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Yokokawa D, Kuroki Y, Mochizuki Y, Oda A, Gohbara S, Yamamoto Y, Ichikawa-Ogura S, Hachiya R, Toyosaki E, Fukuoka H, Sunagawa M, Shinke T. Predominant determinants for evaluation of right parasternal approach in transthoracic echocardiography in aortic stenosis: a study based on three-dimensional cardiac computed tomography analysis. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-024-03160-5. [PMID: 38874672 DOI: 10.1007/s10554-024-03160-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/06/2024] [Indexed: 06/15/2024]
Abstract
The maximum blood flow velocity through the aortic valve (AVmax) using Doppler transthoracic echocardiography (TTE) is important in assessing the severity of aortic stenosis (AS). The right parasternal (RP) approach has been reported to be more useful than the apical approach, but the anatomical rationale has not been studied. We aimed to clarify the influence of the angle formed by the ascending aorta and left ventricle on Doppler analysis by TTE (Sep-Ao angle) and three-dimensional multidetector computed tomography (3D-MDCT) in patients with AS. A total of 151 patients evaluated using the RP approach and 3D-MDCT were included in this study. The Sep-Ao angle determined using TTE was compared with that determined using 3D-MDCT analysis. In MDCT analysis, the left ventricular (LV) axis was measured in two ways and the calcification score was calculated simultaneously. The Sep-Ao angle on TTE was consistent with that measured using 3D-MDCT. In patients with an acute Sep-Ao angle, the Doppler angle in the apical approach was larger, potentially underestimating AVmax. Multivariate analysis revealed that an acute Sep-Ao angle, large Doppler angle in the apical approach, smaller Doppler angle in the RP approach, and low aortic valve calcification were independently associated with a higher AVmax in the RP approach than in the apical approach. The Sep-Ao angle measured using TTE reflected the 3D anatomical angle. In addition to measurements using the RP approach, technical adjustments to minimize the Doppler angle to avoid bulky calcification should always be noted for accurate assessment.
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Affiliation(s)
- Daisuke Yokokawa
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yui Kuroki
- Ultrasound Examination Center, Showa University, Tokyo, Japan
| | - Yasuhide Mochizuki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan.
| | - Ayaka Oda
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Sakiko Gohbara
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Yumi Yamamoto
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Saaya Ichikawa-Ogura
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Rumi Hachiya
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Eiji Toyosaki
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Hiroto Fukuoka
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
| | - Masataka Sunagawa
- Department of Physiology, Showa University Graduate School of Medicine, Tokyo, Japan
| | - Toshiro Shinke
- Division of Cardiology, Department of Medicine, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-Ku, Tokyo, 142-8555, Japan
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2
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Abbasi M, Ong KC, Newman DB, Dearani JA, Schaff HV, Geske JB. Obstruction in Hypertrophic Cardiomyopathy: Many Faces. J Am Soc Echocardiogr 2024; 37:613-625. [PMID: 38428652 DOI: 10.1016/j.echo.2024.02.010] [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: 12/21/2023] [Revised: 02/13/2024] [Accepted: 02/18/2024] [Indexed: 03/03/2024]
Abstract
Hypertrophic cardiomyopathy (HCM), the most common inherited cardiomyopathy, exhibits left ventricular hypertrophy not secondary to other causes, with varied phenotypic expression. Enhanced actin-myosin interaction underlies excessive myocardial contraction, frequently resulting in dynamic obstruction within the left ventricle. Left ventricular outflow tract obstruction, occurring at rest or with provocation in 75% of HCM patients, portends adverse prognosis, contributes to symptoms, and is frequently a therapeutic target. Transthoracic echocardiography plays a crucial role in the screening, initial diagnosis, management, and risk stratification of HCM. Herein, we explore echocardiographic evaluation of HCM, emphasizing Doppler assessment for obstruction. Echocardiography informs management strategies through noninvasive hemodynamic assessment, which is frequently obtained with various provocative maneuvers. Recognition of obstructive HCM phenotypes and associated anatomical abnormalities guides therapeutic decision-making. Doppler echocardiography allows monitoring of therapeutic responses, whether it be medical therapies (including cardiac myosin inhibitor therapy) or septal reduction therapies, including surgical myectomy and alcohol septal ablation. This article discusses the hemodynamics of obstruction and practical application of Doppler assessment in HCM. In addition, it provides a visual atlas of obstruction in HCM, including high-quality figures and complementary videos that illustrate the many facets of dynamic obstruction.
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Affiliation(s)
- Muhannad Abbasi
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Kevin C Ong
- Division of Cardiology, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - D Brian Newman
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Hartzell V Schaff
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey B Geske
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota.
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3
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Smedira NG. Mitral Leaflet Shortening: Less About Technique, More About Collaborative Teamwork. Ann Thorac Surg 2024:S0003-4975(24)00381-3. [PMID: 38796116 DOI: 10.1016/j.athoracsur.2024.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2024] [Accepted: 04/20/2024] [Indexed: 05/28/2024]
Affiliation(s)
- Nicholas G Smedira
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
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4
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Sherrid MV. On the Cause of Systolic Anterior Motion in Obstructive Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2024:S0894-7317(24)00232-3. [PMID: 38761985 DOI: 10.1016/j.echo.2024.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Revised: 05/04/2024] [Accepted: 05/06/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Mark V Sherrid
- Hypertrophic Cardiomyopathy Program and Echocardiography Laboratory, Leon Charney Division of Cardiology, NYU Langone Health and New York University Grossman School of Medicine, New York, New York.
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5
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Tsuda M, Egami Y, Kawanami S, Kawamura A, Ukita K, Yasumoto K, Okamoto N, Matsunaga-Lee Y, Yano M, Nishino M. Impact of left ventricular inflow-outflow angle on heart failure readmission post-transcatheter aortic valve implantation. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2024:10.1007/s10554-023-03045-z. [PMID: 38183508 DOI: 10.1007/s10554-023-03045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 12/30/2023] [Indexed: 01/08/2024]
Abstract
Heart failure (HF) readmission post-transcatheter aortic valve implantation (TAVI) is common; however, its anatomical predictors remain unclear. This study identified a small systolic left ventricular inflow-outflow (LVIO) angle, evaluated using computed tomography, as a potential anatomical predictor associated with HF readmission post-TAVI. Patients with a small systolic LVIO angle may require close follow-up post-TAVI.
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Affiliation(s)
- Masaki Tsuda
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Yasuyuki Egami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Shodai Kawanami
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Akito Kawamura
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Kohei Ukita
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Koji Yasumoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Naotaka Okamoto
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Yasuharu Matsunaga-Lee
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Masamichi Yano
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan
| | - Masami Nishino
- Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, 591-8025, Sakai, Japan.
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Novo Matos J, Payne JR, Mullins J, Luis Fuentes V. Isolated discrete upper septal thickening in a non-referral cat population of senior and young cats. J Vet Cardiol 2023; 50:39-50. [PMID: 37924557 DOI: 10.1016/j.jvc.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 11/06/2023]
Abstract
INTRODUCTION/OBJECTIVES Discrete upper septal thickening (DUST) is a phenotype of elderly people. The cardiac phenotype in senior cats has been incompletely described. We aimed to characterize the echocardiographic phenotype of senior cats, specifically to determine prevalence of DUST and hypertrophic cardiomyopathy (HCM). ANIMALS One hundred and forty-nine healthy, normotensive cats. MATERIALS AND METHODS Prospective cross-sectional study. Senior (≥9 years) and young (<6 years) cats were recruited from non-referral population. We defined DUST as an isolated basilar septal bulge, and HCM as left ventricular wall thickness ≥6 mm. An interventricular septum ratio (basal-to-mid septal thickness ratio) was calculated. We assessed for associations between clinical and echocardiographic variables and DUST. Data are presented as mean (±SD), median (range), or frequency (percentage). RESULTS One-hundred and two senior and 47 young cats were enrolled. Aortoseptal angle (AoSA) was steeper in senior cats (137° (±14.5) vs. 145° (±12.3) in young cats, P=0.002). Eighteen cats had DUST (18/149, 12%), fourteen senior, and four young cats (P=0.4). Cats with DUST had steeper AoSA (125° (±8.3) vs. 142° (±13.7), P<0.0001) and higher interventricular septum ratio (1.4 (1.2-2.0) vs. 1.0 (0.7-1.8)). Univariable analysis showed decreased odds of DUST with greater AoSA (OR 0.9, P<0.0001), age was not associated with DUST. Twenty-nine senior cats had HCM (28.4%). DISCUSSION/CONCLUSIONS Prevalence of DUST was 12%. There was no association between age and DUST. Smaller/steeper AoSA was the main factor associated with DUST. There was a high prevalence of HCM in this senior population.
