Lee SP, Park E, Chang SA, Kim HK, Lee W, Kim YJ, Lee SC, Park SW, Sohn DW, Choe YH. Gender difference in ventricular response to aortic stenosis: insight from cardiovascular magnetic resonance. PLoS One 2015; 10:e0121684. [PMID: 25811358 PMCID: PMC4374835 DOI: 10.1371/journal.pone.0121684] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Accepted: 02/03/2015] [Indexed: 01/20/2023] Open
Abstract
Background Although left ventricular hypertrophy (LVH) and remodeling is associated with cardiac mortality and morbidity, little is known about the impact of gender on the ventricular response in aortic stenosis (AS) patients. This study aimed to analyze the differential effect of gender on ventricular remodeling in moderate to severe AS patients. Methods and Results A total of 118 consecutive patients (67±9 years; 63 males) with moderate or severe AS (severe 81.4%) underwent transthoracic echocardiography and cardiovascular magnetic resonance (CMR) within a 1-month period in this two-center prospective registry. The pattern of LV remodeling was assessed using the LV mass index (LVMI) and LV remodeling index (LVRI; LV mass/LV end-diastolic volume) by CMR. Although there were no differences in AS severity parameters nor baseline characteristics between genders, males showed a significantly higher LVMI (102.6±29.1g/m2 vs. 86.1±29.2g/m2, p=0.003) and LVRI (1.1±0.2 vs. 1.0±0.3, p=0.018), regardless of AS severity. The LVMI was significantly associated with aortic valve area (AVA) index and valvuloarterial impedance in females, whereas it was not in males, resulting in significant interaction between genders (PInteraction=0.007/0.014 for AVA index/valvuloarterial impedance, respectively). Similarly, the LVRI also showed a significantly different association between male and female subjects with the change in AS severity parameters (PInteraction=0.033/<0.001/0.029 for AVA index/transaortic mean pressure gradient/valvuloarterial impedance, respectively). Conclusion Males are associated with greater degree of LVH and higher LVRI compared to females at moderate to severe AS. However, females showed a more exaggerated LV remodeling response, with increased severity of AS and hemodynamic loads, than males.
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Affiliation(s)
- Joo Myung Lee
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-Ji Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung-Pyo Lee
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
- * E-mail:
| | - Eunah Park
- Department of Radiology, Seoul National University Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sung-A Chang
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyung-Kwan Kim
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong-Jin Kim
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang-Chol Lee
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woo Park
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dae-Won Sohn
- Cardiovascular Center, Sungkyunkwan University School of Medicine, Seoul, Korea
- Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yeon Hyeon Choe
- Cardiovascular Imaging Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Schuler B, Rieger G, Gubser M, Arras M, Gianella M, Vogel O, Jirkof P, Cesarovic N, Klohs J, Jakob P, Brock M, Gorr TA, Baum O, Hoppeler H, Samillan-Soto V, Gassmann M, Fischer JA, Born W, Vogel J. Endogenous α-calcitonin-gene-related peptide promotes exercise-induced, physiological heart hypertrophy in mice. Acta Physiol (Oxf) 2014; 211:107-21. [PMID: 24479375 DOI: 10.1111/apha.12244] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 10/10/2013] [Accepted: 01/24/2014] [Indexed: 11/29/2022]
Abstract
AIM It is unknown how the heart distinguishes various overloads, such as exercise or hypertension, causing either physiological or pathological hypertrophy. We hypothesize that alpha-calcitonin-gene-related peptide (αCGRP), known to be released from contracting skeletal muscles, is key at this remodelling. METHODS The hypertrophic effect of αCGRP was measured in vitro (cultured cardiac myocytes) and in vivo (magnetic resonance imaging) in mice. Exercise performance was assessed by determination of maximum oxygen consumption and time to exhaustion. Cardiac phenotype was defined by transcriptional analysis, cardiac histology and morphometry. Finally, we measured spontaneous activity, body fat content, blood volume, haemoglobin mass and skeletal muscle capillarization and fibre composition. RESULTS While αCGRP exposure yielded larger cultured cardiac myocytes, exercise-induced heart hypertrophy was completely abrogated by treatment with the peptide antagonist CGRP(8-37). Exercise performance was attenuated in αCGRP(-/-) mice or CGRP(8-37) treated wild-type mice but improved in animals with higher density of cardiac CGRP receptors (CLR-tg). Spontaneous activity, body fat content, blood volume, haemoglobin mass, muscle capillarization and fibre composition were unaffected, whereas heart index and ventricular myocyte volume were reduced in αCGRP(-/-) mice and elevated in CLR-tg. Transcriptional changes seen in αCGRP(-/-) (but not CLR-tg) hearts resembled maladaptive cardiac phenotype. CONCLUSIONS Alpha-calcitonin-gene-related peptide released by skeletal muscles during exercise is a hitherto unrecognized effector directing the strained heart into physiological instead of pathological adaptation. Thus, αCGRP agonists might be beneficial in heart failure patients.
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Affiliation(s)
- B. Schuler
- Institute of Veterinary Physiology; Vetsuisse Faculty University of Zürich; Zürich Switzerland
- Department of Physiology, Anatomy and Genetics; University of Oxford; Oxford UK
| | - G. Rieger
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - M. Gubser
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - M. Arras
- Division of Surgical Research; University Hospital Zürich; Zürich Switzerland
| | - M. Gianella
- Institute of Veterinary Physiology; Vetsuisse Faculty University of Zürich; Zürich Switzerland
| | - O. Vogel
- Institute of Veterinary Physiology; Vetsuisse Faculty University of Zürich; Zürich Switzerland
| | - P. Jirkof
- Division of Surgical Research; University Hospital Zürich; Zürich Switzerland
| | - N. Cesarovic
- Division of Surgical Research; University Hospital Zürich; Zürich Switzerland
| | - J. Klohs
- Institute for Biomedical Engineering; University of Zurich and Swiss Federal Institute of Technology; Zürich (ETHZ); Zürich Switzerland
| | - P. Jakob
- Institute of Physiology and Cardiovascular Research; University of Zürich; Zürich Switzerland
| | - M. Brock
- Division of Pulmonology; University Hospital Zürich; Zürich Switzerland
- Zürich Center for Integrative Human Physiology (ZIHP); Zürich Switzerland
| | - T. A. Gorr
- Institute of Veterinary Physiology; Vetsuisse Faculty University of Zürich; Zürich Switzerland
- Clinic IV; Division of Pediatric Hematology and Oncology; University Medical Center; Freiburg Germany
| | - O. Baum
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - H. Hoppeler
- Institute of Anatomy; University of Bern; Bern Switzerland
| | - V. Samillan-Soto
- Institute of Veterinary Physiology; Vetsuisse Faculty University of Zürich; Zürich Switzerland
- Physiology Department; Medical School; Universidad Alas Peruanas; Lima Peru
| | - M. Gassmann
- Institute of Veterinary Physiology; Vetsuisse Faculty University of Zürich; Zürich Switzerland
- Zürich Center for Integrative Human Physiology (ZIHP); Zürich Switzerland
- Universidad Peruana Cayetano Heredia (UPCH); Lima Peru
| | - J. A. Fischer
- Former Research Laboratory for Calcium Metabolism; Orthopedic University Hospital Zürich; Zürich Switzerland
| | - W. Born
- Former Research Laboratory for Calcium Metabolism; Orthopedic University Hospital Zürich; Zürich Switzerland
| | - J. Vogel
- Institute of Veterinary Physiology; Vetsuisse Faculty University of Zürich; Zürich Switzerland
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Gender-specific differences in left ventricular remodelling and fibrosis in hypertrophic cardiomyopathy: Insights from cardiovascular magnetic resonance. Eur J Heart Fail 2014; 10:850-4. [DOI: 10.1016/j.ejheart.2008.06.021] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2007] [Revised: 04/23/2008] [Accepted: 06/09/2008] [Indexed: 11/21/2022] Open
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Luijkx T, Cramer MJ, Buckens CF, Zaidi A, Rienks R, Mosterd A, Prakken NHJ, Dijkman B, Mali WPT, Velthuis BK. Unravelling the grey zone: cardiac MRI volume to wall mass ratio to differentiate hypertrophic cardiomyopathy and the athlete's heart. Br J Sports Med 2013; 49:1404-9. [DOI: 10.1136/bjsports-2013-092360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2013] [Indexed: 11/03/2022]
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37