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Affiliation(s)
- J Novo Matos
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, UK.
| | - J R Payne
- Langford Vets Small Animal Referral Hospital, University of Bristol, Langford House, BS40 5DU, Langford, UK
| | - J Mullins
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, UK
| | - V Luis Fuentes
- Clinical Science and Services, Royal Veterinary College, Hawkshead Lane, North Mymms, AL9 7TA, UK
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7
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Kim T, Tjahjadi NS, He X, van Herwaarden JA, Patel HJ, Burris NS, Figueroa CA. Three-Dimensional Characterization of Aortic Root Motion by Vascular Deformation Mapping. J Clin Med 2023; 12:4471. [PMID: 37445507 DOI: 10.3390/jcm12134471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
The aorta is in constant motion due to the combination of cyclic loading and unloading with its mechanical coupling to the contractile left ventricle (LV) myocardium. This aortic root motion has been proposed as a marker for aortic disease progression. Aortic root motion extraction techniques have been mostly based on 2D image analysis and have thus lacked a rigorous description of the different components of aortic root motion (e.g., axial versus in-plane). In this study, we utilized a novel technique termed vascular deformation mapping (VDM(D)) to extract 3D aortic root motion from dynamic computed tomography angiography images. Aortic root displacement (axial and in-plane), area ratio and distensibility, axial tilt, aortic rotation, and LV/Ao angles were extracted and compared for four different subject groups: non-aneurysmal, TAA, Marfan, and repair. The repair group showed smaller aortic root displacement, aortic rotation, and distensibility than the other groups. The repair group was also the only group that showed a larger relative in-plane displacement than relative axial displacement. The Marfan group showed the largest heterogeneity in aortic root displacement, distensibility, and age. The non-aneurysmal group showed a negative correlation between age and distensibility, consistent with previous studies. Our results revealed a strong positive correlation between LV/Ao angle and relative axial displacement and a strong negative correlation between LV/Ao angle and relative in-plane displacement. VDM(D)-derived 3D aortic root motion can be used in future studies to define improved boundary conditions for aortic wall stress analysis.
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Affiliation(s)
- Taeouk Kim
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nic S Tjahjadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Xuehuan He
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - J A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Himanshu J Patel
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nicholas S Burris
- Department of Radiology, University of Michigan, Ann Arbor, MI 48109, USA
| | - C Alberto Figueroa
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109, USA
- Department of Surgery, University of Michigan, Ann Arbor, MI 48109, USA
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8
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Litt MJ, Ali A, Reza N. Familial Hypertrophic Cardiomyopathy: Diagnosis and Management. Vasc Health Risk Manag 2023; 19:211-221. [PMID: 37050929 PMCID: PMC10084873 DOI: 10.2147/vhrm.s365001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023] Open
Abstract
Hypertrophic cardiomyopathy (HCM) is widely recognized as one of the most common inheritable cardiac disorders. Since its initial description over 60 years ago, advances in multimodality imaging and translational genetics have revolutionized our understanding of the disorder. The diagnosis and management of patients with HCM are optimized with a multidisciplinary approach. This, along with increased safety and efficacy of medical, percutaneous, and surgical therapies for HCM, has afforded more personalized care and improved outcomes for this patient population. In this review, we will discuss our modern understanding of the molecular pathophysiology that underlies HCM. We will describe the range of clinical presentations and discuss the role of genetic testing in diagnosis. Finally, we will summarize management strategies for the hemodynamic subtypes of HCM with specific emphasis on the rationale and evidence for the use of implantable cardioverter defibrillators, septal reduction therapy, and cardiac myosin inhibitors.
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MESH Headings
- Humans
- Cardiomyopathy, Hypertrophic, Familial/diagnosis
- Cardiomyopathy, Hypertrophic, Familial/genetics
- Cardiomyopathy, Hypertrophic, Familial/therapy
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/genetics
- Cardiomyopathy, Hypertrophic/therapy
- Diagnostic Imaging
- Defibrillators, Implantable
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Affiliation(s)
- Michael J Litt
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Ayan Ali
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Nosheen Reza
- Division of Cardiovascular Medicine, Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
- Correspondence: Nosheen Reza, Perelman School of Medicine at the University of Pennsylvania, Department of Medicine, 3400 Civic Center Boulevard, 11th Floor South Pavilion, Philadelphia, PA, 19104, USA, Tel +1 215 615 0044, Fax +1 215 615 1263, Email
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9
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Smedira NG. Commentary: Is length (of the anterior mitral leaflet) important? J Thorac Cardiovasc Surg 2023; 165:90-91. [PMID: 33678509 DOI: 10.1016/j.jtcvs.2021.01.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 12/16/2022]
Affiliation(s)
- Nicholas G Smedira
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, Ohio.
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10
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Smedira NG. 10 Commandments to Avoid Systolic Anterior Mitral Leaflet Motion. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2023; 18:7-10. [PMID: 36866714 DOI: 10.1177/15569845231153375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- Nicholas G Smedira
- Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Cleveland, OH, USA
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11
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Huurman R, van der Velde N, Schinkel AF, Hassing HC, Budde RP, van Slegtenhorst MA, Verhagen JM, Hirsch A, Michels M. Contemporary family screening in hypertrophic cardiomyopathy: the role of cardiovascular magnetic resonance. Eur Heart J Cardiovasc Imaging 2022; 23:1144-1154. [PMID: 35670722 PMCID: PMC9365305 DOI: 10.1093/ehjci/jeac099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 04/29/2022] [Accepted: 05/05/2022] [Indexed: 01/09/2023] Open
Abstract
Aims Genetic testing in relatives of hypertrophic cardiomyopathy (HCM) patients leads to early identification of pathogenic DNA variant carriers (G+), before the onset of left ventricular hypertrophy. Routine phenotyping consists of electrocardiography (ECG) and transthoracic echocardiography (TTE). Cardiovascular magnetic resonance (CMR) has become valuable in the work-up of HCM. In this study, we investigated the value of CMR in phenotyping of G+ family members. Methods and results This study included 91 G+ subjects who underwent ECG, TTE and CMR, with a maximal wall thickness (MWT) <15 mm on TTE. The relative performance of TTE and CMR regarding wall thickness measurements and HCM diagnoses was assessed. HCM was defined as MWT of ≥13 mm. Logistic regression was performed to assess whether ECG and TTE parameters can predict CMR results. Most subjects (75%) had an MWT <13 mm on TTE, of which 23 (34%) were diagnosed with HCM based on CMR. MWT differences (range 1–10 mm) were often caused by an anterobasal hook-shaped thickening of the myocardium not visible on TTE. Two of 23 (9%) subjects with HCM on TTE were reclassified as no HCM on CMR. Normal ECG and TTE results almost excluded reclassifications by CMR. The prevalence of other HCM-related abnormalities on CMR was low. Conclusion CMR reclassified 27% of subjects. Subjects with normal ECG/TTE results were reclassified in a low number of cases, justifying screening with ECG and TTE in G+ relatives. In subjects with abnormal ECGs and/or poor TTE image quality, CMR is indicated.
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Affiliation(s)
- Roy Huurman
- Department of Cardiology, Room Rg-419, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands
| | - Nikki van der Velde
- Department of Cardiology, Room Rg-419, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands
| | - Arend Fl Schinkel
- Department of Cardiology, Room Rg-419, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands
| | - H Carlijne Hassing
- Department of Cardiology, Room Rg-419, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands
| | - Ricardo Pj Budde
- Department of Cardiology, Room Rg-419, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands
| | - Marjon A van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands
| | - Judith Ma Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Room Rg-419, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam 3015 GD, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Room Rg-419, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Dr. Molewaterplein 40, Rotterdam 3015 GD, The Netherlands
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12
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Kong LY, Liu F, Chen LL, Zhang R, Wang XJ, Zhang P. Longitudinal change, gender difference and hemodynamic implications of aortoseptal angle in adults without structural heart diseases. Int J Cardiol 2022; 359:105-107. [DOI: 10.1016/j.ijcard.2022.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 11/05/2022]
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13
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Bricker RS, Cleveland JC, Messenger JC. Mechanical Complications of Transcatheter Aortic Valve Replacement. Interv Cardiol Clin 2021; 10:465-480. [PMID: 34593110 DOI: 10.1016/j.iccl.2021.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Mechanical complications after transcatheter aortic valve replacement are fortunately rare with the current generation of devices. Unfortunately, life-threatening complications will occur and it is the responsibility of operators to be familiar with strategies to prevent and manage these challenging scenarios. Because these cases will not occur often, it is important for us to highlight and talk about those that do occur, to learn best practices in how to manage and prevent them going forward. We can learn much from each other's good crash landings.
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Affiliation(s)
- Rory S Bricker
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA
| | - Joseph C Cleveland
- Department of Surgery, Division of Cardiothoracic Surgery, University of Colorado School of Medicine, 12631 East 17th Avenue, 6111, Aurora, CO 80045, USA
| | - John C Messenger
- Department of Medicine, Division of Cardiology, University of Colorado School of Medicine, 12631 East 17th Avenue, B130, Aurora, CO 80045, USA.
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14
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Desai MY, Alashi A, Popovic ZB, Wierup P, Griffin BP, Thamilarasan M, Johnston D, Svensson LG, Lever HM, Smedira NG. Outcomes in Patients With Obstructive Hypertrophic Cardiomyopathy and Concomitant Aortic Stenosis Undergoing Surgical Myectomy and Aortic Valve Replacement. J Am Heart Assoc 2021; 10:e018435. [PMID: 34533040 PMCID: PMC8649531 DOI: 10.1161/jaha.120.018435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Hypertrophic cardiomyopathy (HCM) and aortic stenosis can cause obstruction to the flow of blood out of the left ventricular outflow tract into the aorta, with obstructive HCM resulting in dynamic left ventricular outflow tract obstruction and moderate or severe aortic stenosis causing fixed obstruction caused by calcific degeneration. We sought to report the characteristics and longer-term outcomes of patients with severe obstructive HCM who also had concomitant moderate or severe aortic stenosis requiring surgical myectomy and aortic valve replacement. Methods and Results We studied 191 consecutive patients (age 67±6 years, 52% men) who underwent myectomy and aortic valve (AV) replacement (90% bioprosthesis) at our center between June 2002 and June 2018. Clinical and echo data including left ventricular outflow tract gradient and indexed AV area were recorded. The primary outcome was death. Prevalence of hypertension (63%) and hyperlipidemia (75%) were high, with a Society of Thoracic Surgeons score of 5±4, and 70% of participants had no HCM-related sudden death risk factors. Basal septal thickness and indexed AV area were 1.9±0.4 cm and 0.72±0.2 cm2/m2, respectively, while 100% of patients had dynamic left ventricular outflow tract gradient >50 mm Hg. At 6.5±4 years, 52 (27%) patients died (1.5% in-hospital deaths). One-, 2-, and 5-year survival in the current study sample was 94%, 91%, and 83%, respectively, similar to an age-sex-matched general US population. On multivariate Cox survival analysis, age (hazard ratio [HR], 1.65; 95% CI, 1.24-2.18), chronic kidney disease (HR, 1.58; 95% CI, 1.21-2.32), and right ventricular systolic pressure on preoperative echocardiography (HR, 1.28; 95% CI, 1.05-1.57) were associated with longer-term mortality, but traditional HCM risk factors did not. Conclusions In symptomatic patients with severely obstructive HCM and moderate or severe aortic stenosis undergoing a combined surgical myectomy and AV replacement at our center, the observed postoperative mortality was significantly lower than the expected mortality, and the longer-term survival was similar to a normal age-sex-matched US population.
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Affiliation(s)
- Milind Y Desai
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Alaa Alashi
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Per Wierup
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Brian P Griffin
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Douglas Johnston
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Lars G Svensson
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy and Valve Center Heart and Vascular Institute Cleveland Clinic Cleveland OH
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15
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Kauhanen SP, Saari P, Korpela T, Liimatainen T, Vanninen R, Hedman M. Excess of visceral adipose tissue with or without aortic elongation leads to a steeper heart position. Acta Radiol 2021; 63:1157-1165. [PMID: 34304632 DOI: 10.1177/02841851211034053] [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: 11/15/2022]
Abstract
BACKGROUND The heart's position determined as the heart-aorta angle (HAA) has been demonstrated to associate with ascending aortic (AA) dilatation. Visceral adipose tissue (VAT) and aortic elongation may shift the heart to the steeper position. PURPOSE To investigate whether VAT and aortic length influence the HAA. MATERIAL AND METHODS We examined 346 consecutive patients (58.4% men; mean age = 67.0 ± 14.1 years) who underwent aortic computed tomography angiography (CTA). HAA was measured as the angle between the long axis of the heart and AA midline. The amount of VAT was measured at the level of middle L4 vertebra from a single axial CT slice. Aortic length was measured by combining four anatomical segments in different CTA images. The amount of VAT and aortic length were determined as mild with values in the lowest quartile and as excessive with values in the other three quartiles. RESULTS A total of 191 patients (55.2%) had no history of aortic diseases, 134 (38.7%) displayed AA dilatation, 8 (2.3%) had abdominal aortic aneurysm (AAA), and 13 (3.8%) had both AA dilatation and AAA. There was a strong nonlinear regression between smaller HAA and VAT/height, and HAA and aortic length/height. Median HAA was 124.2° (interquartile range 119.0°-130.8°) in patients with a mild amount of VAT versus 120.5° (interquartile range 115.4°-124.7°) in patients with excessive VAT (P < 0.001). CONCLUSION An excessive amount of VAT and aortic elongation led to a steeper heart position. These aspects may possess clinical value when evaluating aortic diseases in obese patients.
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Affiliation(s)
- S Petteri Kauhanen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Petri Saari
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Tarmo Korpela
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Timo Liimatainen
- Research Unit of Medical Imaging, University of Oulu, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu University Hospital, Oulu, Finland
| | - Ritva Vanninen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Kuopio University Hospital, Kuopio University Hospital, Clinical Imaging Center, Finland
- Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, University of Eastern Finland
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16
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Alashi A, Smedira NG, Popovic ZB, Fava A, Thamilarasan M, Kapadia SR, Wierup P, Lever HM, Desai MY. Characteristics and Outcomes of Elderly Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2021; 10:e018527. [PMID: 33506683 PMCID: PMC7955450 DOI: 10.1161/jaha.120.018527] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background We report characteristics and outcomes of elderly patients with hypertrophic cardiomyopathy (HCM) with basal septal hypertrophy and dynamic left ventricular outflow tract obstruction. Methods and Results We studied 1110 consecutive elderly patients with HCM (excluding moderate or greater aortic stenosis or subaortic membrane, age 80±5 years [range, 75–92 years], 66% women), evaluated at our center between June 2002 and December 2018. Clinical and echocardiographic data, including maximal left ventricular outflow tract gradient, were recorded. The primary outcome was death and appropriate internal defibrillator discharge. Hypertension was observed in 72%, with a Society of Thoracic Surgeons (STS) score (8.6±6); while 80% had no HCM‐related sudden cardiac death risk factors. Left ventricular mass index, basal septal thickness, and maximal left ventricular outflow tract gradient were 127±43 g/m2, 1.7±0.4 cm, and 49±31 mm Hg, respectively. A total of 597 (54%) had a left ventricular outflow tract gradient >30 mm Hg, of which 195 (33%) underwent septal reduction therapy (SRT; 79% myectomy and 21% alcohol ablation). At 5.1±4 years, 556 (50%) had composite events (273 [53%] in nonobstructive, 220 [55%] in obstructive without SRT, and 63 [32%] in obstructive subgroup with SRT). One‐ and 5‐year survival, respectively were 93% and 63% in nonobstructive, 90% and 63% in obstructive subgroup without SRT, and 94% and 84% in the obstructive subgroup with SRT. Following SRT, there were 5 (2.5%) in‐hospital deaths (versus an expected Society of Thoracic Surgeons mortality of 9.2%). Conclusions Elderly patients with HCM have a high prevalence of traditional cardiovascular rather than HCM risk factors. Longer‐term outcomes of the obstructive SRT subgroup were similar to a normal age‐sex matched US population.
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Affiliation(s)
- Alaa Alashi
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Nicholas G Smedira
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Zoran B Popovic
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Agostina Fava
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Maran Thamilarasan
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Samir R Kapadia
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Per Wierup
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Harry M Lever
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
| | - Milind Y Desai
- Hypertrophic Cardiomyopathy Center Heart and Vascular InstituteCleveland Clinic Cleveland OH
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17
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Mitral valve in hypertrophic cardiomyopathy: a three-dimensional transesophageal study. Hellenic J Cardiol 2021; 62:29-34. [DOI: 10.1016/j.hjc.2019.04.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 04/03/2019] [Accepted: 04/10/2019] [Indexed: 11/23/2022] Open
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18
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Naeim HA, Alamodi O, Ajaz Ghani M, Albagi AN, Abuelatta R. Transesophageal echocardiography guidance of percutaneous mitral valve replacement in failed annuloplasty ring: A case report. J Cardiol Cases 2020; 22:64-67. [PMID: 32774522 DOI: 10.1016/j.jccase.2020.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 10/24/2022] Open
Abstract
Severe mitral regurgitation and stenosis due to failed mitral annuloplasty ring can be managed with percutaneous mitral valve in ring in high surgical risk patients. A 66-year-old male underwent coronary artery bypass surgery and mitral valve ring annuloplasty 7 years previously. He started to have shortness of breath with minimal effort in the past 2 years. Transthoracic echocardiogram revealed a new severe mitral regurgitation and severe mitral stenosis. The patient was turned down from surgery due to high surgical risk. The transcatheter mitral valve in ring implantation was decided. In this case, there was a low probability of left ventricular outflow tract obstruction. A stiff wire crossed the mitral valve ring and positioned in the left ventricular apex. The Sapien 3 valve size 26 mm (Edwards Lifesciences, Irvine, CA, USA) was positioned to have 80% ventricular and 20% atrial side. Transesophageal echocardiogram evaluation revealed a mean gradient of 5 mmHg. The left ventricular outflow tract (LVOT) had laminar color flow and the mean pressure gradient across LVOT was 1 mmHg. The patient was discharged after 2 days in good condition. At one year follow up, he had no shortness of breath and no rehospitalization. In conclusion, the percutaneous mitral valve in ring is feasible in selected patients. The risk of LVOT obstruction should be assessed carefully before the procedure with a transthoracic and transesophageal echocardiogram. 〈Learning objective: Understand how to guide the mitral valve in ring procedure with a transesophageal echocardiogram and how to avoid left ventricular outflow tract obstruction. Understand how to position the Sapien valve in mitral valve ring.〉.