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Remmelink M, Sjauw KD, Yong ZY, Haeck JDE, Vis MM, Koch KT, Tijssen JGP, de Winter RJ, Henriques JPS, Piek JJ, Baan J. Coronary microcirculatory dysfunction is associated with left ventricular dysfunction during follow-up after STEMI. Neth Heart J 2013; 21:238-44. [PMID: 23423600 PMCID: PMC3636343 DOI: 10.1007/s12471-013-0382-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Coronary microvascular resistance is increased after primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI), which may be related in part to changed left ventricular (LV) dynamics. Therefore we studied the coronary microcirculation in relation to systolic and diastolic LV function after STEMI. METHODS The study cohort consisted of 12 consecutive patients, all treated with primary PCI for a first anterior wall STEMI. At 4 months, we assessed pressure-volume loops. Subsequently, we measured intracoronary pressure and flow velocity and calculated coronary microvascular resistance. Infarct size and LV mass were assessed using magnetic resonance imaging. RESULTS Patients with an impaired systolic LV function due to a larger myocardial infarction showed a higher baseline average peak flow velocity (APV) than the other patients (26 ± 7 versus 17 ± 5 cm/s, p = 0.003, respectively), and showed an impaired variable microvascular resistance index (2.1 ± 1.0 versus 4.1 ± 1.3 mmHg cm(-1)∙s(-1), p = 0.003, respectively). Impaired diastolic relaxation time was inversely correlated with hyperaemic APV (r = -0.56, p = 0.003) and positively correlated with hyperaemic microvascular resistance (r = 0.48, p = 0.01). LV dilatation was associated with a reduced variable microvascular resistance index (r = 0.78, p = 0.006). CONCLUSION A larger anterior myocardial infarction results in impaired LV performance associated with reduced coronary microvascular resistance variability, in particular due to higher coronary blood flow at baseline in these compromised left ventricles.
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Affiliation(s)
- M Remmelink
- Department of Cardiology, Academic Medical Centre-University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, the Netherlands,
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Engeli S, Utz W, Haufe S, Lamounier-Zepter V, Pofahl M, Traber J, Janke J, Luft FC, Boschmann M, Schulz-Menger J, Jordan J. Fatty acid binding protein 4 predicts left ventricular mass and longitudinal function in overweight and obese women. Heart 2013; 99:944-8. [PMID: 23598540 DOI: 10.1136/heartjnl-2013-303735] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore whether increased adipocyte-derived serum fatty acid binding protein 4 (FABP4) predisposes to cardiac remodelling and left ventricular dysfunction in human obesity. DESIGN Cross-sectional investigation. SETTING Academic clinical research centre. PATIENTS 108 overweight and obese non-diabetic women (body-mass index 33 ± 5 kg/m2). INTERVENTIONS None. MAIN OUTCOME MEASURES Relationship between serum FABP4 and abdominal adipose tissue quantified by MRI. Relationship between serum FABP4 and left ventricular morphology and function assessed by cardiac MRI. RESULTS FABP4 was independently associated with visceral abdominal adipose tissue (β=0.34, p<0.01) and subcutaneous abdominal adipose tissue (β=0.22, p<0.05). After stratification into serum FABP4 tertiles, left ventricular masses were 92 ± 16 g, 86 ± 13 g and 81 ± 12 g in women with high, intermediate and low FABP4 concentrations (p<0.01), respectively. Longitudinal systolic function was reduced by 8% in women with intermediate and high versus low FABP4 concentrations (p<0.01), whereas ejection fraction did not differ among tertiles (p=0.5). In multivariate linear analysis FABP4 remained an independent predictor of left ventricular mass (β=0.17, p<0.05) and reduced longitudinal fractional shortening (β=0.21, p<0.05). CONCLUSIONS In overweight and obese women, FABP4 showed an independent association with parameters of left ventricular remodelling.
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Affiliation(s)
- Stefan Engeli
- Institute of Clinical Pharmacology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany.
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Doesch C, Streitner F, Bellm S, Suselbeck T, Haghi D, Heggemann F, Schoenberg SO, Michaely H, Borggrefe M, Papavassiliu T. Epicardial adipose tissue assessed by cardiac magnetic resonance imaging in patients with heart failure due to dilated cardiomyopathy. Obesity (Silver Spring) 2013; 21:E253-61. [PMID: 23592680 DOI: 10.1002/oby.20149] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 08/30/2012] [Accepted: 10/10/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We sought to investigate the association of the EAT with CMR parameters of ventricular remodelling and left ventricular (LV) dysfunction in patients with non-ischemic dilated cardiomyopathy (DCM). DESIGN AND METHODS One hundred and fifty subjects (112 consecutive patients with DCM and 48 healthy controls) underwent CMR examination. Function, volumes, dimensions, the LV remodelling index (LVRI), the presence of late gadolinium enhancement (LGE) and the amount of EAT were assessed. RESULTS Compared to healthy controls, patients with DCM revealed a significantly reduced indexed EAT mass (31.7 ± 5.6 g/m(2) vs 24.0 ± 7.5 g/m(2) , p<0.0001). There was no difference in the EAT mass between DCM patients with moderate and severe LV dysfunction (23.5 ± 9.8 g/m(2) vs 24.2 ± 6.6 g/m(2) , P = 0.7). Linear regression analysis in DCM patients showed that with increasing LV end-diastolic mass index (LV-EDMI) (r = 0.417, P < 0.0001), increasing LV end-diastolic volume index (r = 0.251, P = 0.01) and increasing LV end-diastolic diameter (r = 0.220, P = 0.02), there was also a significantly increased amount of EAT mass. However, there was no correlation between the EAT and the LV ejection fraction (r = 0.0085, P = 0.37), right ventricular ejection fraction (r = 0.049, P = 0.6), LVRI (r = 0.116, P = 0.2) and the extent of LGE % (r = 0.189, P = 0.1). Among the healthy controls, the amount of EAT only correlated with increasing age (r = 0.461, P = 0.001), BMI (r = 0.426, P = 0.003) and LV-EDMI (r = 0.346, P = 0.02). CONCLUSION In patients with DCM the amount of EAT is decreased compared to healthy controls irrespective of LV function impairment. However, an increase in LV mass and volumes is associated with a significantly increase in EAT in patients with DCM.
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Affiliation(s)
- Christina Doesch
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany.
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Li QM, Li B, Sun YF, Zhang H, Yang XL, Cai LW, Chen H, Ding YH, Jiang J. Association of HLA-DRB1 single nucleotide polymorphisms with left ventricular remodelling in elderly patients with essential hypertension. J Int Med Res 2013; 40:2152-9. [PMID: 23321172 DOI: 10.1177/030006051204000613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To investigate the associations between human leucocyte antigen DRβ1 (HLA-DRB1) gene polymorphisms and cardiovascular remodelling (left ventricular dilatation [LVD]) in Han Chinese patients ≥ 60 years old, with essential hypertension. METHODS LVD was diagnosed via echocardiographic measurements. Multiplex polymerase chain reaction-ligase detection reaction was used to determine the genotypes of three HLA-DRB1 single nucleotide polymorphisms (SNPs; rs2308765, rs9269186 and rs3135388). RESULTS HLADRB1 rs2308765 wild-type (G) allele and genotype (GG) were associated with decreased risk of LVD. HLA-DRB1 rs9269186 and rs3135388 were not associated with LVD risk. Mean waist and abdominal circumferences were significantly larger in patients with, compared with those without, LVD. Multivariate logistic regression analyses found that rs2308765 was associated with LVD (GT + TT versus GG; odds ratio 7.958; 95% confidence interval 1.935, 32.723). CONCLUSIONS Mutation in HLA-DRB1 rs2308765 was associated with increased risk of LVD in elderly patients with hypertension. Genotype analysis may allow identification of patients at high risk of cardiovascular events such LVD.