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19
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Kauhanen SP, Liimatainen T, Kariniemi E, Korhonen M, Parkkonen J, Vienonen J, Vanninen R, Hedman M. A smaller heart-aorta-angle associates with ascending aortic dilatation and increases wall shear stress. Eur Radiol 2020; 30:5149-5157. [PMID: 32323010 PMCID: PMC7431431 DOI: 10.1007/s00330-020-06852-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/10/2020] [Accepted: 03/31/2020] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether the orientation of the heart, measured as an angle between the long axis of the heart and ascending aorta midline (heart-aorta-angle, HAA), associates with ascending aortic (AA) dilatation. Furthermore, the association between HAA and wall shear stress (WSS) was studied. METHODS HAA was retrospectively measured in 1000 consecutive coronary artery computed tomographic angiography (CCTA) images in patients with low-to-moderate pretest probability for coronary artery disease (CAD). To evaluate the effects of HAA on AA flow, 4D flow MRI was performed for 28 patients with AA dilatation (> 40 mm) and WSS was analyzed. RESULTS The mean age of patients undergoing CCTA was 52.9 ± 9.8 years; 66.5% were women. Their median HAA was 128.7° and interquartile range 123.3-134.1°. HAA was significantly smaller in patients with dilated AA (median 126.7° [121.3-130.8°]) compared with the patients with normal AA (median 129.5° [124.3-135.3°], p < 0.001). HAA was smaller in males (p < 0.001) and in patients with diabetes (p = 0.016), hypertension (p = 0.001), CAD (p = 0.003), hypercholesterolemia (p < 0.001), and bicuspid aortic valve (p = 0.025) than without these factors. In a subpopulation without any of these underlying diseases (n = 233), HAA was still significantly smaller in the patients with dilated AA (median 127.9° [124.3-134.3°]) compared with patients with normal AA (median 131.9° [127.6-136.9°], p = 0.013). In 4D flow MRI, a smaller HAA correlated with increased total WSS in the outer curvature of the proximal AA (r = - 0.510, p = 0.006). CONCLUSION A smaller HAA associates with AA dilatation and affects the blood flow in the proximal AA. KEY POINTS • A smaller angle between the long axis of the heart and ascending aorta midline associated with ascending aortic dilatation. • A smaller heart-aorta-angle correlated with increased total wall shear stress in the outer curvature of the proximal ascending aorta.
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Affiliation(s)
- S Petteri Kauhanen
- Doctoral Programme of Clinical Research, University of Eastern Finland, Kuopio, Finland.
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland.
| | - Timo Liimatainen
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Elina Kariniemi
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Clinical Physiology and Nuclear Medicine, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Miika Korhonen
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Johannes Parkkonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Juska Vienonen
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Ritva Vanninen
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
- School of Medicine, Clinical Radiology, University of Eastern Finland, Kuopio, Finland
| | - Marja Hedman
- Department of Clinical Radiology, Clinical Imaging Center, Kuopio University Hospital, Kuopio, Finland
- Department of Cardiothoracic Surgery, Heart Center, Kuopio University Hospital, Kuopio, Finland
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20
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Soeding PF, Steel A, Wong J, Hoy GA. Focused cardiac echocardiography in beach-chair position surgery: A case study. Anaesth Intensive Care 2019; 47:385-388. [PMID: 31299864 DOI: 10.1177/0310057x19863067] [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: 11/17/2022]
Abstract
The haemodynamic response to the beach-chair position may be affected by the presence of left ventricular hypertrophy where remodelling of cardiac chambers can potentially lead to left ventricular outflow tract obstruction. We present a case report of severe hypotension in the beach-chair position, where focused cardiac ultrasound identified left ventricular hypertrophy and geometric features that contributed to the hypotensive response. This case illustrates that focused cardiac ultrasound has the potential to alert the clinician preoperatively to left ventricular outflow tract obstruction susceptibility during surgery in the beach-chair position, and intraoperatively to direct management should sudden decreases in blood pressure occur.
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Affiliation(s)
- Paul F Soeding
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Australia.,Department of Pharmacology and Therapeutics, The University of Melbourne, Melbourne, Australia
| | - Amelia Steel
- Department of Anaesthesia and Pain Medicine, Royal Melbourne Hospital, Melbourne, Australia.,The University of Melbourne, Melbourne, Australia
| | - James Wong
- The University of Melbourne, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
| | - Gregory A Hoy
- Melbourne Orthopaedic Group, The Avenue Hospital, Windsor, Australia.,Monash University, Melbourne, Australia
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21
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Mankad SV, Aldea GS, Ho NM, Mankad R, Pislaru S, Rodriguez LL, Whisenant B, Zimmerman K. Transcatheter Mitral Valve Implantation in Degenerated Bioprosthetic Valves. J Am Soc Echocardiogr 2018; 31:845-859. [DOI: 10.1016/j.echo.2018.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Indexed: 02/07/2023]
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22
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De novo mitral regurgitation as a cause of heart failure exacerbation in patients with hypertrophic cardiomyopathy. Int J Cardiol 2018; 252:122-127. [DOI: 10.1016/j.ijcard.2017.11.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 11/07/2017] [Accepted: 11/15/2017] [Indexed: 11/24/2022]
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23
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Ayoub C, Geske JB, Larsen CM, Scott CG, Klarich KW, Pellikka PA. Comparison of Valsalva Maneuver, Amyl Nitrite, and Exercise Echocardiography to Demonstrate Latent Left Ventricular Outflow Obstruction in Hypertrophic Cardiomyopathy. Am J Cardiol 2017; 120:2265-2271. [PMID: 29054275 DOI: 10.1016/j.amjcard.2017.08.047] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Revised: 08/23/2017] [Accepted: 08/25/2017] [Indexed: 12/21/2022]
Abstract
Guidelines recommend exercise stress echocardiogram (ESE) for patients with hypertrophic cardiomyopathy (HC) if a 50 mm Hg gradient is not present at rest or provoked with Valsalva or amyl nitrite, to direct medical and surgical management. However, no study has directly compared all 3 methods. We sought to evaluate efficacy and degree of provocation of left ventricular outflow gradients by ESE, and compare with Valsalva and amyl nitrite. In patients with HC between 2002 and 2015, resting echocardiograms and ESEs within 1 year were retrospectively reviewed. Gradients elicited by each provocation method were compared. Rest and ESE were available in 97 patients (mean age 54 ± 18 years, 57% male); 78 underwent Valsalva maneuver and 41 amyl nitrite provocation. Median gradients (interquartile range) were 10 mm Hg (7,19) at rest, 16 mm Hg (9,34) with Valsalva, 23 mm Hg (13,49) with amyl nitrite, and 26 mm Hg (13,58) with ESE. ESE and amyl nitrite were able to provoke obstruction (≥30 mm Hg) and severe obstruction (≥50 mm Hg) more frequently than Valsalva. In patients with resting gradient <30 mm Hg (n = 83), provocation maneuvers demonstrated dynamic obstruction in 51%; in those with Valsalva gradient <30 mm Hg (n = 57), ESE or amyl nitrite provoked a gradient in 44%; and in those with amyl nitrite gradient <30 mm Hg (n = 20), ESE provoked a gradient in 29%. No demographic or baseline echocardiographic parameter predicted provocable obstruction. In conclusion, ESE is clinically useful; however, different provocation maneuvers may be effective in different patients with HC, and all maneuvers may be required to provoke dynamic obstruction in symptomatic patients.
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Affiliation(s)
- Chadi Ayoub
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jeffrey B Geske
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Carolyn M Larsen
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | | | - Kyle W Klarich
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota
| | - Patricia A Pellikka
- Division of Cardiovascular Ultrasound, Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota.