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Affiliation(s)
- Q M Li
- First Hospital, Jilin University, Changchun, China
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Cavarretta E, Casella G, Calì B, Dammaro C, Biondi-Zoccai G, Iossa A, Leonetti F, Frati G, Basso N. Cardiac Remodeling in Obese Patients After Laparoscopic Sleeve Gastrectomy. World J Surg 2012; 37:565-72. [PMID: 23254944 DOI: 10.1007/s00268-012-1874-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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El-Hamamsy I, Lekadir K, Olivotto I, El Guindy A, Merrifield R, Rega L, Yang G, Cecchi F, Yacoub MH. Pattern and degree of left ventricular remodeling following a tailored surgical approach for hypertrophic obstructive cardiomyopathy. Glob Cardiol Sci Pract 2012; 2012:9. [PMID: 25610840 PMCID: PMC4239823 DOI: 10.5339/gcsp.2012.9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 05/30/2012] [Indexed: 01/20/2023] Open
Abstract
Background The role of a tailored surgical approach for hypertrophic cardiomyopathy (HCM) on regional ventricular remodelling remains unknown. The aims of this study were to evaluate the pattern, extent and functional impact of regional ventricular remodelling after a tailored surgical approach. Methods From 2005 to 2008, 44 patients with obstructive HCM underwent tailored surgical intervention. Of those, 14 were ineligible for cardiac magnetic resonance (CMR) studies. From the remainder, 14 unselected patients (42±12 years) underwent pre- and post-operative CMR studies at a median 12 months post-operatively (range 4–37 months). Regional changes in left ventricular (LV) thickness as well as global LV function following surgery were assessed using CMR Tools (London, UK). Results Pre-operative mean echocardiographic septal thickness was 21±4 mm and mean LV outflow gradient was 69±32 mmHg. Following surgery, there was a significant degree of regional regression of LV thickness in all segments of the LV, ranging from 16% in the antero-lateral midventricular segment to 41% in the anterior basal segment. Wall thickening was significantly increased in basal segments but showed no significant change in the midventricular or apical segments. Globally, mean indexed LV mass decreased significantly after surgery (120±29g/m2 versus 154±36g/m2; p<0.001). There was a trend for increased indexed LV end-diastolic volume (70±13 mL versus 65±11 mL; p=0.16) with a normalization of LV ejection fraction (68±7% versus 75±9%; p<0.01). Conclusion Following a tailored surgical relief of outflow obstruction for HCM, there is a marked regional reverse LV remodelling. These changes could have a significant impact on overall ventricular dynamics and function.
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Affiliation(s)
- Ismail El-Hamamsy
- Department of Cardiac Surgery, Montreal Heart Institute, Universite de Montreal, Montreal, Canada ; Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK
| | | | - Iacopo Olivotto
- Department of Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Ahmed El Guindy
- Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK
| | | | - Luigi Rega
- Department of Radiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | | | - Franco Cecchi
- Department of Cardiology, Azienda Ospedaliera Universitaria Careggi, Florence, Italy
| | - Magdi H Yacoub
- Harefield Heart Science Center, National Heart and Lung Institute, Imperial College London, UK
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Peters BS, Dornaika R, Hosten N, Hadlich S, Mullins JJ, Peters J, Rettig R. Regression of cardiac hypertrophy in cyp1a1ren-2 transgenic rats. J Magn Reson Imaging 2012; 36:373-8. [PMID: 22517449 DOI: 10.1002/jmri.23661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Accepted: 03/07/2012] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To evaluate the usefulness of the cyp1a1ren-2 transgenic rat model of inducible hypertension for studies of the development and regression of cardiac hypertrophy. MATERIALS AND METHODS Cyp1a1ren-2 rats received a diet containing 0% or 0.167% indole-3-carbinonl (I3C) for 4 weeks to induce hypertension. Cardiac magnetic resonance imaging (MRI) at 7 T was performed every second week for 10 weeks to measure left ventricular mass and the ejection fraction. Concomitantly, in six cyp1a1ren-2 rats blood pressure was recorded telemetrically. RESULTS Plasma prorenin concentrations rose from 138 ± 38 to 15,490 ± 3990 ng/angiotensin I/mL/h (P < 0.001) in I3C-treated transgenic rats and returned to basal levels after cessation of I3C. Mean blood pressure increased to a plateau of 169 ± 11 mmHg by the second week of induction. After cessation of I3C (day 28), arterial pressure dropped to values slightly below those prior to induction within 4 days (basal: 106 ± 7 mmHg, day 32: 103 ± 21 mmHg; NS). At day 28, left ventricular mass was increased by 39% vs. 4% in controls (P < 0.001) without changes of the ejection fraction. Cardiac hypertrophy was completely reversed at day 70, as evaluated by MRI. CONCLUSION The cyp1a1ren-2 transgenic rat is a useful model to study reversal and healing in the absence of surgical interventions.
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Affiliation(s)
- Barbara S Peters
- Department of Cardiovascular Medicine, Institute of Physiology, University of Greifswald, Karlsburg, Germany.
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Corbetti F, Razzolini R, Bettini V, Marshall JD, Naggert J, Tona F, Milan G, Maffei P. Alström syndrome: cardiac magnetic resonance findings. Int J Cardiol 2012; 167:1257-63. [PMID: 22498418 DOI: 10.1016/j.ijcard.2012.03.160] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2011] [Revised: 03/08/2012] [Accepted: 03/18/2012] [Indexed: 01/26/2023]
Abstract
BACKGROUND Alström Syndrome (ALMS) is an extremely rare multiorgan disease caused by mutations in ALMS1. Dilated cardiomyopathy (DCM) is a common finding but only one series has been investigated by Cardiac Magnetic Resonance (CMR). METHODS Eight genetically proven ALMS patients (ages 11-41) underwent CMR performed by standard cine steady state, T1, T2 and late gadolinium enhancement (LGE) sequences. Ejection fraction (EF), Diastolic Volume (EDV) and Systolic Volume normalized for body surface area (ESV), and mass indices were determined, as well as EDV/Mass ratio, an index expressing the adequacy of cardiac mass to heart volume. Regional fibrosis was assessed by LGE; diffuse fibrosis was measured by a TI scout sequence acquired at 5, 10 and 15 min after gadolinium by comparing inversion time values (TI) at null time in ALMS and control group. RESULTS In one patient severe DCM was present with diffuse LGE. There were seven cases without clinical DCM. In these patients, EF was at lower normal limits or slightly reduced and ESV index increased; six patients had decreased mass index and EDV/Mass ratio. Mild regional non ischemic fibrosis was detected by LGE in three cases; diffuse fibrosis was observed in all cases, as demonstrated by shorter TI values in ALMS in comparison with controls (5 min: 152 ± 12 vs 186 ± 16, p 0.0002; 10 min: 175 ± 8 vs 204 ± 18, p 0.0012; 15 min: 193 ± 9 vs 224 ± 16, p 0.0002). CONCLUSIONS Cardiac involvement in ALMS is characterized by progressive DCM, associated with systolic dysfunction, myocardial fibrosis and reduced myocardial mass.
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Pressman GS, Figueredo VM, Romero-Corral A, Murali G, Kotler MN. Effect of obstructive sleep apnea on mitral valve tenting. Am J Cardiol 2012; 109:1055-9. [PMID: 22264596 DOI: 10.1016/j.amjcard.2011.11.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 11/16/2011] [Accepted: 11/16/2011] [Indexed: 11/18/2022]
Abstract
Obstructive apneas produce high negative intrathoracic pressure that imposes an afterload burden on the left ventricle. Such episodes might produce structural changes in the left ventricle over time. Doppler echocardiograms were obtained within 2 months of attended polysomnography. Patients were grouped according to apnea-hypopnea index (AHI): mild/no obstructive sleep apnea (OSA; AHI <15) and moderate/severe OSA (AHI ≥15). Mitral valve tenting height and area, left ventricular (LV) long and short axes, and LV end-diastolic volume were measured in addition to tissue Doppler parameters. Comparisons of measurements at baseline and follow-up between and within groups were obtained; correlations between absolute changes (Δ) in echocardiographic parameters were also performed. After a mean follow-up of 240 days mitral valve tenting height increased significantly (1.17 ± 0.12 to 1.28 ± 0.17 cm, p = 0.001) in moderate/severe OSA as did tenting area (2.30 ± 0.41 to 2.66 ± 0.60 cm(2), p = 0.0002); Δtenting height correlated with ΔLV end-diastolic volume (rho 0.43, p = 0.01) and Δtenting area (rho 0.35, p = 0.04). In patients with mild/no OSA there was no significant change in tenting height; there was a borderline significant increase in tenting area (2.20 ± 0.44 to 2.31 ± 0.43 cm(2), p = 0.05). Septal tissue Doppler early diastolic wave decreased (8.04 ± 2.49 to 7.10 ± 1.83 cm/s, p = 0.005) in subjects with moderate/severe OSA but not in in those with mild/no OSA. In conclusion, in patients with moderate/severe OSA, mitral valve tenting height and tenting area increase significantly over time. This appears to be related, at least in part, to changes in LV geometry.