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Mori S, Anderson RH, Tahara N, Izawa Y, Toba T, Fujiwara S, Shimoyama S, Watanabe Y, Nishii T, Kono AK, Hirata KI. Diversity and Determinants of the Three-dimensional Anatomical Axis of the Heart as Revealed Using Multidetector-row Computed Tomography. Anat Rec (Hoboken) 2017; 300:1083-1092. [DOI: 10.1002/ar.23564] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/26/2016] [Accepted: 09/07/2016] [Indexed: 01/10/2023]
Affiliation(s)
- Shumpei Mori
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Robert H Anderson
- Institute of Genetic Medicine; Newcastle University; Newcastle-upon-Tyne UK
| | - Natsuko Tahara
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Yu Izawa
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Takayoshi Toba
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Sei Fujiwara
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
| | - Shinsuke Shimoyama
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Yoshiaki Watanabe
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Tatsuya Nishii
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Atsushi K Kono
- Department of Radiology; Kobe University Graduate School of Medicine; Kobe Japan
| | - Ken-Ichi Hirata
- Division of Cardiovascular Medicine, Department of Internal Medicine; Kobe University Graduate School of Medicine; Kobe Japan
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25
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Canepa M, Pozios I, Vianello PF, Ameri P, Brunelli C, Ferrucci L, Abraham TP. Distinguishing ventricular septal bulge versus hypertrophic cardiomyopathy in the elderly. Heart 2016; 102:1087-94. [PMID: 27122487 DOI: 10.1136/heartjnl-2015-308764] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 03/16/2016] [Indexed: 02/06/2023] Open
Abstract
The burgeoning evidence of patients diagnosed with sigmoidal hypertrophic cardiomyopathy (HCM) later in life has revived the quest for distinctive features that may help discriminate it from more benign forms of isolated septal hypertrophy often labelled ventricular septal bulge (VSB). HCM is diagnosed less frequently than VSB at older ages, with a reversed female predominance. Most patients diagnosed with HCM at older ages suffer from hypertension, similar to those with VSB. A positive family history of HCM and/or sudden cardiac death and the presence of exertional symptoms usually support HCM, though they are less likely in older patients with HCM, and poorly investigated in individuals with VSB. A more severe hypertrophy and the presence of left ventricular outflow obstruction are considered diagnostic of HCM, though stress echocardiography has not been consistently used in VSB. Mitral annulus calcification is very prevalent in both conditions, whereas a restrictive filling pattern is found in a minority of older patients with HCM. Genetic testing has low applicability in this differential diagnosis at the current time, given that a causative mutation is found in less than 10% of elderly patients with suspected HCM. Emerging imaging modalities that allow non-invasive detection of myocardial fibrosis and disarray may help, but have not been fully investigated. Nonetheless, there remains a considerable morphological overlap between the two conditions. Comprehensive studies, particularly imaging based, are warranted to offer a more evidence-based approach to elderly patients with focal septal thickening.
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Affiliation(s)
- Marco Canepa
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, Maryland, USA Cardiovascular Disease Unit, Department of Internal Medicine, IRCCS AOU San Martino IST / University of Genova, Genova, Italy Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, Maryland, USA
| | - Iraklis Pozios
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, Maryland, USA
| | - Pier Filippo Vianello
- Cardiovascular Disease Unit, Department of Internal Medicine, IRCCS AOU San Martino IST / University of Genova, Genova, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, Department of Internal Medicine, IRCCS AOU San Martino IST / University of Genova, Genova, Italy
| | - Claudio Brunelli
- Cardiovascular Disease Unit, Department of Internal Medicine, IRCCS AOU San Martino IST / University of Genova, Genova, Italy
| | - Luigi Ferrucci
- Translational Gerontology Branch, National Institute on Aging, NIH, Baltimore, Maryland, USA
| | - Theodore P Abraham
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, Maryland, USA
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Cho EJ, Kim SM, Park SJ, Lee SC, Park SW. Identification of Factors that Predict whether the Right Parasternal View Is Required for Accurate Evaluation of Aortic Stenosis Severity. Echocardiography 2016; 33:830-7. [DOI: 10.1111/echo.13181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Eun Jeong Cho
- Cardiology Clinic; National Cancer Center; Gyeonggi-do Korea
| | - Sung-Mok Kim
- Cardiovascular Imaging Center; Heart Vascular Stroke Institute; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Sung-Ji Park
- Cardiovascular Imaging Center; Heart Vascular Stroke Institute; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Sang-Chol Lee
- Cardiovascular Imaging Center; Heart Vascular Stroke Institute; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
| | - Seung Woo Park
- Cardiovascular Imaging Center; Heart Vascular Stroke Institute; Samsung Medical Center; Sungkyunkwan University School of Medicine; Seoul Korea
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27
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Thorburn AN, McKenzie CI, Shen S, Stanley D, Macia L, Mason LJ, Roberts LK, Wong CHY, Shim R, Robert R, Chevalier N, Tan JK, Mariño E, Moore RJ, Wong L, McConville MJ, Tull DL, Wood LG, Murphy VE, Mattes J, Gibson PG, Mackay CR. Evidence that asthma is a developmental origin disease influenced by maternal diet and bacterial metabolites. Nat Commun 2015; 6:7320. [PMID: 26102221 DOI: 10.1038/ncomms8320] [Citation(s) in RCA: 596] [Impact Index Per Article: 66.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2015] [Accepted: 04/27/2015] [Indexed: 12/27/2022] Open
Abstract
Asthma is prevalent in Western countries, and recent explanations have evoked the actions of the gut microbiota. Here we show that feeding mice a high-fibre diet yields a distinctive gut microbiota, which increases the levels of the short-chain fatty acid, acetate. High-fibre or acetate-feeding led to marked suppression of allergic airways disease (AAD, a model for human asthma), by enhancing T-regulatory cell numbers and function. Acetate increases acetylation at the Foxp3 promoter, likely through HDAC9 inhibition. Epigenetic effects of fibre/acetate in adult mice led us to examine the influence of maternal intake of fibre/acetate. High-fibre/acetate feeding of pregnant mice imparts on their adult offspring an inability to develop robust AAD. High fibre/acetate suppresses expression of certain genes in the mouse fetal lung linked to both human asthma and mouse AAD. Thus, diet acting on the gut microbiota profoundly influences airway responses, and may represent an approach to prevent asthma, including during pregnancy.
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Affiliation(s)
- Alison N Thorburn
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Craig I McKenzie
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Sj Shen
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Dragana Stanley
- School of Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland 4702, Australia
| | - Laurence Macia
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Linda J Mason
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Laura K Roberts
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Connie H Y Wong
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Raymond Shim
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Remy Robert
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Nina Chevalier
- 1] Department of Immunology, Monash University, Clayton, Victoria 3800, Australia [2] Department of Rheumatology and Clinical Immunology, University Medical Center, 79106 Freiburg, Germany
| | - Jian K Tan
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Eliana Mariño
- Department of Immunology, Monash University, Clayton, Victoria 3800, Australia
| | - Rob J Moore
- 1] CSIRO Animal, Food, and Health Sciences, Geelong, Victoria 3220, Australia [2] Department of Microbiology, Monash University, Clayton, Victoria 3800, Australia
| | - Lee Wong
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
| | - Malcolm J McConville
- 1] Department of Biochemistry and Molecular Biology, Bio21 Institute of Molecular Science and Biotechnology, University of Melbourne, Melbourne, Victoria 3010, Australia [2] Metabolomics Australia, Bio21 Institute of Molecular Sciences and Biotechnology, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Dedreia L Tull
- Metabolomics Australia, Bio21 Institute of Molecular Sciences and Biotechnology, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Lisa G Wood
- Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales 2300, Australia
| | - Vanessa E Murphy
- Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales 2300, Australia
| | - Joerg Mattes
- Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales 2300, Australia
| | - Peter G Gibson
- Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, University of Newcastle, Newcastle, New South Wales 2300, Australia
| | - Charles R Mackay
- 1] Department of Immunology, Monash University, Clayton, Victoria 3800, Australia [2] Charles Perkins Centre, Sydney University Medical School, University of Sydney, Sydney, New South Wales 2006, Australia
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Girdauskas E, Rouman M, Disha K, Espinoza A, Dubslaff G, Fey B, Theis B, Petersen I, Borger MA, Kuntze T. Aortopathy in patients with bicuspid aortic valve stenosis: role of aortic root functional parameters. Eur J Cardiothorac Surg 2015; 49:635-43; discussion 643-4. [PMID: 25855595 DOI: 10.1093/ejcts/ezv123] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 02/19/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES We prospectively examined functional characteristics of the aortic root and transvalvular haemodynamic flow in order to define factors associated with the severity of aortopathy in patients undergoing surgery for bicuspid aortic valve (BAV) stenosis. METHODS A total of 103 consecutive patients with BAV stenosis (mean age 61 ± 9 years, 66% male) underwent aortic valve replacement ± concomitant aortic surgery from January 2012 through March 2014. All patients underwent preoperative cardiac magnetic resonance imaging (MRI) in order to evaluate the systolic transvalvular flow and the following functional parameters: (i) angulation between the left ventricular outflow axis and the aortic root, (ii) geometrical orientation of residual aortic valve orifice and (iii) BAV cusp fusion pattern. MRI data were used to guide sampling of the ascending aorta during surgery [i.e. jet-sample from the area where the flow-jet impacts on the aortic wall and control sample from the opposite aortic wall (obtained from the aortotomy site)]. Aortopathy was quantified by means of a histological sum-score (0 to 21+) in each sample. RESULTS A significant correlation was found between histological sum-score in the jet-sample and the angle between the LV outflow axis and the aortic root (r = 0.6, P = 0.007). Moreover, there was a linear correlation between proximal aortic diameter and the angle between systolic flow-jet and ascending aortic wall (r = 0.5, P = 0.006). Logistic regression identified the angle between the LV outflow axis and the aortic root (OR 1.1, P = 0.04) and the angle between the flow-jet and the aortic wall (OR 1.2, P = 0.001) as independent predictors of an indexed proximal aortic diameter ≥22 mm/m(2). CONCLUSIONS Functional parameters of the aortic root may be used to predict the severity of aortopathy in patients with BAV stenosis, and may be useful in predicting future risk of aortic disease in such patients.
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Affiliation(s)
- Evaldas Girdauskas
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Mina Rouman
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Kushtrim Disha
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Andres Espinoza
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
| | - Georg Dubslaff
- Department of Radiology, Central Clinic Bad Berka, Bad Berka, Germany
| | - Beatrix Fey
- Department of Radiology, Central Clinic Bad Berka, Bad Berka, Germany
| | - Bernhard Theis
- Institute of Pathology, Friedrich-Schiller University Jena, Jena, Germany
| | - Iver Petersen
- Institute of Pathology, Friedrich-Schiller University Jena, Jena, Germany
| | - Michael A Borger
- Department of Cardiac Surgery, Heart Center Leipzig, Germany Columbia University Medical Center, NY, New York, USA
| | - Thomas Kuntze
- Department of Cardiac Surgery, Central Clinic Bad Berka, Bad Berka, Germany
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29
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Thaden JJ, Nkomo VT, Lee KJ, Oh JK. Doppler Imaging in Aortic Stenosis: The Importance of the Nonapical Imaging Windows to Determine Severity in a Contemporary Cohort. J Am Soc Echocardiogr 2015; 28:780-5. [PMID: 25857547 DOI: 10.1016/j.echo.2015.02.016] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although the highest aortic valve velocity was thought to be obtained from imaging windows other than the apex in about 20% of patients with severe aortic stenosis (AS), its occurrence appears to be increasing as the age of patients has increased with the application of transcatheter aortic valve replacement. The aim of this study was to determine the frequency with which the highest peak jet velocity (Vmax) is found at each imaging window, the degree to which neglecting nonapical imaging windows underestimates AS severity, and factors influencing the location of the optimal imaging window in contemporary patients. METHODS Echocardiograms obtained in 100 consecutive patients with severe AS from January 3 to May 23, 2012, in which all imaging windows were interrogated, were retrospectively analyzed. AS severity (aortic valve area and mean gradient) was calculated on the basis of the apical imaging window alone and the imaging window with the highest peak jet velocity. The left ventricular-aortic root angle measured in the parasternal long-axis view as well as clinical variables were correlated with the location of highest peak jet velocity. RESULTS Vmax was most frequently obtained in the right parasternal window (50%), followed by the apex (39%). Subjects with acute angulation more commonly had Vmax at the right parasternal window (65% vs 43%, P = .05) and less commonly had Vmax at the apical window (19% vs 48%, P = .005), but Vmax was still located outside the apical imaging window in 52% of patients with obtuse aortic root angles. If nonapical windows were neglected, 8% of patients (eight of 100) were misclassified from high-gradient severe AS to low-gradient severe AS, and another 15% (15 of 100) with severe AS (aortic valve area < 1.0 cm(2)) were misclassified as having moderate AS (aortic valve area > 1.0 cm(2)). CONCLUSIONS In this contemporary cohort, Vmax was located outside the apical imaging window in 61% of patients, and neglecting the nonapical imaging windows resulted in the misclassification of AS severity in 23% of patients. Aortic root angulation as measured by two-dimensional echocardiography influences the location of Vmax modestly. Despite increasing time constraints on many echocardiography laboratories, these data confirm that routine Doppler interrogation from multiple imaging windows is critical to accurately determine the severity of AS in contemporary clinical practice.
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Affiliation(s)
- Jeremy J Thaden
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Vuyisile T Nkomo
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota
| | - Kwang Je Lee
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota; Division of Cardiology, Department of Internal Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Jae K Oh
- Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota.
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30
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Cardim N, Galderisi M, Edvardsen T, Plein S, Popescu BA, D'Andrea A, Bruder O, Cosyns B, Davin L, Donal E, Freitas A, Habib G, Kitsiou A, Petersen SE, Schroeder S, Lancellotti P, Camici P, Dulgheru R, Hagendorff A, Lombardi M, Muraru D, Sicari R. Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Heart J Cardiovasc Imaging 2015; 16:280. [PMID: 25650407 DOI: 10.1093/ehjci/jeu291] [Citation(s) in RCA: 178] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Taking into account the complexity and limitations of clinical assessment in hypertrophic cardiomyopathy (HCM), imaging techniques play an essential role in the evaluation of patients with this disease. Thus, in HCM patients, imaging provides solutions for most clinical needs, from diagnosis to prognosis and risk stratification, from anatomical and functional assessment to ischaemia detection, from metabolic evaluation to monitoring of treatment modalities, from staging and clinical profiles to follow-up, and from family screening and preclinical diagnosis to differential diagnosis. Accordingly, a multimodality imaging (MMI) approach (including echocardiography, cardiac magnetic resonance, cardiac computed tomography, and cardiac nuclear imaging) is encouraged in the assessment of these patients. The choice of which technique to use should be based on a broad perspective and expert knowledge of what each technique has to offer, including its specific advantages and disadvantages. Experts in different imaging techniques should collaborate and the different methods should be seen as complementary, not as competitors. Each test must be selected in an integrated and rational way in order to provide clear answers to specific clinical questions and problems, trying to avoid redundant and duplicated information, taking into account its availability, benefits, risks, and cost.
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MESH Headings
- Cardiac Imaging Techniques/methods
- Cardiac Imaging Techniques/standards
- Cardiomyopathy, Hypertrophic/diagnosis
- Cardiomyopathy, Hypertrophic/therapy
- Consensus
- Echocardiography, Doppler/methods
- Echocardiography, Doppler/standards
- Europe
- Female
- Humans
- Image Interpretation, Computer-Assisted
- Magnetic Resonance Imaging, Cine/methods
- Magnetic Resonance Imaging, Cine/standards
- Male
- Multimodal Imaging/methods
- Multimodal Imaging/standards
- Positron-Emission Tomography/methods
- Positron-Emission Tomography/standards
- Practice Guidelines as Topic/standards
- Role
- Saudi Arabia
- Societies, Medical/standards
- Tomography, X-Ray Computed/methods
- Tomography, X-Ray Computed/standards
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31
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Gregory TS, Schmidt EJ, Zhang SH, Kwong RY, Stevenson WG, Murrow JR, Ho Tse ZT. Left-ventricular mechanical activation and aortic-arch orientation recovered from magneto-hydrodynamic voltages observed in 12-lead ECGs obtained inside MRIs: a feasibility study. Ann Biomed Eng 2014; 42:2480-9. [PMID: 25224074 PMCID: PMC4241154 DOI: 10.1007/s10439-014-1109-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 09/04/2014] [Indexed: 10/24/2022]
Abstract
To explore use of the Magnetohydrodynamic Voltage (VMHD), observed in intra-MRI 12-lead electrocardiograms (ECG), to indicate the timing of the onset of left-ventricular mechanical activation (LVMA) and the orientation of the aortic-arch (AAO). Blood flow through the aortic arch during systole, in the presence of the MRI magnetic field (B 0), generates VMHD. Since the magnitude and direction of VMHD are determined by the timing and directionality of blood flow relative to B 0, we hypothesized that clinically useful measures, LVMA and AAO, could be extracted from temporal and vectorial VMHD characteristics. VMHD signals were extracted from 12-lead ECG traces by comparing traces obtained inside and outside the MRI scanner. VMHD was converted into the Vectorcardiogram frame of reference. LVMA was quantified in 1 subject at 1.5T and 3 subjects at 3T, and the result compared to CINE MRI. AAO was inferred for 4 subjects at 3T and compared to anatomical imaging of the aortic arch orientation in the transverse plane. A < 10% error was observed in LVMA measurements, while a < 3° error was observed in aortic arch orientation measurements. The temporal and vectorial nature of VMHD is useful in estimating these clinically relevant parameters.