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Affiliation(s)
- Gregg S Pressman
- Department of Medicine, Division of Cardiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
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Three-dimensional echocardiographic characterization of left ventricular remodeling in Olympic athletes. Am J Cardiol 2011; 108:141-7. [PMID: 21550573 DOI: 10.1016/j.amjcard.2011.02.350] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 02/19/2011] [Accepted: 02/19/2011] [Indexed: 11/22/2022]
Abstract
The aim of the present study was to assess, using 3-dimensioanl echocardiography, the morphologic characteristics, determinants, and physiologic limits of left ventricular (LV) remodeling in 511 Olympic athletes (categorized in skill, power, mixed, and endurance sport disciplines) and 159 sedentary controls matched for age and gender. All subjects underwent 3-dimensional echocardiography for the assessment of LV volumes, ejection fraction, mass, remodeling index (LV mass/LV end-diastolic volume), and systolic dyssynchrony index (obtained by the dispersion of the time to minimum systolic volume in 16 segments). Athletes had higher LV end-diastolic volumes (157 ± 35 vs 111 ± 26 ml, p <0.001) and mass (156 ± 38 vs 111 ± 25 g, p <0.001) compared to controls. Body surface area and age had significant associations with LV end-diastolic volume (R(2) = 0.49, p <0.001) and mass (R(2) = 0.51, p <0.001). Covariance analysis showed that also gender and type of sport were significant determinants of LV remodeling; in particular, the highest impact on LV end-diastolic volume and mass was associated with male gender and endurance disciplines (p <0.001). Regardless of the type of sport, athletes had similar LV remodeling indexes to controls (1.00 ± 0.06 vs 1.01 ± 0.07 g/mL, p = 0.410). No differences were found between athletes and controls for the ejection fraction (62 ± 5% and 62 ± 5%, p = 0.746) and systolic dyssynchrony index (1.06 ± 0.40% and 1.37 ± 0.41%, p = 0.058). In conclusion, 3-dimensional echocardiographic morphologic and functional assessment of the left ventricle in Olympic athletes demonstrated a balanced adaptation of LV volume and mass, with preserved systolic function, regardless of specific disciplines participated.
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Left ventricular systolic performance is improved in elite athletes. EUROPEAN JOURNAL OF ECHOCARDIOGRAPHY 2011; 12:514-9. [DOI: 10.1093/ejechocard/jer071] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Kaku K, Takeuchi M, Otani K, Sugeng L, Nakai H, Haruki N, Yoshitani H, Watanabe N, Yoshida K, Otsuji Y, Mor-Avi V, Lang RM. Age- and Gender-Dependency of Left Ventricular Geometry Assessed with Real-Time Three-Dimensional Transthoracic Echocardiography. J Am Soc Echocardiogr 2011; 24:541-7. [DOI: 10.1016/j.echo.2011.01.011] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Indexed: 12/01/2022]
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Mazur W, Hor KN, Germann JT, Fleck RJ, Al-Khalidi HR, Wansapura JP, Chung ES, Taylor MD, Jefferies JL, Benson DW, Gottliebson WM. Patterns of left ventricular remodeling in patients with Duchenne Muscular Dystrophy: a cardiac MRI study of ventricular geometry, global function, and strain. Int J Cardiovasc Imaging 2011; 28:99-107. [PMID: 21222036 DOI: 10.1007/s10554-010-9781-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 12/22/2010] [Indexed: 01/02/2023]
Abstract
The cardiac disease ubiquitously associated in Duchenne Muscular Dystrophy (DMD) has traditionally been considered a progressive dilated cardiomyopathy (DCM). However, left ventricular (LV) dilatation as measured with cardiac MRI has not been a consistent finding in this population, even as circumferential strain (ε(cc)) declines with advancing disease. We hypothesized that a distinct pattern of changes in LV geometry, during the course of ε(cc) decline, distinguishes DMD associated heart disease from DCM. Using CMR, LV end-diastolic volume (EDV), mass (LVM), ejection fraction, ε(cc) and myocardial delayed enhancement (MDE) were determined in DMD patients and normal control subjects. The LV Remodeling Index (LVRI) was calculated as the ratio of LV Mass to Volume (LVM/EDV). Statistical comparisons between all LV parameters and genotype were also performed. Median LVRI in DMD (n = 127) and control subjects (n = 41) were different (0.75 vs. 0.65, P = 0.0150) but within normal range. Furthermore, the median LVRI in DMD boys with reduced LV systolic function was significantly reduced compared to those with normal LV systolic function (0.64 vs. 0.75, P = 0.0974). However, the presence of MDE was associated with a lower median LVRI (0.57 vs. 0.76, P = 0.0471). Regression analysis showed no significant correlation between ε(cc) and LVRI (r = -0.03). The LVRI of DMD patients is unexpectedly normal and not correlated with ε(cc.) Based on these findings, DMD-associated heart disease exhibits a unique remodeling pattern distinct from DCM.