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Affiliation(s)
- T. Stan Gregory
- College of Engineering, The University of Georgia, Athens, GA, USA
| | - Ehud J. Schmidt
- Cardiology and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | - Raymond Y. Kwong
- Cardiology and Radiology, Brigham and Women’s Hospital, Boston, MA, USA
| | | | | | - Zion Tsz Ho Tse
- College of Engineering, The University of Georgia, Athens, GA, USA
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32
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Critoph CH, Pantazis A, Tome Esteban MT, Salazar-Mendiguchía J, Pagourelias ED, Moon JC, Elliott PM. The influence of aortoseptal angulation on provocable left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Open Heart 2014; 1:e000176. [PMID: 25371813 PMCID: PMC4216933 DOI: 10.1136/openhrt-2014-000176] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2014] [Revised: 08/27/2014] [Accepted: 10/01/2014] [Indexed: 02/06/2023] Open
Abstract
Objectives Aortoseptal angulation (AoSA) can predict provocable left ventricular outflow tract obstruction (LVOTO) in patients with symptomatic hypertrophic cardiomyopathy (HCM). Lack of a standardised measurement technique in HCM without the need for complex three-dimensional (3D) imaging limits its usefulness in routine clinical practice. This study aimed to validate a simple measurement of AoSA using 2D echocardiography and cardiac MR (CMR) imaging as a predictor of LVOTO. Methods We retrospectively assessed 160 patients with non-obstructive HCM, referred for exercise stress echocardiography. AoSA was measured using resting 2D echocardiography in all patients, and CMR in 29. Twenty-five controls with normal echocardiograms were used for comparison. Results Patients with HCM had a reduced AoSA compared with controls (113°±12 vs 126°±6), p<0.0001. Sixty (38%) patients had provocable LVOTO, with smaller angles than non-obstructive patients (108°±12 vs 116°±12, p<0.0001). AoSA, degree of mitral valvular regurgitation and incomplete systolic anterior motion (SAM) were associated with peak left ventricular outflow tract gradient (r=0.508, p<0.0001). An angle ≤100° had 27% sensitivity, 91% specificity and 59% positive predictive value for predicting provocable LVOTO. When combined with SAM, specificity was 99% and positive predictive value 88%. Intraclass correlation coefficient of AoSA measured by two observers was 0.901 (p<0.0001). Bland-Altman analysis of echocardiographic AoSA showed good agreement with the CMR-derived angle. Conclusions Measurement of AoSA using echocardiography in HCM is easy, reproducible and comparable to CMR. Patients with provocable LVOTO have reduced angles compared with non-obstructive patients. AoSA is highly specific for provocable LVOTO and should prompt further evaluation in symptomatic patients without resting obstruction.
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Affiliation(s)
- Christopher Howell Critoph
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Antonios Pantazis
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Maria Teresa Tome Esteban
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Joel Salazar-Mendiguchía
- Cardiomyopathies, Advanced Heart Failure and Transplant Unit , Hospital Universitari de Bellvitge , Barcelona , Spain
| | - Efstathios D Pagourelias
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - James C Moon
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
| | - Perry Mark Elliott
- Department of Inherited Cardiovascular Disease , The Heart Hospital, University College London , London , UK
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Canepa M, Malti O, David M, AlGhatrif M, Strait JB, Ameri P, Brunelli C, Lakatta EG, Ferrucci L, Abraham TP. Prevalence, clinical correlates, and functional impact of subaortic ventricular septal bulge (from the Baltimore Longitudinal Study of Aging). Am J Cardiol 2014; 114:796-802. [PMID: 25129067 DOI: 10.1016/j.amjcard.2014.05.068] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 05/30/2014] [Accepted: 05/30/2014] [Indexed: 02/06/2023]
Abstract
A localized hypertrophy of the subaortic segment of the ventricular septum-ventricular septal bulge (VSB)-has been frequently described in series of elderly population, but its prevalence with age, clinical correlates, and impact on cardiac function and exercise capacity remain uncertain. We explored these associations in a cross-sectional sample without known cardiac disease from the Baltimore Longitudinal Study of Aging. We randomly selected 700 participants (50% men, mean age 64 ± 15, range 26 to 95 years) and reviewed their echocardiograms. We identified 28 men and 21 women with VSB (7% overall prevalence). The prevalence of VSB significantly increased with age in both genders (p <0.0001). In multivariate logistic regression including hypertension and other cardiovascular risk factors, only age displayed a significant independent association with VSB (OR 1.06 per year, 95% confidence interval 1.03 to 1.10, p = 0.0001). After multiple adjustments, participants with VSB compared with those without had enhanced global left ventricular contractility (fractional shortening 41 ± 1.3 vs 38 ± 0.3%, p = 0.04; ejection fraction 71 ± 1.6 vs 67 ± 0.4%, p = 0.06; systolic velocity of the mitral annulus 8.4 ± 0.1 vs 8.9 ± 0.3, p = 0.06), and larger aortic root diameters (3.3 ± 0.06 vs 3.1 ± 0.02 cm, p = 0.02). In subgroup of participants who completed a maximal treadmill test (177 women and 196 men), those with VSB (19, 5.1%) had significantly lower peak oxygen consumption than their counterparts (19.6 ± 3.8 vs 22.9 ± 6.6 ml/kg/min, p = 0.03). However, this association was no longer significant after multiple adjustments. In conclusion, the presence of VSB is independently associated with older age and determines enhanced left ventricular contractility, without any evident impact on exercise capacity.
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Affiliation(s)
- Marco Canepa
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland; Department of Internal Medicine, University of Genova, Genova, Italy
| | - Omar Malti
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland
| | - Melissa David
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland; MedStar Health Research Institute, Washington, District of Columbia
| | - Majd AlGhatrif
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland; Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland; Division of Cardiology, Johns Hopkins University, Baltimore, Maryland
| | - James B Strait
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland
| | - Pietro Ameri
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Claudio Brunelli
- Department of Internal Medicine, University of Genova, Genova, Italy
| | - Edward G Lakatta
- Laboratory of Cardiovascular Sciences, Human Cardiovascular Studies Unit, National Institute on Aging/National Institute of Health, Baltimore, Maryland
| | - Luigi Ferrucci
- Longitudinal Studies Section, Translational Gerontology Branch, NIA/NIH, Baltimore, Maryland
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Mihăilă S, Muraru D, Piasentini E, Miglioranza MH, Peluso D, Cucchini U, Iliceto S, Vinereanu D, Badano LP. Quantitative Analysis of Mitral Annular Geometry and Function in Healthy Volunteers Using Transthoracic Three-Dimensional Echocardiography. J Am Soc Echocardiogr 2014; 27:846-57. [DOI: 10.1016/j.echo.2014.04.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Indexed: 10/25/2022]
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35
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Kobayashi T, Dhillon A, Popovic Z, Bhonsale A, Smedira NG, Thamilarasan M, Lytle BW, Lever HM, Desai MY. Differences in global and regional left ventricular myocardial mechanics in various morphologic subtypes of patients with obstructive hypertrophic cardiomyopathy referred for ventricular septal myotomy/myectomy. Am J Cardiol 2014; 113:1879-85. [PMID: 24837268 DOI: 10.1016/j.amjcard.2014.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 03/06/2014] [Accepted: 03/06/2014] [Indexed: 11/24/2022]
Abstract
Patients with obstructive hypertrophic cardiomyopathy (HC) have various left ventricular (LV) shapes: reverse septal curvature (RSC, commonly familial), sigmoid septum (SS, common in hypertensives), and concentric hypertrophy (CH). Longitudinal (systolic and early diastolic) strain rate (SR) is sensitive in detecting regional myocardial dysfunction. We sought to determine differences in longitudinal SR of patients with obstructive HC, based on LV shapes. We studied 199 consecutive patients with HC (50% men) referred for surgical myectomy. Clinical and echocardiographic parameters were recorded. LV shapes were classified on echocardiography, using basal septal 1/3 to posterior wall ratio: RSC = ratio >1.3 (extending to mid and distal septum), SS = ratio >1.3 (extending only to basal 1/3), and concentric = ratio ≤1.3. Longitudinal systolic and early diastolic SRs were measured from apical 4- and 2-chamber views (VVI 2.0; Siemens, Erlangen). Distribution of RSC, SS, and CH was 50%, 28%, and 22%, respectively. Patients with RSC were significantly younger (47 ± 12 vs 64 ± 10 and 57 ± 11, respectively) with lower hypertension (40% vs 71% and 67%, respectively) than patients with SS or CH (both p <0.001). Patients with RSC had lower global systolic (-0.99 ± 0.3 vs -1.05 ± 0.3 and -1.17 ± 0.3) and early diastolic SR (0.95 ± 0.4 vs 0.98 ± 0.3 and 1.16 ± 0.4) versus patients with SS and CH (in 1/s, both p <0.01), despite being much younger and less hypertensive. RSC was associated with abnormal global LV systolic (beta 0.16) and early diastolic (beta -0.17) SR (both p <0.01). In conclusion, patients with HC with RCS have significantly abnormal LV mechanics, despite being younger and less hypertensive. A combination of LV mechanics and shapes could help differentiate between genetically mediated and other causes of obstructive HC.