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Affiliation(s)
- Wojciech Mazur
- The Heart and Vascular Center at the Christ Hospital, Cincinnati, OH, USA.
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Doesch C, Haghi D, Flüchter S, Suselbeck T, Schoenberg SO, Michaely H, Borggrefe M, Papavassiliu T. Epicardial adipose tissue in patients with heart failure. J Cardiovasc Magn Reson 2010; 12:40. [PMID: 20624277 PMCID: PMC2914772 DOI: 10.1186/1532-429x-12-40] [Citation(s) in RCA: 91] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2009] [Accepted: 07/12/2010] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the extent of epicardial adipose tissue (EAT) and its relationship with left ventricular (LV) parameters assessed by cardiovascular magnetic resonance (CMR) in patients with congestive heart failure (CHF) and healthy controls. BACKGROUND EAT is the true visceral fat deposited around the heart which generates various bioactive molecules. Previous studies found that EAT is related to left ventricular mass (LVM) in healthy subjects. Further studies showed a constant EAT to myocardial mass ratio in normal, ischemic and hypertrophied hearts. METHODS CMR was performed in 66 patients with CHF due to ischemic cardiomyopathy (ICM), or dilated cardiomyopathy (DCM) and 32 healthy controls. Ventricular volumes, dimensions and LV function were assessed. The amount of EAT was determined volumetrically and expressed as mass indexed to body surface area. Additionally, the EAT/LVM and the EAT/left ventricular remodelling index (LVRI) ratios were calculated. RESULTS Patients with CHF had less indexed EAT mass than controls (22 +/- 5 g/m2 versus 34 +/- 4 g/m2, p < 0.0001). In the subgroup analysis there were no significant differences in indexed EAT mass between patients with ICM and DCM (21 +/- 4 g/m2 versus 23 +/- 6 g/m2, p = 0.14). Linear regression analysis showed that with increasing LV end-diastolic diameter (LV-EDD) (r = 0.42, p = 0.0004) and LV end-diastolic mass (LV-EDM) (r = 0.59, p < 0.0001), there was a significantly increased amount of EAT in patients with CHF. However, the ratio of EAT mass/LV-EDM was significantly reduced in patients with CHF compared to healthy controls (0.54 +/- 0.1 versus 0.21 +/- 0.1, p < 0.0001). In CHF patients higher indexed EAT/LVRI-ratios in CHF patients correlated best with a reduced LV-EF (r = 0.49, p < 0.0001). CONCLUSION Patients with CHF revealed significantly reduced amounts of EAT. An increase in LVM is significantly related to an increase in EAT in both patients with CHF and controls. However, different from previous reports the EAT/LVEDM-ratio in patients with CHF was significantly reduced compared to healthy controls. Furthermore, the LV function correlated best with the indexed EAT/LVRI ratio in CHF patients. Metabolic abnormalities and/or anatomic alterations due to disturbed cardiac function and geometry seem to play a key role and are a possible explanation for these findings.
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Affiliation(s)
- Christina Doesch
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Dariusch Haghi
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Stephan Flüchter
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Tim Suselbeck
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Stefan O Schoenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Henrik Michaely
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Martin Borggrefe
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
| | - Theano Papavassiliu
- 1st Department of Medicine, University Medical Centre Mannheim, Medical Faculty Mannheim, University of Heidelberg, Germany
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