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36
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Isolated hypertrophy of the basal ventricular septum: Characteristics of patients with and without outflow tract obstruction. Int J Cardiol 2014; 173:487-93. [DOI: 10.1016/j.ijcard.2014.03.078] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/08/2014] [Accepted: 03/12/2014] [Indexed: 01/13/2023]
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37
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Krishnaswamy A, Tuzcu EM, Svensson LG, Kapadia SR. Combined transcatheter aortic valve replacement and emergent alcohol septal ablation. Circulation 2014; 128:e366-8. [PMID: 24166418 DOI: 10.1161/circulationaha.112.000470] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Amar Krishnaswamy
- Departments of Cardiovascular Medicine (A.K., E.M.T., S.R.K.), and Cardiothoracic Surgery (L.G.S.), Cleveland Clinic, Cleveland, OH
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Vernick WJ. Con: patient-prosthesis mismatch now is not an important consideration in the majority of patients after aortic valve replacement. J Cardiothorac Vasc Anesth 2013; 28:184-188. [PMID: 24183317 DOI: 10.1053/j.jvca.2013.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Indexed: 11/11/2022]
Affiliation(s)
- William J Vernick
- Department of Anesthesia and Critical Care, Hospital of the University of Pennsylvania, Philadelphia, PA.
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39
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Martin R, Lairez O, Boudou N, Méjean S, Lhermusier T, Dumonteil N, Berry M, Cognet T, Massabuau P, Elbaz M, Rousseau H, Galinier M, Carrié D. Relation between left ventricular outflow tract obstruction and left ventricular shape in patients with hypertrophic cardiomyopathy: A cardiac magnetic resonance imaging study. Arch Cardiovasc Dis 2013; 106:440-7. [DOI: 10.1016/j.acvd.2013.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/19/2013] [Accepted: 05/16/2013] [Indexed: 11/24/2022]
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Olafiranye O, Ibrahim M, Kamran H, Venner-Jones K, McFarlane SI, Salciccioli L, Lazar JM. Narrowed Aortoseptal Angle Is Related to Increased Central Blood Pressure and Aortic Pressure Wave Reflection. Cardiorenal Med 2012; 2:177-183. [PMID: 22969773 DOI: 10.1159/000338827] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2012] [Accepted: 04/12/2012] [Indexed: 11/19/2022] Open
Abstract
The left ventricular (LV) aortoseptal angle (ASA) decreases with age, and is associated with basal septal hypertrophy (septal bulge). Enhanced arterial pressure wave reflection is known to impact LV hypertrophy. We assessed whether ASA is related to central blood pressure (BP) and augmentation index (AI), a measure of the reflected pressure wave. We studied 75 subjects (age 62 ± 16 years; 66% female) who were referred for transthoracic echocardiography and had radial artery applanation tonometry within 24 h. Peripheral systolic BP (P-SBP), peripheral diastolic BP (P-DBP), and peripheral pulse pressure (P-PP) were obtained by sphygmomanometry. Central BPs (C-SBP, C-DBP, C-PP) and AI were derived from applanation tonometry. AI was corrected for heart rate (AI75). The basal septal wall thickness (SWT), mid SWT and ASA were measured using the parasternal long axis echocardiographic view. Mean ASA and AI75 were 117 ± 11° and 22 ± 11%, respectively. ASA correlated with AI75 (r = -0.31, p ≤ 0.01), C-SBP (r = -0.24, p = 0.04), C-PP (r = -0.29, p = 0.01), but only showed a trend towards significance with P-SBP (r = -0.2, p = 0.09) and P-PP (r = -0.21, p = 0.08). Interestingly, C-PP was correlated with basal SWT (r = 0.27, p = 0.02) but not with mid SWT (r = 0.19, p = 0.11). On multivariate linear regression analysis, adjusted for age, gender, weight, and mean arterial pressure, AI75 was an independent predictor of ASA (p = 0.02). Our results suggest that a narrowed ASA is related to increased pressure wave reflection and higher central BP. Further studies are needed to determine whether narrowed LV ASA is a cause or consequence of enhanced wave reflection and whether other factors are involved.
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Affiliation(s)
- Oladipupo Olafiranye
- Division of Cardiovascular Medicine, Department of Medicine, Brooklyn, N.Y., USA
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Sorajja P, Binder J, Nishimura RA, Holmes DR, Rihal CS, Gersh BJ, Bresnahan JF, Ommen SR. Predictors of an optimal clinical outcome with alcohol septal ablation for obstructive hypertrophic cardiomyopathy. Catheter Cardiovasc Interv 2012; 81:E58-67. [PMID: 22511295 DOI: 10.1002/ccd.24328] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Accepted: 01/03/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcohol septal ablation has emerged as a therapy for patients with obstructive hypertrophic cardiomyopathy (HCM). However, there are limited data on the predictors of success with the procedure. METHODS We examined patient characteristics and cardiac morphology as well as procedural data on 166 HCM patients (mean age, 63 years; 43% men), who underwent ablation at Mayo Clinic. Patients were contacted to determine vital status and symptoms to assess the primary endpoint of survival free of death and severe symptoms (New York Heart Association, class III or IV dyspnea). RESULTS The strongest patient characteristics that predicted clinical success were older age, less severe left ventricular outflow tract gradient, lesser ventricular septal hypertrophy, and a smaller left anterior descending (LAD) diameter. Mitral valve geometry or ventricular septal morphology did not predict outcome. Patients with ≥3 characteristics (age ≥65 years, gradient <100 mmHg, septal hypertrophy ≤18 mm, LAD diameter <4.0 mm) had superior 4-year survival free of death and severe symptoms (90.4%) in comparison to those with two characteristics (81.6%) and ≤1 characteristic (57.5%). Case volume with >50 patients was an independent predictor of survival free of severe symptoms. The volume of alcohol injected, number of arteries injected, or size of septal perforator artery were not predictive of clinical success. CONCLUSIONS Greater case volume and selection for key patient and anatomic characteristics are associated with superior outcomes with alcohol septal ablation.
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Affiliation(s)
- Paul Sorajja
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
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Cardiac Magnetic Resonance in Hypertrophic Cardiomyopathy. JACC Cardiovasc Imaging 2011; 4:1123-37. [DOI: 10.1016/j.jcmg.2011.06.022] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 05/27/2011] [Accepted: 06/29/2011] [Indexed: 01/19/2023]
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Capdeville M, Mangi A, Lytle BW. An Unusual Cause of Left Ventricular Outflow Tract Obstruction. J Cardiothorac Vasc Anesth 2011; 25:673-7. [DOI: 10.1053/j.jvca.2010.06.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2010] [Indexed: 11/11/2022]
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Lorenz R, Benk C, Bock J, Stalder A, Korvink J, Hennig J, Markl M. Closed circuit MR compatible pulsatile pump system using a ventricular assist device and pressure control unit. Magn Reson Med 2011; 67:258-68. [DOI: 10.1002/mrm.22983] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Revised: 03/16/2011] [Accepted: 04/06/2011] [Indexed: 11/06/2022]
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Nagueh SF, Bierig SM, Budoff MJ, Desai M, Dilsizian V, Eidem B, Goldstein SA, Hung J, Maron MS, Ommen SR, Woo A. American Society of Echocardiography Clinical Recommendations for Multimodality Cardiovascular Imaging of Patients with Hypertrophic Cardiomyopathy. J Am Soc Echocardiogr 2011; 24:473-98. [PMID: 21514501 DOI: 10.1016/j.echo.2011.03.006] [Citation(s) in RCA: 266] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Sherif F Nagueh
- Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Desai MY, Ommen SR, McKenna WJ, Lever HM, Elliott PM. Imaging Phenotype Versus Genotype in Hypertrophic Cardiomyopathy. Circ Cardiovasc Imaging 2011; 4:156-68. [DOI: 10.1161/circimaging.110.957936] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Milind Y. Desai
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - Steve R. Ommen
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - William J. McKenna
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - Harry M. Lever
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
| | - Perry M. Elliott
- From the Heart and Vascular Institute (M.Y.D.), Cleveland Clinic, and Cleveland Clinic Foundation (H.M.L.), Cleveland, OH; Department of Cardiovascular Medicine (S.R.O.), Mayo Clinic, Rochester, MN; and Department of Cardiovascular Medicine (W.J.M., P.M.E.), The Heart Hospital, University College, London, England
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Kwon DH, Desai MY. Cardiac magnetic resonance in hypertrophic cardiomyopathy: current state of the art. Expert Rev Cardiovasc Ther 2010; 8:103-11. [PMID: 20014937 DOI: 10.1586/erc.09.108] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Hypertrophic cardiomyopathy is a complex disorder with significant heterogeneity in clinical characteristics and natural history. Traditionally, the diagnosis has been based on clinical assessment and echocardiography; however, persistent challenges in its noninvasive evaluation remain. Hence, improved diagnostic techniques could lead to better risk stratification of patients, which would potentially identify patients likely to benefit from effective therapies. Recent studies have demonstrated the increasing utility of cardiac magnetic resonance in the management of this disease. With the increasing utilization of genetics, cardiac magnetic resonance is likely to play an even more important role in discerning the subtle morphologic differences seen in such patients with similar genotypic profiles.
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Affiliation(s)
- Deborah H Kwon
- Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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